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Objectives The primary aim is to compare the effects of backward walking exercise to forward walking exercise on knee pain, knee functions, and thigh muscle strength in individuals with mild to moderate knee osteoarthritis using lower body positive pressure, in addition to mobility functions, balance, and self-reported health status. Methods The study is a single blind randomized clinical trial with two independent groups. This study will enroll 26 participants with mild to moderate knee osteoarthritis. The participants will be randomized into either experimental group (backward walking exercise) or control group (forward walking exercise). Both groups will use lower body positive pressure treadmill for walking exercise. Both groups will perform regular conventional exercise and worm-up exercise before walking exercise. The treatment will be three times a week for six weeks. Walking session will be up to 30 min each session. Data collection will be collected during pre- and post- intervention including primary outcomes including numeric pain rating scale (NPRS), knee injury and osteoarthritis outcome score (KOOS), and thigh muscle strength test. The secondary outcomes include five times sit to stand test (FTSTS), 3-meter backward walk test (3MBWT), timed up and go test (TUG), four square step test (FSST), functional reach test (FRT), 10-meter walk test (10-MWT), six minute walk test (6MWT), medical outcomes study short form 12 (SF-12), patient health questionnaire -9 (PHQ-9), and rapid assessment of physical activity (RAPA). An independent t-test will be used to evaluate the effect of treatment on the outcome measures. Results Not applicable. Conclusion Using lower body positive pressure may have promising results against knee osteoarthritis. Moreover, walking backward exercise using lower body positive pressure might add more benefits to individuals with knee osteoarthritis and help clinicians in decision making. Trial registration: This study was registered in ClinicalTrails.gov (ID: NCT05585099).

Background Normative values for hand grip and pinch strength among children in Saudi Arabia has not been well established. Therefore, the main aim of this study is to establish normative values for hand grip and pinch strength in children aged 6 to 18 years in Saudi Arabia. Methods A cross-sectional study was conducted from different 5 regions in Saudi Arabia. Participants between the age of 6 years and 18 years old were recruited through different primary and secondary schools in Saudi Arabia. Data for age, gender, Body Mass Index, and preferred hand were collected. Hand grip strength was measured using digital hand dynamometer and the tip pinch, palmar pinch, and key pinch strength were measured using the hydraulic pinch gauge. Results A total of 616 participants included in this study (318 boys and 298 girls). Participants were stratified into 5 chronological age groups of 6–7 years, 8–9, 10–11, 12–13, 14–15, 16–17, and 18 years. The results showed an overall trend of increasing hand grip strength and pinch strength with age regardless of hand preference. Boys had significantly higher grip strength than girls in all age groups (P Conclusion This study established normative values for hand grip and pinch strength in the healthy Saudi pediatric and adolescent population, using boys and girls aged 6 to 18. The outcomes of this study also demonstrated that gender, age, and hand preference can all have an impact on how strong a handgrip develops.

Osteoarthritis (OA) is a common degenerative disease affecting joints with an increasing prevalence around the world and in the Middle East region. Research about the prevalence/incidence of OA in the Gulf Cooperation Council (GCC) countries was limited with inconsistent findings. Therefore, the aim of this study was to conduct a systematic review and meta-analysis for studies reporting the prevalence/incidence of OA among people living in the GCC countries. A comprehensive search was performed using MEDLINE, PubMed, CINAHL, Web of Science, and Google Scholar from inception to December 2020 to identify eligible studies examining the prevalence/incidence of OA in the GCC countries. Meta-analysis was conducted, and the Newcastle Ottawa Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was utilized to evaluate methodological quality. Thirteen studies were included (12 studies reported prevalence and one study reported incidence), with a total of 24,625 participants with an estimated overall prevalence of 16.13% and incidence of 3.5% of OA in the GCC countries. The quality of the included studies was unsatisfactory (six studies), satisfactory (six studies), and good quality (one study). Common risk factors were being older adult, female, obese, and having lower scores for quality of life. This study shows a high prevalence of OA among individuals living in the GCC countries at approximately 16.13%. Only one study reported incidence of 3.5% of OA in this population. This prevalence rate needs to be confirmed in future research with a similar population and at the site of joint OA levels. Common risk factors should be interpreted with caution since only a few studies reported risk factors. Key Points • The pooled prevalence of Osteoarthritis in the Gulf Cooperation Council countries was 16.13% based on 12 included studies.

