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Sports Health 2020Dosing parameters are needed to ensure the best practice guidelines for knee osteoarthritis.
CONTEXT
Dosing parameters are needed to ensure the best practice guidelines for knee osteoarthritis.
OBJECTIVE
To determine whether resistance training affects pain and physical function in individuals with knee osteoarthritis, and whether a dose-response relationship exists. Second, we will investigate whether the effects are influenced by Kellgren-Lawrence grade or location of osteoarthritis.
DATA SOURCES
A search for randomized controlled trials was conducted in MEDLINE, Embase, and CINAHL, from their inception dates, between November 1, 2018, and January 15, 2019. Keywords included , and .
STUDY SELECTION
Inclusion criteria were randomized controlled trials reporting changes in pain and physical function on humans with knee osteoarthritis comparing resistance training interventions with no intervention. Two reviewers screened 471 abstracts; 12 of the 13 studies assessed were included.
STUDY DESIGN
Systematic review.
LEVEL OF EVIDENCE
Level 2.
DATA EXTRACTION
Mean baseline and follow-up Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and standard deviations were extracted to calculate the standard mean difference. Articles were assessed for methodological quality using the CONSORT (Consolidated Standards of Reporting Trials) 2010 scale and Cochrane Collaboration tool for assessing risk of bias.
RESULTS
The 12 included studies had high methodological quality. Of these, 11 studies revealed that resistance training improved pain and/or physical function. The most common regimen was a 30- to 60-minute session of 2 to 3 sets of 8 to 12 repetitions with an initial resistance of 50% to 60% of maximum resistance that progressed over 3 sessions per week for 24 weeks. Seven studies reported Kellgren-Lawrence grade, and 4 studies included osteoarthritis location.
CONCLUSION
Resistance training improves pain and physical function in knee osteoarthritis. Large effect sizes were associated with 24 total sessions and 8- to 12-week duration. No optimal number of repetitions, maximum strength, or frequency of sets or repetitions was found. No trends were identified between outcomes and location or Kellgren-Lawrence grade of osteoarthritis.
Topics: Activities of Daily Living; Humans; Osteoarthritis, Knee; Pain; Quality of Life; Resistance Training; Weight Lifting
PubMed: 31850826
DOI: 10.1177/1941738119887183 -
Annals of Medicine Dec 2023Although there is an assertion that weather conditions affect osteoarthritis (OA) pain, the results from clinical studies remain inconsistent. This meta-analysis was... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Although there is an assertion that weather conditions affect osteoarthritis (OA) pain, the results from clinical studies remain inconsistent. This meta-analysis was performed to evaluate the association between weather conditions and OA pain.
METHODS
Cochrane Library, Embase, PubMed, and Web of Science were searched from inception to September 30, 2022. Observational studies that explored all weather conditions associated with pain intensity were included. In the systematic review, the methodological quality of the selected studies was assessed and a best-evidence synthesis was used to make qualitative conclusions. Based on homogeneous results, Fisher's scores derived from the effect size of temperature (T), barometric pressure (BP) or relative humidity (RH) related to OA pain were synthesized and further transformed to the correlation coefficients (summary r) in meta-analysis.
RESULTS
A total of 14 studies were included in the best-evidence synthesis of a qualitative systematic review. There was strong evidence with 13 of 14 studies reporting consistent findings that weather factors in general, including any kind of meteorological condition, were associated with OA pain. Subsequently, 3 studies regarding BP or T, and 5 studies regarding RH with the pain of OA were included in quantitative meta-analyses. Both BP (pooled Fisher's = 0.37, 95% CI 0.15 to 0.59; summary = 0.35, 95% CI 0.15 to 0.53) and RH (pooled Fisher's = 0.10, 95% CI 0.01 to 0.18; summary = 0.086, 95% CI -0.05 to 0.22) were positively related to OA pain, while T was negatively related to OA pain (pooled Fisher's = -0.38, 95% CI -0.60 to -0.16; summary = -0.36, 95% CI -0.54 to -0.16).
CONCLUSIONS
In this study, weather factors in general were significantly associated with OA pain. It may provide useful references for the daily health management of OA. More studies designed with the consistent meteorological condition are warranted to validate the findings.KEY MESSAGEMany people with osteoarthritis think their joint pain is affected by the weather, while the association between OA pain and weather conditions is still unclear.This is a systematic review and meta-analysis of 14 observational studies for the association between weather conditions and OA pain.Weather conditions appear to be associated with OA pain. Barometric pressure and relative humidity were positively correlated to OA pain intensity, while temperature was negatively correlated to OA pain.
