Pub Date : 2018-01-01Epub Date: 2018-02-05DOI: 10.15226/2374-6904/5/1/00167
Ashley Y Disantis, Sara R Piva, James J Irrgang
Background: The physical function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC-PF) is widely used and endorsed by professional organizations for patients with knee osteoarthritis. Its use post total knee replacement (TKR) has been challenged as it may not represent the high level of functional performance that is expected by patients who undergo contemporary TKR with more advanced techniques and care pathways.
Objective: To assess whether the items of the WOMAC-PF reflect the activity limitations identified by patients following TKR.
Design: Data for this descriptive study were obtained from baseline assessments of a randomized clinical trial comparing exercise interventions following TKR.
Methods: Participants completed the WOMAC-PF and identified activity limitations in the Canadian Occupational Performance Measure (COPM) in the same day. The responses to both questionnaires were compared.
Results: This investigation included 50 participants (36 women, mean age 63.8±6.7). The WOMAC-PF failed to capture 50% of the activity limitations identified by participants in the COPM. These activities included kneeling, squatting, carrying/lifting items, strength/endurance exercise, floor transfer, lower extremity exercise, walking up/down hills, yard work, climbing a ladder, driving, managing the environment, carrying objects up/down stairs, gait initiation, balance, and going up/down curbs. Only one activity on the WOMAC-PF (going shopping) was not identified by participant responses on the COPM.
Limitations: Participants were included if they had TKR between 3 and 6 months prior, which may limit generalizability to those immediately after TKR, and the study sample was relatively small.
Conclusions: In individuals following TKR, the WOMAC-PF failed to represent a subset of higher level, more physically demanding activities that were identified as important by patients following TKR.
{"title":"Standardized Patient Reported Outcomes Do Not Capture Functional Deficits of Patients Following Contemporary Total Knee Replacement: Descriptive Study.","authors":"Ashley Y Disantis, Sara R Piva, James J Irrgang","doi":"10.15226/2374-6904/5/1/00167","DOIUrl":"10.15226/2374-6904/5/1/00167","url":null,"abstract":"<p><strong>Background: </strong>The physical function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC-PF) is widely used and endorsed by professional organizations for patients with knee osteoarthritis. Its use post total knee replacement (TKR) has been challenged as it may not represent the high level of functional performance that is expected by patients who undergo contemporary TKR with more advanced techniques and care pathways.</p><p><strong>Objective: </strong>To assess whether the items of the WOMAC-PF reflect the activity limitations identified by patients following TKR.</p><p><strong>Design: </strong>Data for this descriptive study were obtained from baseline assessments of a randomized clinical trial comparing exercise interventions following TKR.</p><p><strong>Methods: </strong>Participants completed the WOMAC-PF and identified activity limitations in the Canadian Occupational Performance Measure (COPM) in the same day. The responses to both questionnaires were compared.</p><p><strong>Results: </strong>This investigation included 50 participants (36 women, mean age 63.8±6.7). The WOMAC-PF failed to capture 50% of the activity limitations identified by participants in the COPM. These activities included kneeling, squatting, carrying/lifting items, strength/endurance exercise, floor transfer, lower extremity exercise, walking up/down hills, yard work, climbing a ladder, driving, managing the environment, carrying objects up/down stairs, gait initiation, balance, and going up/down curbs. Only one activity on the WOMAC-PF (going shopping) was not identified by participant responses on the COPM.</p><p><strong>Limitations: </strong>Participants were included if they had TKR between 3 and 6 months prior, which may limit generalizability to those immediately after TKR, and the study sample was relatively small.</p><p><strong>Conclusions: </strong>In individuals following TKR, the WOMAC-PF failed to represent a subset of higher level, more physically demanding activities that were identified as important by patients following TKR.</p>","PeriodicalId":90894,"journal":{"name":"Journal of exercise, sports & orthopedics","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203347/pdf/nihms948055.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36626426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01Epub Date: 2017-12-06DOI: 10.15226/2374-6904/4/3/00164
Gustavo J Almeida, Lauren Terhorst, James J Irrgang, G Kelley Fitzgerald, John M Jakicic, Sara R Piva
Background: Few instruments that measure physical activity (pa) can accurately quantify pa performed at light and moderate intensities, which is particularly relevant to older adults. Evidence for responsiveness of these instruments after an intervention is limited.
