98 results on '"Dekker, Joost"'
Search Results
2. Cohort Profile: Cohort Hip and Cohort Knee (CHECK) study.
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Wesseling J, Boers M, Viergever MA, Hilberdink WK, Lafeber FP, Dekker J, and Bijlsma JW
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- Aged, Disease Progression, Female, Follow-Up Studies, Hip diagnostic imaging, Humans, Knee diagnostic imaging, Longitudinal Studies, Male, Middle Aged, Pain Measurement, Radiography, Severity of Illness Index, Biomarkers, Hip physiopathology, Knee physiopathology, Osteoarthritis diagnostic imaging, Pain diagnosis
- Abstract
The Cohort Hip and Cohort Knee (CHECK) study included participants with early symptomatic osteoarthritis (OA) of the hip or knee and evaluated clinical, radiographic and biochemical variables in order to establish the course, prognosis and underlying mechanisms of early symptomatic osteoarthritis. A total of 1002 participants aged 45-65 years, with symptomatic OA characterized by pain of knee and/ or hip, entered the cohort in the period October 2002 to September 2005. They were included at or within 6 months of their first visit to the general practitioner for these symptoms. An overview of measures that are included in the study can be found on the website [www.check-research.com]. On the basis of their presenting symptoms, participants were divided into two groups. Participants with mild symptoms visited the research centre at years 0, 2, 5, 8 and 10 (variable visiting group) and participants with more serious symptoms visited the research centre each year (annual visiting group). After 7 years, only 105 participants (10%) had dropped out; their baseline characteristics did not differ significantly from those of other participants. CHECK is a valuable source of information on early symptomatic OA, that allows the examination of high-quality data on clinical, radiographic and biochemical variables. The CHECK steering group welcomes collaboration with national and international colleagues. Requests for collaboration or access to data can be sent to [checkreu@umcutrecht.nl]., (© The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.)
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- 2016
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3. Effect of stepped care on health outcomes in patients with osteoarthritis: an observational study in Dutch general practice.
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Smink AJ, van den Ende CH, Vliet Vlieland TP, Bijlsma JW, Swierstra BA, Kortland JH, Voorn TB, Teerenstra S, Schers HJ, Dekker J, and Bierma-Zeinstra SM
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- Aged, Analgesics, Attitude of Health Personnel, Female, Humans, Male, Middle Aged, Netherlands epidemiology, Osteoarthritis epidemiology, Patient Education as Topic, Physical Therapy Modalities, Practice Guidelines as Topic, Practice Patterns, Physicians', Quality of Health Care, Directive Counseling statistics & numerical data, General Practice, Guideline Adherence, Osteoarthritis therapy, Pain Management methods
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Background: A stepped care strategy (SCS) to improve adequate healthcare use in patients with osteoarthritis was developed and implemented in a primary care region in the Netherlands., Aim: To assess the association between care that is in line with the SCS recommendations and health outcomes., Design and Setting: Data were used from a 2-year observational study of 313 patients who had consulted their GP because of osteoarthritis., Method: Care was considered 'SCS-consistent' if all advised modalities of the previous steps of the SCS were offered before more advanced modalities of subsequent steps. Pain and physical function were measured with the Western Ontario and McMaster Universities Osteoarthritis Index (range 0-100); active pain coping with the Pain Coping Inventory (range 10-40); and self-efficacy with the Dutch General Self-Efficacy Scale (range 12-48). Crude and adjusted associations between SCS-consistent care and outcomes were estimated with generalised estimating equations., Results: No statistically significant differences were found in changes over a 2-year period in pain and physical function between patients who received SCS-inconsistent care (n = 163) and patients who received SCS-consistent care (n = 117). This was also the case after adjusting for possible confounders, that is, -4.3 (95% confidence interval [CI] = -10.3 to 1.7) and -1.9 (95% CI = -7.0 to 3.1), respectively. Furthermore, no differences were found in changes over time between groups in self-efficacy and pain coping., Conclusion: The results raised several important issues that need to be considered regarding the value of the SCS, such as the reasons that GPs provide SCS-inconsistent care, the long-term effects of the SCS, and the effects on costs and side effects., (© British Journal of General Practice 2014.)
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- 2014
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4. Exercise adherence improving long-term patient outcome in patients with osteoarthritis of the hip and/or knee.
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Pisters MF, Veenhof C, Schellevis FG, Twisk JW, Dekker J, and De Bakker DH
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- Aged, Exercise, Female, Follow-Up Studies, Humans, Knee Joint physiopathology, Male, Middle Aged, Motor Activity, Osteoarthritis complications, Osteoarthritis therapy, Pain complications, Pain rehabilitation, Pain Management, Physical Therapy Modalities, Treatment Outcome, Exercise Therapy, Osteoarthritis rehabilitation, Patient Compliance
- Abstract
Objective: To determine the effect of patient exercise adherence within the prescribed physical therapy treatment period and after physical therapy discharge on patient outcomes of pain, physical function, and patient self-perceived effect in individuals with osteoarthritis (OA) of the hip and/or knee., Methods: We performed a prospective observational followup study in which 150 patients with OA of the hip and/or knee receiving exercise therapy were followed for 60 months. Data were obtained from a randomized controlled trial, with assessments at baseline and 3, 15, and 60 months of followup. The association between exercise adherence and patient outcomes of pain, physical function, and self-perceived effect was examined using generalized estimating equations analyses., Results: Adherence to recommended home exercises and being more physically active were significantly associated with better treatment outcomes of pain, self-reported physical function, physical performance, and self-perceived effect. The association between adherence and outcome was consistent over time. Adherence to home activities was only associated with better self-perceived effect., Conclusion: Better adherence to recommended home exercises as well as being more physically active improves the long-term effectiveness of exercise therapy in patients with OA of the hip and/or knee. Both within and after the treatment period, better adherence is associated with better patient outcomes of pain, physical function, and self-perceived effect. Since exercise adherence declines over time, future research should focus on how exercise behavior can be stimulated and maintained in the long term.
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- 2010
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5. Which patients with osteoarthritis of hip and/or knee benefit most from behavioral graded activity?
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Veenhof C, Van den Ende CH, Dekker J, Köke AJ, Oostendorp RA, and Bijlsma JW
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- Adult, Female, Humans, Male, Conditioning, Operant, Exercise, Hip pathology, Knee pathology, Osteoarthritis complications, Osteoarthritis pathology, Pain etiology, Pain Management
- Abstract
Our objective was to investigate whether behavioral graded activity (BGA) has particular benefit in specific subgroups of osteoarthritis (OA) patients. Two hundred participants with OA of hip or knee, or both (clinical American College of Rheumatology, ACR, criteria) participated in a randomized clinical trial on the efficacy of BGA compared to treatment according to the Dutch physiotherapy guideline (usual care; UC). Changes in pain (Visual Analog Scale, VAS), physical functioning (Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC, and McMaster Toronto Arthritis Questionnaire, MACTAR), and patient global assessment were compared for specific subgroups. Subgroups were assigned by the median split method and were analyzed using analysis of covariance. Beneficial effects of BGA were found for patients with a relatively low level of physical functioning (p?0.03). Furthermore, beneficial effects of BGA in patients with a low level of internal locus of control were marginally significant (p = .05). Patients with a relatively low level of physical functioning benefit more from BGA compared to UC. Compared to UC, BGA is the preferred treatment option in patients with a low level of physical functioning.
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- 2007
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6. Active involvement and long-term goals influence long-term adherence to behavioural graded activity in patients with osteoarthritis: a qualitative study.