Topics: Humans; Osteoarthritis; Pain; Weather; Temperature; Observational Studies as Topic
PubMed: 37078741
DOI: 10.1080/07853890.2023.2196439 -
International Journal of Molecular... Jul 2021Temporomandibular joint osteoarthritis (TMJ OA) is a low-inflammatory disorder with multifactorial etiology. The aim of this review was to present the current state of...
Mechanisms of Action and Efficacy of Hyaluronic Acid, Corticosteroids and Platelet-Rich Plasma in the Treatment of Temporomandibular Joint Osteoarthritis-A Systematic Review.
Temporomandibular joint osteoarthritis (TMJ OA) is a low-inflammatory disorder with multifactorial etiology. The aim of this review was to present the current state of knowledge regarding the mechanisms of action and the efficacy of hyaluronic acid (HA), corticosteroids (CS) and platelet-rich plasma (PRP) in the treatment of TMJ OA.: The PubMed database was analyzed with the keywords: "(temporomandibular joint) AND ((osteoarthritis) OR (dysfunction) OR (disorders) OR (pain)) AND ((treatment) OR (arthrocentesis) OR (arthroscopy) OR (injection)) AND ((hyaluronic acid) OR (corticosteroid) OR (platelet rich plasma))". After screening of 363 results, 16 studies were included in this review. Arthrocentesis alone effectively reduces pain and improves jaw function in patients diagnosed with TMJ OA. Additional injections of HA, either low-molecular-weight (LMW) HA or high-molecular-weight (HMW) HA, or CS at the end of the arthrocentesis do not improve the final clinical outcomes. CS present several negative effects on the articular cartilage. Results related to additional PRP injections are not consistent and are rather questionable. Further studies should be multicenter, based on a larger group of patients and should answer the question of whether other methods of TMJ OA treatment are more beneficial for the patients than simple arthrocentesis.
Topics: Adolescent; Adrenal Cortex Hormones; Adult; Humans; Hyaluronic Acid; Injections, Intra-Articular; Osteoarthritis; Platelet-Rich Plasma; Signal Transduction; Temporomandibular Joint Disorders
PubMed: 34299024
DOI: 10.3390/ijms22147405 -
Journal of Medicinal Food Aug 2016Although turmeric and its curcumin-enriched extracts have been used for treating arthritis, no systematic review and meta-analysis of randomized clinical trials (RCTs)... (Meta-Analysis)
Meta-Analysis Review
Although turmeric and its curcumin-enriched extracts have been used for treating arthritis, no systematic review and meta-analysis of randomized clinical trials (RCTs) have been conducted to evaluate the strength of the research. We systemically evaluated all RCTs of turmeric extracts and curcumin for treating arthritis symptoms to elucidate the efficacy of curcuma for alleviating the symptoms of arthritis. Literature searches were conducted using 12 electronic databases, including PubMed, Embase, Cochrane Library, Korean databases, Chinese medical databases, and Indian scientific database. Search terms used were "turmeric," "curcuma," "curcumin," "arthritis," and "osteoarthritis." A pain visual analogue score (PVAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used for the major outcomes of arthritis. Initial searches yielded 29 articles, of which 8 met specific selection criteria. Three among the included RCTs reported reduction of PVAS (mean difference: -2.04 [-2.85, -1.24]) with turmeric/curcumin in comparison with placebo (P < .00001), whereas meta-analysis of four studies showed a decrease of WOMAC with turmeric/curcumin treatment (mean difference: -15.36 [-26.9, -3.77]; P = .009). Furthermore, there was no significant mean difference in PVAS between turmeric/curcumin and pain medicine in meta-analysis of five studies. Eight RCTs included in the review exhibited low to moderate risk of bias. There was no publication bias in the meta-analysis. In conclusion, these RCTs provide scientific evidence that supports the efficacy of turmeric extract (about 1000 mg/day of curcumin) in the treatment of arthritis. However, the total number of RCTs included in the analysis, the total sample size, and the methodological quality of the primary studies were not sufficient to draw definitive conclusions. Thus, more rigorous and larger studies are needed to confirm the therapeutic efficacy of turmeric for arthritis.