Objectives: o estimate and compare the responsiveness of two activity monitors and one questionnaire in assessing PA after an intervention following total knee Arthroplasty.
Methods: This one-group pretest-posttest, repeated-measures study analyzed changes in duration of daily PA and the standardized response mean (SRM) to assess internal responsiveness that were compared across instruments. Correlations between changes in PA measured by the proposed instruments and the global rating of change were used to test external responsiveness. Agreement between PA instruments on identifying individuals who changed their PA based on measurement error was assessed using weighted-Kappa (K).
Results: Thirty subjects, mean age 67(6) and 73% female, were analyzed. Changes in PA measured by each instrument were small (p>0.05), resulting in a small degree of responsiveness (SRM<0.30). Global rating of change scores did not correlate with changes in PA (rho=0.13-0.28, p>0.05). The activity monitors agreed on identifying changes in moderate-intensity PA (K=0.60) and number of steps (K=0.63), but did not agree with scores from questionnaire(K≤0.22).
Conclusion: Analyzing group-based changes in PA is challenging due to high-variability in the outcome. Investigating changes in PA at the individual-level may be a more viable alternative.
{"title":"Responsiveness of Physical Activity Measures Following Exercise Programs after Total Knee Arthroplasty.","authors":"Gustavo J Almeida, Lauren Terhorst, James J Irrgang, G Kelley Fitzgerald, John M Jakicic, Sara R Piva","doi":"10.15226/2374-6904/4/3/00164","DOIUrl":"https://doi.org/10.15226/2374-6904/4/3/00164","url":null,"abstract":"<p><strong>Background: </strong>Few instruments that measure physical activity (pa) can accurately quantify pa performed at light and moderate intensities, which is particularly relevant to older adults. Evidence for responsiveness of these instruments after an intervention is limited.</p><p><strong>Objectives: </strong>o estimate and compare the responsiveness of two activity monitors and one questionnaire in assessing PA after an intervention following total knee Arthroplasty.</p><p><strong>Methods: </strong>This one-group pretest-posttest, repeated-measures study analyzed changes in duration of daily PA and the standardized response mean (SRM) to assess internal responsiveness that were compared across instruments. Correlations between changes in PA measured by the proposed instruments and the global rating of change were used to test external responsiveness. Agreement between PA instruments on identifying individuals who changed their PA based on measurement error was assessed using weighted-Kappa (K).</p><p><strong>Results: </strong>Thirty subjects, mean age 67(6) and 73% female, were analyzed. Changes in PA measured by each instrument were small (p>0.05), resulting in a small degree of responsiveness (SRM<0.30). Global rating of change scores did not correlate with changes in PA (rho=0.13-0.28, p>0.05). The activity monitors agreed on identifying changes in moderate-intensity PA (K=0.60) and number of steps (K=0.63), but did not agree with scores from questionnaire(K≤0.22).</p><p><strong>Conclusion: </strong>Analyzing group-based changes in PA is challenging due to high-variability in the outcome. Investigating changes in PA at the individual-level may be a more viable alternative.</p>","PeriodicalId":90894,"journal":{"name":"Journal of exercise, sports & orthopedics","volume":"4 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051713/pdf/nihms930699.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36334960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-01-01DOI: 10.15226/2374-6904/1/1/00104
Daniel J Leong, Hui B Sun
Osteoarthritis (OA) is a degenerative joint disease and a leading cause of adult disability. The etiology of OA is not clear, but common risk factors for developing OA include age, joint injury, mechanical overuse, and obesity. Exercise is the most common non-pharmacologic therapy prescribed to patients with osteoarthritis. The Arthritis Foundation promotes an exercise program involving low-impact physical activity, and participants have reported less pain and fatigue, and increased strength. Clinical trials of patients with OA report physical activities including aerobic exercise, stretching/flexibility, endurance training, aquatic exercise, and muscle strengthening lead to improvements in pain relief, body weight, and metabolic abnormalities [1]. Factors which are critical to successful outcomes of exercise programs include performing exercises at an appropriate intensity and duration, and long-term adherence to exercise programs. Individualized exercise programs are important to educate patients to avoid exercises which may be harmful to injured joints (e.g. high impact activities). Patient monitoring or prescription of exercises which the patients find enjoyable may promote long-term adherence to an exercise program. In addition to the symptom-modifying effects of exercise, there is evidence of exercise exerting disease-modifying effects. For example, increased physical