This study investigated the association of combined arthritis and diabetes, diabetes only, and arthritis only compared with neither with gait speed in the general population. This cross-sectional study included data from the second wave of Midlife in the United States-2 (MIDUS 2) project 4: Biomarker Project, 2004–2009. The MIDUS 2 biomarker project included 1255 individuals aged between 34 and 84 years. Participants were categorized into four groups: combined arthritis and diabetes, diabetes only, arthritis only, or neither. The main outcome measure was gait speed measured by the 50-ft walk test. Covariates included age, gender, body mass index (BMI), depression symptoms, and number of chronic conditions/symptoms. A total of 1255 participants were included with mean age 54.52 ± 11.71, of those 713 (56.8%) participants were females. The results showed that combined arthritis and diabetes was significantly associated with a greater decline in gait speed (B = − 0.11, 95% confidence interval (CI) [− 0.17 to − 0.6], p

Stroke is a leading cause of death and disability worldwide. However, our knowledge of the incidence of stroke for Saudi Arabian population is not known. Thus, we aimed to determine the pooled annual incidence of stroke in Saudi Arabia. We conducted a comprehensive literature search of PubMed, Web of Science, and SCOPUS, without language or publication year limits. Outcomes of interest were stroke incidence rate for both first and recurrent. A total of five studies met the inclusion criteria for this review. The pooled annual incidence of stroke in Saudi Arabia was 0.029% (95% CI: 0.015 to 0.047) equivalent of 29 strokes per 100,000 people annually (95% CI: 15 to 47). The findings indicate that there are 29 stroke cases for every 100,000 people annually for individuals residing Saudi Arabia. Our values were lower than those of other high-income countries. Establishing a nationwide stroke registry is warranted for monitoring and improving healthcare services provided to stroke survivors.

Individuals with type 2 diabetes (T2DM) are advised to undertake diabetes self-care behavior (DSCB) in order to avoid complications of T2DM. However, comorbidities, such as insomnia symptoms which are commonly reported in people with T2DM, may limit the ability to engage in DSCB. Insomnia and the common sequelae accompanying insomnia such as pain, depression, and anxiety may negatively influence the performance of DSCB. Therefore, this study aimed to compare the DSCB of people with T2DM with and without insomnia symptoms. Sixty participants with T2DM were divided into two groups based on the presence of insomnia symptoms: T2DM-only group and T2DM+ insomnia group. Insomnia symptoms were identified using the Insomnia Severity Index (ISI). DSCB was assessed using the Diabetic Care Profile (DCP). A standardized composite score was established to account for all of the DCP domains. Chi-square and independent sample t tests were used to assess between-group differences in categorical and continuous variables, respectively. Stepwise linear regression analysis used the ISI score to predict standardized DCP composite score, while controlling for covariates. Significant between-group differences were found in age, symptoms of pain, depression, and anxiety. The total DCP composite score was significantly lower in the T2DM+ insomnia group compared to the T2DM-only group (− 0.30 ± 0.46 vs. 0.36 ± 0.48, respectively, p