Topics: Arthritis, Rheumatoid; Curcuma; Curcumin; Humans; Osteoarthritis; Pain; Phytotherapy; Plant Extracts; Treatment Outcome
PubMed: 27533649
DOI: 10.1089/jmf.2016.3705 -
Sports Medicine (Auckland, N.Z.) May 2019Guidelines recommend exercise as a core treatment for osteoarthritis (OA). However, it is unclear which type of exercise is most effective, leading to inconsistency... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Guidelines recommend exercise as a core treatment for osteoarthritis (OA). However, it is unclear which type of exercise is most effective, leading to inconsistency between different recommendations.
OBJECTIVES
The aim of this systematic review and network meta-analysis was to investigate the relative efficacy of different exercises (aerobic, mind-body, strengthening, flexibility/skill, or mixed) for improving pain, function, performance and quality of life (QoL) for knee and hip OA at, or nearest to, 8 weeks.
METHODS
We searched nine electronic databases up until December 2017 for randomised controlled trials that compared exercise with usual care or with another exercise type. Bayesian network meta-analysis was used to estimate the relative effect size (ES) and corresponding 95% credibility interval (CrI) (PROSPERO registration: CRD42016033865).
FINDINGS
We identified and analysed 103 trials (9134 participants). Aerobic exercise was most beneficial for pain (ES 1.11; 95% CrI 0.69, 1.54) and performance (1.05; 0.63, 1.48). Mind-body exercise, which had pain benefit equivalent to that of aerobic exercise (1.11; 0.63, 1.59), was the best for function (0.81; 0.27, 1.36). Strengthening and flexibility/skill exercises improved multiple outcomes at a moderate level. Mixed exercise was the least effective for all outcomes and had significantly less pain relief than aerobic and mind-body exercises. The trend was significant for pain (p = 0.01), but not for function (p = 0.07), performance (p = 0.06) or QoL (p = 0.65).
CONCLUSION
The effect of exercise varies according to the type of exercise and target outcome. Aerobic or mind-body exercise may be the best for pain and function improvements. Strengthening and flexibility/skill exercises may be used for multiple outcomes. Mixed exercise is the least effective and the reason for this merits further investigation.
Topics: Bayes Theorem; Exercise Therapy; Humans; Network Meta-Analysis; Osteoarthritis, Hip; Osteoarthritis, Knee; Pain Management; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 30830561
DOI: 10.1007/s40279-019-01082-0 -
BMJ Open Dec 2017Physical activity (PA), including engagement in structured exercise, has a key role in the management of hip and knee osteoarthritis (OA). However, maintaining a... (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
Physical activity (PA), including engagement in structured exercise, has a key role in the management of hip and knee osteoarthritis (OA). However, maintaining a physically active lifestyle is a challenge for people with OA. PA determinants in this population need to be understood better so that they can be optimised by public health or healthcare interventions and social policy changes.
OBJECTIVES
The primary aim of this study is to conduct a systematic review of the existing qualitative evidence on barriers and facilitators of PA for patients with hip or knee OA. Secondary objective is to explore differences in barriers and facilitators between (1) lifestyle PA and exercise and (2) PA uptake and maintenance.
METHODS
Medline, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Scopus, Grey literature and qualitative journals were searched. Critical Appraisal Skills Programme-Qualitative checklist and Lincoln and Guba's criteria were used for quality appraisal. Thematic synthesis was applied.
FINDINGS
Ten studies were included, seven focusing on exercise regimes, three on overall PA. The findings showed a good fit with the biopsychosocial model of health. Aiming at symptom relief and mobility, positive exercise experiences and beliefs, knowledge, a 'keep going' attitude, adjusting and prioritising PA, having healthcare professionals' and social support emerged as PA facilitators. Pain and physical limitations; non-positive PA experiences, beliefs and information; OA-related distress; a resigned attitude; lack of motivation, behavioural regulation, professional support and negative social comparison with coexercisers were PA barriers. All themes were supported by high and medium quality studies. Paucity of data did not allow for the secondary objectives to be explored.
CONCLUSION
Our findings reveal a complex interplay among physical, personal including psychological and social-environmental factors corresponding to the facilitation and hindrance of PA, particularly exercise, engagement. Further research on the efficacy of individualised patient education, psychological interventions or social policy change to promote exercise engagement and lifestyle PA in individuals with lower limb OA is required.
TRIAL REGISTRATION NUMBER
CRD42016030024.