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Veenhof C, van Hasselt TJ, Koke AJ, Dekker J, Bijlsma JW, and van den Ende CH
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- Aged, Aged, 80 and over, Female, Humans, Interviews as Topic, Male, Middle Aged, Motivation, Activities of Daily Living, Behavior Therapy methods, Goals, Osteoarthritis psychology, Osteoarthritis rehabilitation, Patient Compliance, Physical Therapy Modalities
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Question: Why do some patients who have received a behavioural graded activity program successfully integrate the activities into their daily lives and others do not?, Design: Qualitative study., Participants: 12 patients were selected according to the model of deliberate sampling for heterogeneity, based on their success with the intervention as assessed on the Patient Global Assessment., Intervention: Behavioural graded activity., Outcome Measures: Data from 12 interviews were coded and analysed using the methods developed in grounded theory. The interviews covered three main themes: aspects related to the content of behavioural graded activity, aspects related to experience with the physiotherapist, and aspects related to characteristics of the participant., Results: Interview responses suggest that two factors influence long-term adherence to exercise and activity.First, initial long-term goals rather than short-term goals seem to relate to greater adherence to performing activities in the long term. Second, active involvement by participants in the intervention process seems to relate to greater adherence to performing activities in the long term., Conclusion: Although involvement of patients in the intervention process is already part of behavioural graded activity, it would be beneficial to emphasise the importance of active involvement by patients right from the start of the intervention. Furthermore, to increase the success of behavioural graded activity, physiotherapists should gain a clear understanding of the patient's initial motives in undergoing intervention.
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- 2006
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7. Analgesic use in patients with knee and/or hip osteoarthritis referred to an outpatient center: a cross-sectional study within the Amsterdam Osteoarthritis Cohort
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Knoop, Jesper, van Tunen, Joyce, van der Esch, Martin, Roorda, Leo D., Dekker, Joost, van der Leeden, Marike, and Lems, Willem F.
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- 2017
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8. Association of malalignment, muscular dysfunction, proprioception, laxity and abnormal joint loading with tibiofemoral knee osteoarthritis - a systematic review and meta-analysis
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van Tunen, Joyce A. C., Dell’Isola, Andrea, Juhl, Carsten, Dekker, Joost, Steultjens, Martijn, Thorlund, Jonas B., and Lund, Hans
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- 2018
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9. Self-reported knee instability and activity limitations in patients with knee osteoarthritis: results of the Amsterdam osteoarthritis cohort
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van der Esch, Martin, Knoop, Jesper, van der Leeden, Marike, Voorneman, Ramon, Gerritsen, Martijn, Reiding, Dick, Romviel, Suzanne, Knol, Dirk L., Lems, Willem F., Dekker, Joost, and Roorda, Leo D.
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- 2012
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10. Influence of the instrumented force shoe on gait pattern in patients with osteoarthritis of the knee
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van den Noort, Josien, van der Esch, Martin, Steultjens, Martijn P., Dekker, Joost, Schepers, Martin, Veltink, Peter H., and Harlaar, Jaap
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- 2011
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11. Osteoarthritis of the hip or knee: which coexisting disorders are disabling?
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Reeuwijk, Kerstin G., de Rooij, Mariëtte, van Dijk, Gabriella M., Veenhof, Cindy, Steultjens, Martijn P., and Dekker, Joost
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- 2010
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12. Physiotherapists’ experiences with a blended osteoarthritis intervention: a mixed methods study
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Kloek, Corelien, Bossen, Daniël, Vries,de, Herman J., Bakker,de, Dinny H., Veenhof, Cindy, and Dekker, Joost
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musculoskeletal diseases ,osteoarthritis ,e-health ,implementation ,physiotherapy - Abstract
E-Exercise is an effective 12-week blended intervention consisting of around five face-to-face physiotherapy sessions and a web-based application for patients with hip/knee osteoarthritis. In order to facilitate effective implementation of e-Exercise, this study aims to identify physiotherapists' experiences and determinants related to the usage of e-Exercise. Methods: An explanatory sequential mixed methods design embedded in a randomized controlled trial comparing e-Exercise with usual physiotherapy in patients with hip/knee osteoarthritis. Usage of e-Exercise was based on recruitment rates of 123 physiotherapists allocated to e-Exercise and objective web-based application usage data. Experiences and determinants related to e-Exercise usage were investigated with a questionnaire and clarified with semi-structured interviews. Results: Of the 123 physiotherapists allocated to e-Exercise, 54 recruited more than one eligible patient, of whom 10 physiotherapists continued using e-Exercise after the study period. Physiotherapists had mixed experiences with e-Exercise. Determinants related to intervention usage were appropriateness, added value, time, workload, professional autonomy, environmental factors, and financial consequences. Physiotherapists recommended to improve the ability to tailor e-Exercise to the individual needs of the patient patients' individual needs. Discussion: Determinants related to the usage of e-Exercise provided valuable information for the implementation of e-Exercise on broader scale. Most importantly, the flexibility of e-Exercise needs to be improved. Next, there is a need for education on how to integrate an online program within physiotherapy
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- 2020
13. Pain and disability in osteoarthritis: A review of biobehavioral mechanisms
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Dekker, Joost, Boot, Bob, van der Woude, Luc H. V., and Bijlsma, J. W. J.
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- 1992
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14. Construct validity of the OCTOPuS stratification algorithm for allocating patients with knee osteoarthritis into subgroups.
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Knoop, Jesper, Ostelo, Raymond W. J. G., van der Esch, Martin, de Zwart, Arjan, Bennell, Kim L., van der Leeden, Marike, and Dekker, Joost
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KNEE pain ,OSTEOARTHRITIS ,EXERCISE therapy ,ALGORITHMS ,TEST validity ,MUSCLE strength ,PHYSICAL mobility - Abstract
Background: We recently developed a model of stratified exercise therapy, consisting of (i) a stratification algorithm allocating patients with knee osteoarthritis (OA) into one of the three subgroups ('high muscle strength subgroup' representing a post-traumatic phenotype, 'low muscle strength subgroup' representing an age-induced phenotype, and 'obesity subgroup' representing a metabolic phenotype) and (ii) subgroup-specific exercise therapy. In the present study, we aimed to test the construct validity of this algorithm.Methods: Data from five studies (four exercise therapy trial cohorts and one cross-sectional cohort) were used to test the construct validity of our algorithm by 63 a priori formulated hypotheses regarding three research questions: (i) are the proportions of patients in each subgroup similar across cohorts? (15 hypotheses); (ii) are the characteristics of each of the subgroups in line with their proposed underlying phenotypes? (30 hypotheses); (iii) are the effects of usual exercise therapy in the 3 subgroups in line with the proposed effect sizes? (18 hypotheses).Results: Baseline data from a total of 1211 patients with knee OA were analyzed for the first and second research question, and follow-up data from 584 patients who were part of an exercise therapy arm within a trial for the third research question. In total, the vast majority (73%) of the hypotheses were confirmed. Regarding our first research question, we found similar proportions in each of the three subgroups across cohorts, especially for three cohorts. Regarding our second research question, subgroup characteristics were almost completely in line with the proposed underlying phenotypes. Regarding our third research question, usual exercise therapy resulted in similar, medium to large effect sizes for knee pain and physical function for all three subgroups.Conclusion: We found mixed results regarding the construct validity of our stratification algorithm. On the one hand, it is a valid instrument to consistently allocate patients into subgroups that aligned our hypotheses. On the other hand, in contrast to our hypotheses, subgroups did not differ substantially in effects of usual exercise therapy. An ongoing trial will assess whether this algorithm accompanied by subgroup-specific exercise therapy improves clinical and economic outcomes. [ABSTRACT FROM AUTHOR]- Published
- 2021
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15. Physical Activity Patterns Among Older Adults With and Without Knee Osteoarthritis in Six European Countries
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Herbolsheimer, Florian, Schaap, Laura A., Edwards, Mark H., Maggi, Stefania, Otero, Angel, Timmermans, Erik J., Denkinger, Michael D., van der Pas, Suzan, Dekker, Joost, Cooper, Cyrus, Dennison, Elaine M., van Schoor, Natasja M., Peter, Richard, Nutrition and Health, EMGO+ - Musculoskeletal Health, Division 6, Epidemiology and Data Science, EMGO - Musculoskeletal health, and Rehabilitation medicine
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Aged, 80 and over ,Male ,Research Support, Non-U.S. Gov't ,Osteoarthritis, Knee ,Research Support ,Europe ,Multicenter Study ,Cross-Sectional Studies ,Osteoarthritis ,SDG 1 - No Poverty ,80 and over ,Journal Article ,Humans ,Female ,Knee ,Comparative Study ,Non-U.S. Gov't ,Exercise ,Aged - Abstract
OBJECTIVE: To investigate patterns of physical activity in older adults with knee osteoarthritis (OA) compared to older adults without knee OA across 6 European countries. We expect country-specific differences in the physical activity levels between persons with knee OA compared to persons without knee OA. A varying degree of physical activity levels across countries would express a facilitating or impeding influence of the social, environmental, and other contextual factors on a physically active lifestyle.METHODS: Baseline cross-sectional data from the European Project on Osteoarthritis were analyzed. In total, 2,551 participants from 6 European countries (Germany, Italy, The Netherlands, Spain, Sweden, and the UK) were included.RESULTS: Participants with knee OA were less likely to follow physical activity recommendations and had poorer overall physical activity profiles than those without knee OA (mean 62.9 versus 81.5 minutes/day, respectively; P = 0.015). The magnitude of this difference varied across countries. Detailed analysis showed that low physical activity levels in persons with knee OA could be attributed to less everyday walking time (odds ratio 1.31, 95% confidence interval 1.07-1.62).CONCLUSION: This study highlighted the fact that having knee OA is associated with a varying degree of physical activity patterns in different countries. This national variation implies that low levels of physical activity among persons with knee OA cannot be explained exclusively by individual or disease-specific factors, but that social, environmental, and other contextual factors should also be taken into account.