activity in the form of aerobic and weight-bearing exercises resulted in increased proteoglycan content, one of the major components of the cartilage extracellular matrix, in the cartilage of OA patients [2]. Strength training for 30 months, compared to range of motion exercises alone, resulted in a decreased mean rate of joint space narrowing [3]. Exercise at a moderate intensity is extremely important. Acute or chronic high-intensity loads, which often occur in athletes participating in high-impact sports such as soccer, football, and basketball, may increase risk of developing OA [4–6]. Inadequate loading also creates a degradative response within the articular cartilage [7,8]. Partial weight bearing for 7 weeks leads to cartilage thinning in the knee articular cartilage [9]. Patients with spinal cord injury, who have been subjected to bed rest, exhibit a rate of cartilage atrophy greater than that reported in age-associated osteoarthritis [10]. Exercise at moderate levels will also help avoid joint injuries. Traumatic joint injuries, such as anterior cruciate ligament (ACL) tears, result in degenerative changes in the articular joint such as chondral softening and fracture [11,12]. The definition of “moderate exercise” however, remains a challenge. It may be necessary to determine appropriate exercise intensities on an individual basis. While degradation of the articular cartilage is considered a hallmark of OA, the pathogenesis of this disease includes pathologic changes to tissues of the entire joint, including altered bone remodeling, synovitis, and degeneratio
{"title":"Osteoarthritis - Why Exercise?","authors":"Daniel J Leong, Hui B Sun","doi":"10.15226/2374-6904/1/1/00104","DOIUrl":"https://doi.org/10.15226/2374-6904/1/1/00104","url":null,"abstract":"Osteoarthritis (OA) is a degenerative joint disease and a leading cause of adult disability. The etiology of OA is not clear, but common risk factors for developing OA include age, joint injury, mechanical overuse, and obesity. Exercise is the most common non-pharmacologic therapy prescribed to patients with osteoarthritis. The Arthritis Foundation promotes an exercise program involving low-impact physical activity, and participants have reported less pain and fatigue, and increased strength. Clinical trials of patients with OA report physical activities including aerobic exercise, stretching/flexibility, endurance training, aquatic exercise, and muscle strengthening lead to improvements in pain relief, body weight, and metabolic abnormalities [1]. Factors which are critical to successful outcomes of exercise programs include performing exercises at an appropriate intensity and duration, and long-term adherence to exercise programs. Individualized exercise programs are important to educate patients to avoid exercises which may be harmful to injured joints (e.g. high impact activities). Patient monitoring or prescription of exercises which the patients find enjoyable may promote long-term adherence to an exercise program. \u0000 \u0000In addition to the symptom-modifying effects of exercise, there is evidence of exercise exerting disease-modifying effects. For example, increased physical activity in the form of aerobic and weight-bearing exercises resulted in increased proteoglycan content, one of the major components of the cartilage extracellular matrix, in the cartilage of OA patients [2]. Strength training for 30 months, compared to range of motion exercises alone, resulted in a decreased mean rate of joint space narrowing [3]. \u0000 \u0000Exercise at a moderate intensity is extremely important. Acute or chronic high-intensity loads, which often occur in athletes participating in high-impact sports such as soccer, football, and basketball, may increase risk of developing OA [4–6]. Inadequate loading also creates a degradative response within the articular cartilage [7,8]. Partial weight bearing for 7 weeks leads to cartilage thinning in the knee articular cartilage [9]. Patients with spinal cord injury, who have been subjected to bed rest, exhibit a rate of cartilage atrophy greater than that reported in age-associated osteoarthritis [10]. Exercise at moderate levels will also help avoid joint injuries. Traumatic joint injuries, such as anterior cruciate ligament (ACL) tears, result in degenerative changes in the articular joint such as chondral softening and fracture [11,12]. The definition of “moderate exercise” however, remains a challenge. It may be necessary to determine appropriate exercise intensities on an individual basis. \u0000 \u0000While degradation of the articular cartilage is considered a hallmark of OA, the pathogenesis of this disease includes pathologic changes to tissues of the entire joint, including altered bone remodeling, synovitis, and degeneratio","PeriodicalId":90894,"journal":{"name":"Journal of exercise, sports & orthopedics","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4350574/pdf/nihms643856.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33111841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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