Topics: Exercise; Exercise Therapy; Health Knowledge, Attitudes, Practice; Humans; Osteoarthritis, Hip; Osteoarthritis, Knee; Qualitative Research; Social Support
PubMed: 29282257
DOI: 10.1136/bmjopen-2017-017042 -
Osteoarthritis and Cartilage Nov 2011To understand the differences in prevalence and incidence estimates of osteoarthritis (OA), according to case definition, in knee, hip and hand joints. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To understand the differences in prevalence and incidence estimates of osteoarthritis (OA), according to case definition, in knee, hip and hand joints.
METHOD
A systematic review was carried out in PUBMED and SCOPUS databases comprising the date of publication period from January 1995 to February 2011. We attempted to summarise data on the incidence and prevalence of OA according to different methods of assessment: self-reported, radiographic and symptomatic OA (clinical plus radiographic). Prevalence estimates were combined through meta-analysis and between-study heterogeneity was quantified.
RESULTS
Seventy-two papers were reviewed (nine on incidence and 63 on prevalence). Higher OA prevalences are seen when radiographic OA definition was used for all age groups. Prevalence meta-analysis showed high heterogeneity between studies even in each specific joint and using the same OA definition. Although the knee is the most studied joint, the highest OA prevalence estimates were found in hand joints. OA of the knee tends to be more prevalent in women than in men independently of the OA definition used, but no gender differences were found in hip and hand OA. Insufficient data for incidence studies didn't allow us to make any comparison according to joint site or OA definition.
CONCLUSIONS
Radiographic case definition of OA presented the highest prevalences. Within each joint site, self-reported and symptomatic OA definitions appear to present similar estimates. The high heterogeneity found in the studies limited further conclusions.
Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Female; Hand Joints; Humans; Incidence; Male; Middle Aged; Osteoarthritis; Osteoarthritis, Hip; Osteoarthritis, Knee; Prevalence; Radiography; Self Report; Sex Distribution; Young Adult
PubMed: 21907813
DOI: 10.1016/j.joca.2011.08.009 -
European Journal of Physical and... Sep 2009Total hip arthroplasty (THA) has revolutionized the care of patients with end-stage joint disease, leading to pain relief, functional recovery, and substantial... (Review)
Review
Total hip arthroplasty (THA) has revolutionized the care of patients with end-stage joint disease, leading to pain relief, functional recovery, and substantial improvement in quality of life. However, long-term studies indicate persistence of impairment and functional limitation after THA, and the optimal rehabilitation protocols are largely unknown. The aim of this paper was to systematically review the controlled trials published on the effectiveness of physical exercise programs after THA. Nine studies were retrieved from MEDLINE and reviewed. Results show that the physical exercise protocols most frequently used after THA in the early postoperative phase are neither supported nor denied by clinical controlled trials. Convincing evidence for the effectiveness of single interventions in addition to usual exercise programs exists for each of the three following options: treadmill training with partial body-weight support, unilateral resistance training of the quadriceps muscle (operated side), and arm-interval exercises with an arm ergometer. In the late postoperative phase (operation interval > 8 weeks) exercise programs consistently improve both impairment and ability to function. Weight-bearing exercises with hip-abductor eccentric strengthening may be the crucial component of the late-phase protocols. Substantial limitations were found in the nine studies, including small sample size, patient selection, heterogeneity of outcome assessments, and potential sources of variability not investigated. Despite limitations, we conclude that three main suggestions emerge from controlled trials on physical exercise after THA: early postoperative protocols should include additive interventions whose effectiveness has been shown. Late postoperative programs are useful and should comprise weight-bearing exercises with hip-abductor eccentric strengthening.
Topics: Arthroplasty, Replacement, Hip; Controlled Clinical Trials as Topic; Exercise Therapy; Humans; Osteoarthritis, Hip
PubMed: 19238130
DOI: No ID Found -
BioMed Research International 2020Osteoarthritis is the most common musculoskeletal disease. Extracorporeal shockwave therapy had shown an effect on osteoarthritis in both some animal experiments and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Osteoarthritis is the most common musculoskeletal disease. Extracorporeal shockwave therapy had shown an effect on osteoarthritis in both some animal experiments and clinical studies, but there was no systematic review to confirm the value of shockwave therapy in the treatment of all types of osteoarthritis and compare it with other traditional therapies (especially traditional Chinese medicine).
METHOD
PubMed, Medline, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese National Knowledge Infrastructure, WANFANG database, and VIP database were searched up to December 10, 2019, to identify randomized controlled trials comparing shockwave therapy and other treatments for osteoarthritis. Visual analogue scale and the Western Ontario and McMaster Universities Osteoarthritis Index were extracted and analyzed by RevMan and STATA software as outcomes of pain reduction and functional improvement. Adverse reactions were recorded to evaluate the safety of shockwave therapy.