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- 2016
16. Vitality and the course of limitations in activities in osteoarthritis of the hip or knee
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van Dijk Gabriella M, Veenhof Cindy, Lankhorst Guus J, van den Ende Cornelia HM, and Dekker Joost
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osteoarthritis ,prognosis ,body functions ,comorbidity ,cognitive functioning ,vitality ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Background The objective of the study was to determine whether psychological and social factors predict the course of limitations in activities in elderly patients with osteoarthritis of the hip or knee, in addition to established somatic and cognitive risk factors. Methods A longitudinal cohort study with a follow-up period of three years was conducted. Patients (N = 237) with hip or knee osteoarthritis were recruited from rehabilitation centers and hospitals. Body functions, comorbidity, cognitive functioning, limitations in activities and psychological and social factors (mental health, vitality, pain coping and perceived social support) were assessed. Statistical analyses included univariate and multivariate regression analyses. Psychological and social factors were added to a previously developed model with body functions, comorbidity and cognitive functioning. Results In knee OA, low vitality has a negative impact on the course of self-reported and performance-based limitations in activities, after controlling for somatic and cognitive factors. In hip OA, psychological and social factors had no additional contribution to the model. Conclusion Low vitality predicts deterioration of limitations in activities in elderly patients with osteoarthritis of the knee, in addition to established somatic and cognitive risk factors. However, the contribution of vitality is relatively small. Results of this study are relevant for the group of patients with knee or hip OA, attending hospitals and rehabilitation centers.
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- 2011
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17. Lateral Trunk Motion and Knee Pain in Osteoarthritis of the Knee: a cross-sectional study
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Knol Dirk L, van den Noort Josien C, Harlaar Jaap, Steultjens Martijn PM, van der Esch Martin, and Dekker Joost
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Osteoarthritis ,Knee ,Trunk Motion ,Knee Pain ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Background Patients with osteoarthritis of the knee may change their gait in an attempt to reduce loading of the affected knee, thereby reducing pain. Especially changes in lateral trunk motion may be potentially effective, since these will affect the position of the centre of mass relative to the knee, enabling minimization of the load on the knee and thereby knee pain. The aim of the study was to test the hypothesis that a higher level of knee pain is associated with higher lateral trunk motion in patients with knee OA. Methods Fifty-two patients with OA of the knee were tested. Lateral trunk motion was measured during the stance phase of walking with an optoelectronic motion analysis system and a force plate. Knee pain was measured with the VAS and the WOMAC pain questionnaire. Regression analyses were performed to assess the relationship between lateral trunk motion and knee pain. Results It was shown that in bivariate analyses knee pain was not associated with lateral trunk motion. In regression analyses, pain was associated with more lateral trunk motion. In addition, more lateral trunk motion was associated with younger age, being female, higher self-reported knee stiffness and higher maximum walking speed. Conclusion Pain is associated with lateral trunk motion. This association is weak and is influenced by age, gender, self-reported stiffness and maximum walking speed.
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- 2011
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18. Factors Associated With Referral to Secondary Care in Patients With Osteoarthritis of the Hip or Knee After Implementation of a Stepped-Care Strategy
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Barten, Di-Janne, Smink, Agnes, Swinkels, Ilse, Veenhof, Cindy, Schers, Henk J., Vliet Vlieland, Thea, Bakker,de, Dinny H., Dekker, Joost, and Ende,van den, Cornelia
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doorverwijzing ,osteoarthritis ,zorg - Abstract
Objective. We introduced a stepped-care strategy (SCS) for hip and knee osteoarthritis, focusing on delivery of highquality stepped care. In this study, we aimed to identify factors associated with various steps of the SCS. Methods. We used data from a 2-year observational prospective cohort study, including 313 patients visiting their general practitioner (GP) with a new episode of hip/knee osteoarthritis. We used logistic multilevel analyses to identify factors at the level of the patient, the GP, and the general practice, related to treatment limited to primary care, referral to nonsurgical secondary care, or surgical procedures.
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- 2017
19. Determinants of adherence to the online component of a blended intervention for patients with hip- and/or knee osteoarthritis: a mixed methods study embedded in the e-Exercise trial
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Vries,de, Herman J., Kloek, Corelien, Bakker,de, Dinny H., Dekker, Joost, Bossen, Daniël, and Veenhof, Cindy
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musculoskeletal diseases ,osteoarthritis ,technology, industry, and agriculture ,e-health - Abstract
This study explores which patient-, intervention-, and environment-related factors are determinants of adherence to the online component of e-Exercise, a 12-week blended intervention for patients with hip and/or knee osteoarthritis.