Type 2 diabetes mellitus (T2DM) has been associated with osteoarthritis (OA). T2DM may be associated with generalized OA (GOA ≥ 3 joints) rather than localized OA (LOA 3 joints). The purpose of this study was to examine the prevalence of T2DM in people with GOA compared with LOA and to investigate the association between demographic risk factors and chronic diseases (i.e., T2DM, hypertension, dyslipidemia, neuropathy, and body mass index (BMI)) with GOA compared with LOA.A retrospective review of data was performed, and patients with diagnostic codes for OA were selected. Identified codes included primary GOA, primary LOA, T2DM, hypertension, dyslipidemia, neuropathy, depression, anxiety, and sleep disorders. Information about BMI and medication list was obtained. Chi-square and logistic regression were performed to examine the prevalence and risk factors, respectively.Data from 3855 patients (mean age = 66.43 ± 11.02, 60.9% women) included patients with GOA (n = 1265) and LOA (n = 2590). The prevalence of T2DM was significantly greater among patients with GOA (25.8%) compared with those with LOA (12.0%); however, the GOA group were older. Based on age groups, T2DM was prevalent in 17.8% of GOA compared with 7.2% in LOA for younger adults (aged 45-64 years) and was prevalent in 28.8% of GOA compared with 15.7% in LOA for older adults (aged 65 years or older). The odds ratio of GOA increased in people with chronic diseases compared with those without including T2DM (odds ratio (OR) 1.37, 95% confidence interval (CI) 1.05-1.78, p = 0.02), hypertension (OR 1.99, CI 1.63-2.43, p 0.001), and dyslipidemia (OR 3.46, CI 2.86-4.19, p 0.001), adjusting for covariates.Higher prevalence of T2DM was found in people with GOA when compared with LOA across both age groups. T2DM, hypertension, and dyslipidemia were associated with GOA. Future research with longitudinal designs is needed to test the causality of this association.Key Points• The prevalence of type 2 diabetes in people with generalized osteoarthritis was almost double compared with localized osteoarthritis, although generalized osteoarthritis group were older.• Among people with osteoarthritis, the risk of generalized osteoarthritis is increased by 37% when people had type 2 diabetes, by 99% when people had hypertension, and by 246% when people had dyslipidemia.

Background Sleep apnea and diabetes mellitus (DM) negatively impact cardiovascular health. One important indicator of cardiovascular health is the Ankle-Brachial Index (ABI). Either low ABI or high ABI are signs of peripheral vascular impairment. Impaired vascular health and DM, together, might provoke sleep apnea; however, information regarding these relationships is limited. Therefore, this study aimed to investigate the association between ABI, DM status, and severity of obstructive sleep apnea in people of Hispanic/Latino descent who are diverse in culture, environmental exposures, nativity, socioeconomic status, and disease burden. Methods A cross sectional analysis from a multi-center epidemiologic study, Hispanic Community Health Study/Study of Latinos, was utilized and included 3779 participants (mean age 55.32 ± 7.67, females 57.9%). The sample was divided into 4 groups based on the American Diabetes Association diagnostic guidelines (no DM or DM), and the ABI status (normal and abnormal). Multiple linear regression analysis was used to determine the association of the four groups and other independent variables with severity of sleep apnea measured by apnea-hypopnea index. Kruskal-Wallis H test was used for comparisons between groups for the apnea-hypopnea index. The significant level was set at 0.01. Results There were significant differences between groups in the mean of apnea-hypopnea index (P P = 0.001) after controlling for age, sex, BMI, income, education, alcohol use, cigarette use, hypertension or related medication, stroke and statin use. Conclusion These findings suggest that people with DM and abnormal ABI were more likely to have high apnea-hypopnea index compared to the other groups. We observed gradual increasing in the severity of sleep apnea from low abnormality groups to high abnormality groups for Hispanic/Latino. Further work should elucidate the association of DM, abnormal ABI and sleep apnea with longer term outcomes, and replicate this work in different populations.

Limited research has examined the association between diabetes mellitus (DM) and knee pain in people with osteoarthritis (OA). Therefore, this study aimed at examining the association between DM and knee pain severity, and to explore the association between DM and knee pain distribution (unilateral or bilateral versus no pain) in subjects with knee OA. This is a cross-sectional analysis of the baseline visit of individuals who were enrolled in the Osteoarthritis Initiative. Data of participants with knee OA were used for this analysis (n = 1319), and grouped into subjects with both knee OA and DM (n = 148) or knee OA only without DM (n = 1171). Pain severity was measured using a numeric rating scale from 0 to 10 over the past 7 and 30 days for each knee, and the more symptomatic knee with higher pain severity was chosen for analysis. DM was significantly associated with increased knee pain severity over 7 days (B 0.68; 95% CI 0.25–1.11) and over 30 days (B 0.59; 95% CI 0.17–1.01) after adjustments for all covariates, including age, gender, BMI, race, depression symptoms, composite OA score, use of pain medications, and knee injections. Multinomial regression showed that participants with knee OA and DM had 2.45 (95% CI 1.07–5.61) to 2.55 (95% CI 1.12–5.79) times higher likelihood of having unilateral and bilateral knee pain than those without DM and without knee pain. This study found that DM was associated with higher pain severity and unilateral and bilateral knee pain distribution.