RESULTS
Shockwave therapy had significant improvement in both pain reduction and functional improvement compared with placebo, corticosteroid, hyaluronic acid, medication, and ultrasound ( < 0.05). In functional improvement, shockwave therapy showed statistical improvement compared with kinesiotherapy and moxibustion ( < 0.05) but not with acupotomy surgery ( = 0.24). A significant difference between shockwave therapy and platelet-rich plasma was observed in pain reduction ( < 0.05) but not in functional improvement ( = 0.89). Meanwhile, a statistical difference was found between shockwave therapy and fumigation in functional improvement ( < 0.05) but not in pain reduction ( = 0.26). Additionally, there was no statistically significant difference between shockwave therapy and manipulation in both pain reduction ( = 0.21) and functional improvement ( = 0.45). No serious adverse reaction occurred in all of studies.
CONCLUSIONS
Extracorporeal shockwave therapy could be recommended in the treatment of osteoarthritis as a noninvasive therapy with safety and effectiveness, but the grade of recommendations needs to be discussed in a further study.
Topics: Animals; Databases, Factual; Extracorporeal Shockwave Therapy; Humans; Hyaluronic Acid; Injections, Intra-Articular; Medicine, Chinese Traditional; Osteoarthritis; Osteoarthritis, Knee; Pain; Pain Measurement; Placebos; Platelet-Rich Plasma; Ultrasonic Therapy
PubMed: 32309424
DOI: 10.1155/2020/1907821 -
BMJ (Clinical Research Ed.) Jan 2021To investigate the efficacy and safety of antidepressants for back and osteoarthritis pain compared with placebo. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate the efficacy and safety of antidepressants for back and osteoarthritis pain compared with placebo.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, International Pharmaceutical Abstracts, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform from inception to 15 November and updated on 12 May 2020.
ELIGIBILITY CRITERIA FOR STUDY SELECTION
Randomised controlled trials comparing the efficacy or safety, or both of any antidepressant drug with placebo (active or inert) in participants with low back or neck pain, sciatica, or hip or knee osteoarthritis.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers extracted data. Pain and disability were primary outcomes. Pain and disability scores were converted to a scale of 0 (no pain or disability) to 100 (worst pain or disability). A random effects model was used to calculate weighted mean differences and 95% confidence intervals. Safety (any adverse event, serious adverse events, and proportion of participants who withdrew from trials owing to adverse events) was a secondary outcome. Risk of bias was assessed with the Cochrane Collaboration's tool and certainty of evidence with the grading of recommendations assessment, development and evaluation (GRADE) framework.
RESULTS
33 trials (5318 participants) were included. Moderate certainty evidence showed that serotonin-noradrenaline reuptake inhibitors (SNRIs) reduced back pain (mean difference -5.30, 95% confidence interval -7.31 to -3.30) at 3-13 weeks and low certainty evidence that SNRIs reduced osteoarthritis pain (-9.72, -12.75 to -6.69) at 3-13 weeks. Very low certainty evidence showed that SNRIs reduced sciatica at two weeks or less (-18.60, -31.87 to -5.33) but not at 3-13 weeks (-17.50, -42.90 to 7.89). Low to very low certainty evidence showed that tricyclic antidepressants (TCAs) did not reduce sciatica at two weeks or less (-7.55, -18.25 to 3.15) but did at 3-13 weeks (-15.95, -31.52 to -0.39) and 3-12 months (-27.0, -36.11 to -17.89). Moderate certainty evidence showed that SNRIs reduced disability from back pain at 3-13 weeks (-3.55, -5.22 to -1.88) and disability due to osteoarthritis at two weeks or less (-5.10, -7.31 to -2.89), with low certainty evidence at 3-13 weeks (-6.07, -8.13 to -4.02). TCAs and other antidepressants did not reduce pain or disability from back pain.
CONCLUSION
Moderate certainty evidence shows that the effect of SNRIs on pain and disability scores is small and not clinically important for back pain, but a clinically important effect cannot be excluded for osteoarthritis. TCAs and SNRIs might be effective for sciatica, but the certainty of evidence ranged from low to very low.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42020158521.
Topics: Antidepressive Agents; Back Pain; Humans; Osteoarthritis; Pain Management; Sciatica; Serotonin and Noradrenaline Reuptake Inhibitors
PubMed: 33472813
DOI: 10.1136/bmj.m4825