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- 2017
20. Physiotherapists' experiences with a blended osteoarthritis intervention: a mixed methods study.
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Kloek, Corelien J.J., Bossen, Daniël, de Vries, Herman J., de Bakker, Dinny H., Veenhof, Cindy, and Dekker, Joost
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OSTEOARTHRITIS treatment ,AUTONOMY (Psychology) ,CHI-squared test ,EXERCISE therapy ,HIP joint diseases ,INTERNET ,INTERVIEWING ,KNEE diseases ,RESEARCH methodology ,EVALUATION of medical care ,MEDICAL care costs ,HEALTH policy ,PHYSICAL therapy ,PROFESSIONS ,RESEARCH funding ,STATISTICAL sampling ,T-test (Statistics) ,TIME ,EMPLOYEES' workload ,RANDOMIZED controlled trials ,HUMAN services programs ,DATA analysis software ,PHYSICAL therapists' attitudes - Abstract
E-Exercise is an effective 12-week blended intervention consisting of around five face-to-face physiotherapy sessions and a web-based application for patients with hip/knee osteoarthritis. In order to facilitate effective implementation of e-Exercise, this study aims to identify physiotherapists' experiences and determinants related to the usage of e-Exercise. Methods: An explanatory sequential mixed methods design embedded in a randomized controlled trial comparing e-Exercise with usual physiotherapy in patients with hip/knee osteoarthritis. Usage of e-Exercise was based on recruitment rates of 123 physiotherapists allocated to e-Exercise and objective web-based application usage data. Experiences and determinants related to e-Exercise usage were investigated with a questionnaire and clarified with semi-structured interviews. Results: Of the 123 physiotherapists allocated to e-Exercise, 54 recruited more than one eligible patient, of whom 10 physiotherapists continued using e-Exercise after the study period. Physiotherapists had mixed experiences with e-Exercise. Determinants related to intervention usage were appropriateness, added value, time, workload, professional autonomy, environmental factors, and financial consequences. Physiotherapists recommended to improve the ability to tailor e-Exercise to the individual needs of the patient patients' individual needs. Discussion: Determinants related to the usage of e-Exercise provided valuable information for the implementation of e-Exercise on broader scale. Most importantly, the flexibility of e-Exercise needs to be improved. Next, there is a need for education on how to integrate an online program within physiotherapy. [ABSTRACT FROM AUTHOR]
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- 2020
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21. Stratified exercise therapy compared with usual care by physical therapists in patients with knee osteoarthritis: A randomized controlled trial protocol (OCTOPuS study).
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Knoop, Jesper, Dekker, Joost, Leeden, Marike, Rooij, Mariëtte, Peter, Wilfred F.H., Bodegom‐Vos, Leti, Dongen, Johanna M., Lopuhäa, Nique, Bennell, Kim L., Lems, Willem F., Esch, Martin, Vliet Vlieland, Thea P.M., and Ostelo, Raymond W.J.G.
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COST effectiveness , *EXERCISE therapy , *KNEE diseases , *OSTEOARTHRITIS , *QUESTIONNAIRES , *STATISTICAL sampling , *RANDOMIZED controlled trials , *TREATMENT effectiveness , *DESCRIPTIVE statistics - Abstract
Objectives: Knee osteoarthritis (OA) is characterized by its heterogeneity, with large differences in clinical characteristics between patients. Therefore, a stratified approach to exercise therapy, whereby patients are allocated to homogeneous subgroups and receive a stratified, subgroup‐specific intervention, can be expected to optimize current clinical effects. Recently, we developed and pilot tested a model of stratified exercise therapy based on clinically relevant subgroups of knee OA patients that we previously identified. Based on the promising results, it is timely to evaluate the (cost‐)effectiveness of stratified exercise therapy compared with usual, "nonstratified" exercise therapy. Methods: A pragmatic cluster randomized controlled trial including economic and process evaluation, comparing stratified exercise therapy with usual care by physical therapists (PTs) in primary care, in a total of 408 patients with clinically diagnosed knee OA. Eligible physical therapy practices are randomized in a 1:2 ratio to provide the experimental (in 204 patients) or control intervention (in 204 patients), respectively. The experimental intervention is a model of stratified exercise therapy consisting of (a) a stratification algorithm that allocates patients to a "high muscle strength subgroup," "low muscle strength subgroup," or "obesity subgroup" and (b) subgroup‐specific, protocolized exercise therapy (with an additional dietary intervention from a dietician for the obesity subgroup only). The control intervention will be usual best practice by PTs (i.e., nonstratified exercise therapy). Our primary outcome measures are knee pain severity (Numeric Rating Scale) and physical functioning (Knee Injury and Osteoarthritis Outcome Score subscale daily living). Measurements will be performed at baseline, 3‐month (primary endpoint), 6‐month (questionnaires only), and 12‐month follow‐up, with an additional cost questionnaire at 9 months. Intention‐to‐treat, multilevel, regression analysis comparing stratified versus usual care will be performed. Conclusion: This study will demonstrate whether stratified care provided by primary care PTs is effective and cost‐effective compared with usual best practice from PTs. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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22. Self‐reported knee instability associated with pain, activity limitations, and poorer quality of life before and 1 year after total knee arthroplasty in patients with knee osteoarthritis.
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Leichtenberg, Claudia S., Vliet Vlieland, Thea P. M., Nelissen, Rob G. H. H., Kroon, Herman M., Dekker, Joost, Marijnissen, Willem Jan, Damen, Pieter‐Jan, and van der Esch, Martin
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OSTEOARTHRITIS ,QUALITY of life ,ARTHROPLASTY ,BODY mass index ,KNEE abnormalities - Abstract
Information on the association of self‐reported knee instability with clinical outcomes after Total Knee Arthroplasty (TKA) and 1 year follow‐up is scarce. The aims were to determine (i) the course and prevalence of self‐reported knee instability before and 1 year after TKA and (ii) the associations of preoperative, postoperative, and retained self‐reported knee instability with pain, activity limitations, and quality of life (QoL) in patients with knee osteoarthritis. Patients undergoing primary TKA, selected from the Longitudinal Leiden Orthopaedics and Outcomes of OsteoArthritis Study, had their knee instability measured using a questionnaire. The Knee injury and Osteoarthritis Outcome Score pain, activity limitations, and QoL subscales were administered before and 1 year after surgery. Multivariable regression analyses were performed to examine associations between knee instability, pain, activity limitations, and QoL, adjusted for covariates (age, gender, comorbidities, and radiographic severity). Of the 908 included patients, 649 (71%) and 187 (21%) reported knee instability before and following TKA, respectively. Of the patients with preoperative knee instability, this perception was retained in 165 (25%) cases. Knee instability was preoperatively associated with pain (B −9.6; 95%CI: −12.4 to −6.7), activity limitations (B −7.5; 95%CI: −10.2 to −4.8), and QoL (B −4.7; 95%CI: −7.0 to −2.4) and postoperatively with pain (B −15.0; 95%CI: −18.5 to −11.6), activity limitations (B −15.1; 95%CI: −18.4 to −11.8), and QoL (B −18.7; 95%CI: −22.3 to −15.3). Retained knee instability was associated with postoperative pain (B −15.1; 95%CI: −18.9 to −11.2), activity limitations (B −14.1; 95%CI: −17.8 to −10.4), and QoL (B −18.0; 95%CI: −21.7 to −14.3). In conclusion, in clinical care, self‐reported knee instability is retained postoperatively in 25% of the patients. Retained knee instability is associated with more pain, activity limitations, and poorer QoL postoperatively. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2671–2678, 2018 [ABSTRACT FROM AUTHOR]
- Published
- 2018
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23. Effects of a progressive aquatic resistance exercise program on the biomechanical composition and morphology of cartilage in women with mild knee osteoarthritis: protocol for a randomised controlled trial
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Waller, Benjamin, Munukka, Matti, Multanen, Juhani, Rantalainen, Timo, Pöyhönen, Tapani, Nieminen, Miika, Kiviranta, Ilkka, Kautiainen, Hannu, Selänne, Harri, Dekker, Joost, Sipilä, Sarianna, Kujala, Urho, Häkkinen, Arja, and Heinonen, Ari
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dGEMRIC ,Aquatic exercise ,Osteoarthritis ,luu ,Quantitative MRI ,T2 relaxation time - Abstract
Background. Symptoms associated with osteoarthritis of the knee result in decreased function, loss of working capacity and extensive social and medical costs. There is a need to investigate and develop effective interventions to minimise the impact of and even prevent the progression of osteoarthritis. Aquatic exercise has been shown to be effective at reducing the impact of osteoarthritis. The purpose of this article is to describe the rationale, design and intervention of a study investigating the effect of an aquatic resistance exercise intervention on cartilage in postmenopausal women with mild knee osteoarthritis. Methods. A minimum of 80 volunteers who meet the inclusion criteria will be recruited from the local population through newspaper advertisements. Following initial assessment volunteers will be randomised into two groups. The intervention group will participate in a progressive aquatic resistance exercise program of 1-hour duration 3 times a week for four months. The control group will be asked to maintain normal care during this period. Primary outcome measure for this study is the biochemical composition of knee cartilage measured using quantitative magnetic resonance imaging; T2 relaxation time and delayed gadolinium-enhanced magnetic resonance imaging techniques. In addition, knee cartilage morphology as regional cartilage thickness will be studied. Secondary outcomes include measures of body composition and bone traits using dual energy x-ray absorptiometry and peripheral quantitative computed tomography, pain, function using questionnaires and physical performance tests and quality of life. Measurements will be performed at baseline, after the 4-month intervention period and at one year follow up. Discussion. This randomised controlled trial will investigate the effect a progressive aquatic resistance exercise program has on the biochemical composition of cartilage in post-menopausal women with mild knee osteoarthritis. This is the first study to investigate what impact aquatic exercise has on human articular cartilage. In addition it will investigate the effect aquatic exercise has on physical function, pain, bone and body composition and quality of life. The results of this study will help optimise the prescription of aquatic exercise to persons with mild knee osteoarthritis. peerReviewed
- Published
- 2013
24. Effectiveness of a Blended Physical Therapist Intervention in People With Hip Osteoarthritis, Knee Osteoarthritis, or Both: A Cluster-Randomized Controlled Trial.
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Kloek, Corelien J. J., Bossen, Daniël, Spreeuwenberg, Peter M., Dekker, Joost, de Bakker, Dinny H., and Veenhof, Cindy
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CHI-squared test ,CONFIDENCE intervals ,EXERCISE therapy ,HIP joint diseases ,KNEE diseases ,LONGITUDINAL method ,MEDICAL cooperation ,OSTEOARTHRITIS ,PHYSICAL therapy ,PROBABILITY theory ,RESEARCH ,RESEARCH funding ,STATISTICAL sampling ,STATISTICS ,T-test (Statistics) ,STATISTICAL power analysis ,DATA analysis ,EFFECT sizes (Statistics) ,PAIN measurement ,RANDOMIZED controlled trials ,ACCELEROMETRY ,TREATMENT effectiveness ,PRE-tests & post-tests ,BLIND experiment ,DATA analysis software ,DESCRIPTIVE statistics - Abstract
Background. Integrating physical therapy sessions and an online application (e-Exercise) might support people with hip osteoarthritis (OA), knee OA, or both (hip/ knee OA) in taking an active role in the management of their chronic condition and may reduce the number of physical therapy sessions. Objective. The objective of this study was to investigate the short- and long-term effectiveness of e-Exercise compared to usual physical therapy in people with hip/knee OA. Design. The design was a prospective, single-blind, multicenter, superiority, clusterrandomized controlled trial. Setting. The setting included 143 primary care physical therapist practices. Participants. The participants were 208 people who had hip/knee OA and were 40 to 80 years of age. Intervention. e-Exercise is a 3-month intervention in which about 5 face-to-face physical therapy sessions were integrated with an online application consisting of graded activity, exercise, and information modules. Usual physical therapy was conducted according to the Dutch physical therapy guidelines on hip and knee OA. Measurements. Primary outcomes, measured at baseline after 3 and 12 months, were physical functioning and free-living physical activity. Secondary outcome measures were pain, tiredness, quality of life, self-efficacy, and the number of physical therapy sessions. Results. The e-Exercise group (n = 109) received, on average, 5 face-to-face sessions; the usual physical therapy group (n = 99) received 12. No significant differences in primary outcomes between the e-Exercise group and the usual physical therapy group were found. Within-group analyses for both groups showed a significant improvement in physical functioning. After 3 months, participants in the e-Exercise group reported an increase in physical activity; however, no objectively measured differences in physical activity were found. With respect to secondary outcomes, after 12 months, sedentary behavior signifi- cantly increased in the e-Exercise group compared with the usual physical therapy group. In both groups, there were significant improvements for pain, tiredness, quality of life, and self-efficacy. Limitations. The response rate at 12 months was 65%. Conclusions. The blended intervention, e-Exercise, was not more effective than usual physical therapy in people with hip/knee OA. [ABSTRACT FROM AUTHOR]
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- 2018
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25. Determinants of Adherence to the Online Component of a Blended Intervention for Patients with Hip and/or Knee Osteoarthritis: A Mixed Methods Study Embedded in the e-Exercise Trial.
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de Vries, Herman. J., Kloek, Corelien J.J., de Bakker, Dinny H., Dekker, Joost, Bossen, Daniël, and Veenhof, Cindy
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PHYSICAL therapy ,PHYSIOLOGICAL therapeutics ,OSTEOARTHRITIS ,PHYSICAL therapists ,PATIENT compliance ,PATIENTS - Abstract
Background: Embedding Web-based interventions within physiotherapy has potential, but knowledge on patient adherence to these interventions is limited. Introduction: This study explores which patient-, intervention-, and environment-related factors are determinants of adherence to the online component of e-Exercise, a 12-week blended intervention for patients with hip and/or knee osteoarthritis. Methods: A convergent mixed methods study was performed, embedded within an ongoing trial. Quantitative data of 109 participants that received e-Exercise were used for negative binomial regression analysis. Adherence was defined as the number of online evaluated weeks. Next, semistructured interviews on factors related to adherence to the online component were analyzed. Results: Nineteen participants with missing outcome data because their program was not started were excluded. Of the 90 analyzed participants, 81.1% were evaluated for at least 8 weeks. Adherence was highest for participants with middle education, 1-5-year osteoarthritis duration, and participants who were physiotherapist recruited. The 10 analyzed interviews revealed that sufficient Internet skills, self-discipline, execution of the exercise plan, the intervention's usability, flexibility, persuasive design, added value, and acceptable required time, and research participation were linked to favorable adherence. Discussion: It is unknown if patients who adhered to the online component also adhered to their exercise plans. The relationship between adherence to the online component and clinical outcomes will be addressed in a future study. Conclusions: The majority of the participants adhered to the online component of e-Exercise, illustrating its applicability. The integration within the physiotherapy setting and intervention's persuasive design appear to have an important role in optimizing patient adherence. [ABSTRACT FROM AUTHOR]
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- 2017
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26. The knee adduction moment measured with an instrumented force shoe in patients with knee osteoarthritis
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van den Noort, J.C., van den Noort, Josien C., van der Esch, Martin, Steultjens, Martijn P.M., Dekker, Joost, Schepers, H. Martin, Veltink, Petrus H., Harlaar, Jaap, EMGO+ - Musculoskeletal Health, Research Institute MOVE, Rehabilitation medicine, EMGO - Musculoskeletal health, MOVE Research Institute, Radiology and Nuclear Medicine, AMS - Musculoskeletal Health, and AMS - Rehabilitation & Development
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Male ,musculoskeletal diseases ,medicine.medical_specialty ,Joint moment ,Knee Joint ,Biomedical Engineering ,Biophysics ,Osteoarthritis ,Kinematics ,Measurement system ,Models, Biological ,BSS-Biomechatronics and rehabilitation technology ,Gait (human) ,Physical medicine and rehabilitation ,medicine ,Humans ,Biomechanics ,Knee ,Orthopedics and Sports Medicine ,In patient ,Ground reaction force ,Gait ,Aged ,IR-79360 ,business.industry ,Rehabilitation ,METIS-284966 ,Middle Aged ,Osteoarthritis, Knee ,medicine.disease ,Shoe ,Biomechanical Phenomena ,Shoes ,Adduction moment ,Physical therapy ,EWI-21170 ,Female ,business - Abstract
The external knee adduction moment (KAdM) during gait is an important parameter in patients with knee osteoarthritis (OA). KAdM measurement is currently restricted to instruments only available in gait laboratories. However, ambulatory movement analysis technology, including instrumented force shoes (IFS) and inertial and magnetic measurement systems (IMMS), can measure kinetics and kinematics of human gait free of laboratory restrictions.The objective of this study was a quantitative validation of the accuracy of the KAdM in patients with knee OA, when estimated with an ambulatory-based method (AmbBM) versus a laboratory-based method (LabBM). AmbBM is employing the IFS and a linked-segment model, while LabBM is based on a force plate and optoelectronic marker system. Effects of ground reaction force (GRF), centre of pressure (CoP), and knee joint position measurement are evaluated separately. Twenty patients with knee OA were measured.The GRFs showed differences up to 0.22. N/kg, the CoPs showed differences up to 4. mm, and the medio-lateral and vertical knee position showed differences to 9. mm, between AmbBM and LabBM. The GRF caused an under-estimation in KAdM in early stance. However, this effect was counteracted by differences in CoP and joint position, resulting in a net 5% over-estimation. In midstance and late stance the accuracy of the KAdM was mainly limited by use of the linked-segment model for joint position estimation, resulting in an under-estimation (midstance 6% and late stance 22%). Further improvements are needed in the estimation of joint position from segment orientation. © 2011 Elsevier Ltd.
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- 2012
27. Efficacy of Tailored Exercise Therapy on Physical Functioning in Patients With Knee Osteoarthritis and Comorbidity: A Randomized Controlled Trial.
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de Rooij, Mariëtte, van der Leeden, Marike, Cheung, John, van der Esch, Martin, Häkkinen, Arja, Haverkamp, Daniël, Roorda, Leo D., Twisk, Jos, Vollebregt, Joke, Lems, Willem F., Dekker, Joost, de Rooij, Mariëtte, Häkkinen, Arja, and Haverkamp, Daniël
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CARDIOVASCULAR disease diagnosis ,CARDIOVASCULAR disease treatment ,TYPE 2 diabetes diagnosis ,OSTEOARTHRITIS diagnosis ,CARDIOVASCULAR diseases ,COMPARATIVE studies ,CONVALESCENCE ,EXERCISE ,EXERCISE therapy ,KNEE diseases ,RESEARCH methodology ,MEDICAL cooperation ,TYPE 2 diabetes ,OSTEOARTHRITIS ,QUESTIONNAIRES ,REHABILITATION centers ,RESEARCH ,COMORBIDITY ,EVALUATION research ,RANDOMIZED controlled trials ,TREATMENT effectiveness ,BLIND experiment ,DIAGNOSIS - Abstract
Objective: To evaluate the efficacy on physical functioning and safety of tailored exercise therapy in patients with knee osteoarthritis (OA) and comorbidities.Methods: In a randomized controlled trial, 126 participants were included with a clinical diagnosis of knee OA and at least 1 of the following target comorbidities: coronary disease, heart failure, type 2 diabetes mellitus, chronic obstructive pulmonary disease, or obesity (body mass index ≥30 kg/m2 ), with severity score ≥2 on the Cumulative Illness Rating Scale. The intervention group received a 20-week, individualized, comorbidity-adapted exercise program consisting of aerobic and strength training and training of daily activities. The control group received their current medical care for knee OA and were placed on a waiting list for exercise therapy. Primary outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index, subscale physical functioning (WOMAC-pf), and the 6-minute walk test (6MWT). Measurements were performed at baseline, after 20 weeks (directly posttreatment), and at 3 months posttreatment.Results: Statistically significant physical functioning differences over time were found between the intervention and control group (WOMAC: B = -7.43 [95% confidence interval (95% CI) -9.99, -4.87], P < 0.001; and 6MWT: B = 34.16 [95% CI 17.68, 50.64], P < 0.001) in favor of the intervention group. At 3 months followup, the mean improvements in the intervention group were 33% on the WOMAC scale and 15% on the 6MWT. These improvements are of clinical relevance. No serious adverse events occurred during the intervention.Conclusion: This is the first study showing that tailored exercise therapy is efficacious in improving physical functioning and safe in patients with knee OA and severe comorbidities. [ABSTRACT FROM AUTHOR]- Published
- 2017
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28. Predictors of self-reported knee instability among patients with knee osteoarthritis: results of the Amsterdam osteoarthritis cohort.
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Esch, Martin, Leeden, Marike, Roorda, Leo, Lems, Willem, and Dekker, Joost
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SELF-evaluation ,OSTEOARTHRITIS ,OSTEOARTHRITIS treatment ,KNEE diseases ,PATIENTS - Abstract
The aims of the study were to (i) determine the prevalence and course of self-reported knee instability at 2-year follow-up and (ii) identify factors predictive of retention of self-reported knee instability among patients with established knee osteoarthritis (OA). Among 201 patients from the Amsterdam Osteoarthritis (AMS-OA) cohort, demographic characteristics, self-reported knee instability, muscle strength, proprioception, pain, and physical function were assessed at baseline and at 2 years. Exercise over the past 2 years was assessed by evaluating the medical files. The course of self-reported knee instability was determined in patients reporting instability at baseline. Baseline predictors of self-reported knee instability were determined by uni- and multivariable logistic regression analyses. At baseline, 123 (61 %) patients reported knee instability, and of these, 85 (64 %) patients reported instability 2 years later, while 38 (29 %) reported no instability 2 years later. Poor proprioception and high pain assessed at baseline predicted retention of self-reported knee instability at 2 years among patients with self-reported instability at baseline. Knee instability is highly prevalent among patients with knee osteoarthritis. In patients with self-reported knee instability, the majority retained instability over 2 years. Poor proprioception and high pain predicted retention of self-reported knee instability over time. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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29. Optimization of Analgesics for Greater Exercise Therapy Participation Among Patients With Knee Osteoarthritis and Severe Pain: A Feasibility Study.
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van Tunen, Joyce A. C., van der Leeden, Marike, Bos, Wouter H., Cheung, John, van der Esch, Martin, Gerritsen, Martijn, Peter, Wilfred F., Roorda, Leo D., Tijhuis, Gerard J., Voorneman, Ramon E., Lems, Willem F., and Dekker, Joost
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OSTEOARTHRITIS diagnosis ,OSTEOARTHRITIS treatment ,PAIN management ,ANALGESICS ,CLINICAL trials ,COMPARATIVE studies ,CONVALESCENCE ,FUNCTIONAL assessment ,EXERCISE therapy ,RESEARCH methodology ,KNEE diseases ,MEDICAL cooperation ,OSTEOARTHRITIS ,PATIENT compliance ,RESEARCH ,TIME ,PILOT projects ,EVALUATION research ,PAIN measurement ,TREATMENT effectiveness ,SEVERITY of illness index ,JOINT pain ,DIAGNOSIS ,THERAPEUTICS - Abstract
Objective: Severe pain in patients with knee osteoarthritis (OA) hampers the ability to exercise. A protocol for the standardized optimization of analgesics in combination with exercise therapy was developed. The purpose of this protocol was to reduce pain, thereby allowing the patient to participate in exercise therapy. The objective of the present study was to evaluate the feasibility and outcome of the protocol.Methods: Forty-nine patients with knee OA and severe knee pain (numerical rating scale for pain ≥7) were included. Analgesics were prescribed following an incremental protocol. After 6 weeks, a 12-week exercise therapy program was added. Information about analgesic use and exercise therapy content was recorded. Knee pain and activity limitations were assessed at baseline, after 6 weeks, and after 18 weeks.Results: Statistically significant improvements in pain and activity limitations were found in intent-to-treat analysis after 6 weeks of analgesic use and after the intervention was completed. Mean improvements from baseline were 30% (P < 0.001) for pain and 17% (P < 0.001) for activity limitations after the intervention was completed. Seventy-eight percent of the patients were able to exercise according to the protocol. In these patients, exercise therapy following 6 weeks of analgesic use resulted in a further improvement of activity limitations of 10% (P = 0.004).Conclusion: The combined intervention of standardized analgesic prescription and exercise therapy allows most patients with knee OA and severe pain to participate in exercise therapy, leading to reduction of pain and activity limitations. These promising results need to be confirmed in a randomized controlled trial. [ABSTRACT FROM AUTHOR]- Published
- 2016
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30. Treatment of hip/knee osteoarthritis in Dutch general practice and physical therapy practice: an observational study.
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Barten, Di-Janne J. A., Swinkels, Ilse C. S., Dorsman, Sara A., Dekker, Joost, Veenhof, Cindy, and de Bakker, Dinny H.
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HIP joint diseases ,KNEE disease treatment ,OSTEOARTHRITIS treatment ,MEDICAL protocols ,SCIENTIFIC observation ,PHYSICAL therapy ,PRIMARY health care ,RESEARCH funding ,DESCRIPTIVE statistics ,THERAPEUTICS - Abstract
Background: A multidisciplinary, guideline-based Stepped-Care-Strategy (SCS), has recently been developed to improve the management of hip and knee osteoarthritis (OA). To date, it is unknown to what extent current Dutch OA care is consistent with the SCS, both with respect to the content of care as well as the sequence of care. Furthermore, there is a lack of clarity regarding the role of different health care providers in the performance of OA care according to the SCS. Therefore, the main purpose of this study is to describe the content of primary care in patients with hip/knee OA, including the compliance to the SCS and taking into account the introduction of patient self-referral to physical therapy. Methods: Data were used from NIVEL Primary Care Database. In total, 12.118 patients with hip/knee OA who visited their GP or physical therapist were selected. Descriptive statistics were used to compare the content of care in GP-referred and self-referred patients to physical therapy. Results: Content of care performed by GPs mostly concerned consultations, followed by NSAID prescriptions and referrals to secondary care. Both prescriptions of acetaminophen and referrals to physical therapy respectively dietary therapy were rarely mentioned. Nevertheless, still 65% of the patients in physical therapy practice were referred by their GP. Compared to GP-referred patients, self-referred patients more often presented recurrent complaints and were treated less often by activity-related exercise therapy. Education was rarely registered as singular intervention, neither in GP-referred nor in self-referred patients. Conclusion: In accordance with the SCS, less advanced interventions are more often applied than more advanced interventions. To optimize the adherence to the SCS, GPs could reconsider the frequent use of NSAIDs instead of analgesics and the low referral rate to allied health care. Self-referral to physical therapy partially distorts both the low referral rate in general practice and the low application rate of education as singular intervention in physical therapy practice. Further research is recommended to evaluate the effects of task-shifting in OA care, taking into account the content of the SCS. [ABSTRACT FROM AUTHOR]
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- 2015
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31. The avoidance model in knee and hip osteoarthritis: a systematic review of the evidence.
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Holla, Jasmijn, Sanchez-Ramirez, Diana, Leeden, Marike, Ket, Johannes, Roorda, Leo, Lems, Willem, Steultjens, Martijn, and Dekker, Joost
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ATTITUDE (Psychology) ,CINAHL database ,DATABASE searching ,DISEASES ,HIP joint diseases ,PSYCHOLOGY information storage & retrieval systems ,KNEE diseases ,MATHEMATICAL models ,MEDLINE ,MUSCLE strength ,ONLINE information services ,OSTEOARTHRITIS ,RESEARCH funding ,SYSTEMATIC reviews ,THEORY ,MUSCLE weakness - Abstract
The avoidance model in patients with knee and hip osteoarthritis (OA) hypothesizes that pain and psychological distress lead to avoidance of activities, and thereby to muscle weakness and activity limitations. This paper systematically reviews the scientific evidence for the validity of this avoidance model. A qualitative data synthesis was used to identify levels of evidence. Sixty studies were included. In knee OA, strong evidence was found that avoidance of activities is associated with activity limitations via muscle weakness (mediation by muscle weakness), strong evidence was found for an association between muscle weakness and activity limitations, and weak evidence was found that pain and psychological distress are associated with muscle weakness via avoidance of activities (mediation by avoidance). In hip OA, weak evidence was found for mediation by muscle weakness; and strong evidence was found for an association between muscle weakness and activity limitations. More research is needed on the consecutive associations between pain or psychological distress, avoidance of activities and muscle weakness, and to confirm causal relationships. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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32. Non-surgical care in patients with hip or knee osteoarthritis is modestly consistent with a stepped care strategy after its implementation.
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Smink, Agnes J., Bierma-Zeinstra, Sita M.A., Schers, Henk J., Swierstra, Bart A., Kortland, Joke H., Bijlsma, Johannes W.J., Teerenstra, Steven, Voorn, Theo B., Dekker, Joost, Vliet Vlieland, Thea P.M., and van den Ende, Cornelia H.M.
- Subjects
OSTEOARTHRITIS ,KNEE disease treatment ,JOINT disease treatment ,DIET therapy ,PHYSICIAN practice patterns ,FOLLOW-up studies (Medicine) ,LONGITUDINAL method ,COHORT analysis ,PATIENTS - Abstract
Objective To improve the management of hip or knee osteoarthritis (OA), a stepped care strategy (SCS) has been developed that presents the optimal sequence for care in three steps. This study evaluates the extent to which clinical practice is consistent with the strategy after implementation and identifies determinants of SCS-consistent care. Design A 2-year observational prospective cohort study. Setting General practices in the region of Nijmegen in the Netherlands. Participants Three hundred and thirteen patients with hip or knee OA and their general practitioner (GP). Interventions Multifaceted interventions were developed to implement the strategy. Main Outcome Measures Consistency between clinical practice and the strategy was examined regarding three aspects of care: (i) timing of radiological assessment, (ii) sequence of non-surgical treatment options and (iii) making follow-up appointments. Results Out of the 212 patients who reported to have had an X-ray, 92 (44%) received it in line with the SCS. The sequence of treatment was inconsistent with the SCS in 58% of the patients, which was mainly caused by the underuse of lifestyle advice and dietary therapy. In 57% of the consultations, the patient reported to have been advised to make a follow-up appointment. No determinants that influenced all three aspects of care were identified. Conclusions Consistency with the SCS was found in about half of the patients for each of the three aspects of care. Health care can be further optimized by encouraging GP s to use X-rays more appropriately and to make more use of lifestyle advice, dietary therapy and follow-up appointments. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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33. Effectiveness and cost-effectiveness of a blended exercise intervention for patients with hip and/or knee osteoarthritis: study protocol of a randomized controlled trial.
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Kloek, Corelien J. J., Bossen, Daniël, Veenhof, Cindy, van Dongen, Johanna M., Dekker, Joost, and de Bakker, Dinny H.
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COST effectiveness ,EXERCISE therapy ,OSTEOARTHRITIS ,PHYSICAL activity ,RANDOMIZED controlled trials - Abstract
Background: Exercise therapy in patients with hip and/or knee osteoarthritis is effective in reducing pain, increasing physical activity and physical functioning, but costly and a burden for the health care budget. A web-based intervention is cheap in comparison to face-to-face exercise therapy and has the advantage of supporting in home exercises because of the 24/7 accessibility. However, the lack of face-to-face contact with a professional is a disadvantage of web-based interventions and is probably one of the reasons for low adherence rates. In order to combine the best of two worlds, we have developed the intervention e-Exercise. In this blended intervention face-to-face contacts with a physical therapist are partially replaced by a web-based exercise intervention. The aim of this study is to investigate the short- (3 months) and long-term (12 months) (cost)-effectiveness of e-Exercise compared to usual care physical therapy. Our hypothesis is that e-Exercise is more effective and cost-effective in increasing physical functioning and physical activity compared to usual care. Methods/Design: This paper presents the protocol of a prospective, single-blinded, multicenter cluster randomized controlled trial. In total, 200 patients with OA of the hip and/or knee will be randomly allocated into either e-Exercise or usual care (physical therapy). E-Exercise is a 12-week intervention, consisting of maximum five face-to-face physical therapy contacts supplemented with a web-based program. The web-based program contains assignments to gradually increase patients' physical activity, strength and stability exercises and information about OA related topics. Primary outcomes are physical activity and physical functioning. Secondary outcomes are health related quality of life, self-perceived effect, pain, tiredness and self-efficacy. All measurements will be performed at baseline, 3 and 12 months after inclusion. Retrospective cost questionnaires will be sent at 3, 6, 9 and 12 months and used for the cost-effectiveness and cost-utility analysis. Discussion: This study is the first randomized controlled trial in the (cost)-effectiveness of a blended exercise intervention for patients with osteoarthritis of the hip and/or knee. The findings will help to improve the treatment of patients with osteoarthritis. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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34. Development of comorbidity-adapted exercise protocols for patients with knee osteoarthritis.
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de Rooij, Mariëtte, van der Leeden, Marike, Avezaat, Ellis, Häkkinen, Arja, Klaver, Rob, Tjieu Maas, Peter, Wilfred F., Roorda, Leo D., Lems, Willem F., and Dekker, Joost
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OSTEOARTHRITIS ,KNEE disease treatment ,EXERCISE therapy ,COMORBIDITY ,DISEASE prevalence ,PATIENTS - Abstract
Background: Exercise therapy is generally recommended for patients with osteoarthritis (OA) of the knee. Comorbidity, which is highly prevalent in OA, may interfere with exercise therapy. To date, there is no evidence-based protocol for the treatment of patients with knee OA and comorbidity. Special protocols adapted to the comorbidity may facilitate the application of exercise therapy in patients with knee OA and one or more comorbidities. Purpose: The purpose of this study was to develop comorbidity-adapted exercise protocols for patients with knee OA and comorbidity. Method: Several steps were undertaken to develop comorbidity-adapted protocols: selection of highly prevalent comorbidities in OA, a literature search to identify restrictions and contraindications for exercise therapy for the various comorbid diseases, consultation of experts on each comorbid disease, and field testing of the protocol in eleven patients with knee OA and comorbidity. Results: Based on literature and expert opinion, comorbidity-adapted protocols were developed for highly prevalent comorbidities in OA. Field testing showed that the protocols provided guidance in clinical decision making in both the diagnostic and the treatment phase. Because of overlap, the number of exercise protocols could be reduced to three: one for physiological adaptations (coronary disease, heart failure, hypertension, diabetes type 2, chronic obstructive pulmonary diseases, obesity), one for behavioral adaptations (chronic a-specific pain, nonspecific low back pain, depression), and one for environmental adaptations (visual or hearing impairments). Evaluation of patient outcome after treatment showed significant (P<0.05) and clinically relevant improvements in activity limitations and pain. Conclusion: Comorbidity-adapted exercise protocols for patients with knee OA were developed, providing guidance in clinical reasoning with regard to diagnostics and treatment. To evaluate the effectiveness of treatment in line with our protocols, a randomized clinical trial should be performed. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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35. Osteoarthritis of the knee: multicompartmental or compartmental disease?
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van der Esch, Martin, Knol, Dirk L., Schaffers, Ilse C., Reiding, Dick J., van Schaardenburg, Dirkjan, Knoop, Jesper, Roorda, Leo D., Lems, Willem F., and Dekker, Joost
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ACADEMIC medical centers ,CONFIDENCE intervals ,INFLAMMATION ,KNEE diseases ,OSTEOARTHRITIS ,STATISTICS ,INTER-observer reliability ,SEVERITY of illness index ,DESCRIPTIVE statistics - Abstract
Objective. Knee OA has been conceptualized as a multicompartmental disease, as a compartmental disease or as a combination of these two disease processes. The aim of this study was to determine the associations between four radiographic features (joint space narrowing, osteophyte formation, sclerosis and cysts) across and within the three knee compartments (medial tibiofemoral, lateral tibiofemoral and patellofemoral compartment) in knee OA.Methods. Data from the Amsterdam OA Cohort were used. In 298 patients diagnosed with knee OA, radiographic features were examined in three knee joint compartments. Radiographic features were scored according to standardized scoring methods. Factor analysis was used to examine associations between the four radiographic features across and within compartments.Results. A bifactor model showed a general multicompartmental factor: 10 of 12 radiographic features across the entire joint were associated with the general factor. The bifactor model also showed three compartmental factors—one for each compartment: joint space narrowing, sclerosis and to a lesser extent osteophyte formation were associated with these compartmental factors.Conclusion. These findings suggest a multicompartmental disease process in the knee, characterized by associations among features across the entire joint, as well as compartmental disease processes in each knee compartment, characterized by associations among features within specific compartments. Longitudinal studies are needed to explore the possibility of the development from a compartmental disease to a multicompartmental disease and the impact of contributing factors on the development. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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36. The association of body-mass index and depressed mood with knee pain and activity limitations in knee osteoarthritis: results from the Amsterdam osteoarthritis cohort.
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Holla, Jasmijn F. M., van der Leeden, Marike, Knol, Dirk L., Roorda, Leo D., van der Esch, Martin, Voorneman, Ramon E., Lems, Willem F., and Dekker, Joost
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KNEE pain ,OSTEOARTHRITIS ,BODY mass index ,MENTAL depression ,REGRESSION analysis ,PSYCHOLOGY ,PHYSIOLOGY - Abstract
Background Body-mass index (BMI) and depressed mood are both positively associated with pain and activity limitations in knee osteoarthritis (OA), and are interrelated. The aims of the present study were: 1) to assess whether BMI and depressed mood are independently associated with knee pain and activity limitations; and 2) to compare the relative contributions of BMI and depressed mood to knee pain and activity limitations. Methods A cross-sectional study in 294 patients with clinical knee OA. Regression analyses were performed with knee pain or activity limitations (self-reported and performance-based) as dependent variables, and BMI and depressed mood as independent variables. All analyses were adjusted for age, gender, marital status, education level, radiographic OA and comorbidity. Dominance analyses were performed to examine the relative contributions of BMI and depressed mood to knee pain and activity limitations. Results BMI and depressed mood were positively and independently associated with knee pain and activity limitations. BMI and depressed mood explained small parts (3.0% and 2.3%, respectively) of variance in knee pain. BMI explained a substantial part of variance in both self-reported (9.8%) and performance-based (20.4%) activity limitations, while depressed mood explained a small part of variance (3.1% in self-reported and 2.6% in performancebased activity limitations). Conclusions In patients with knee OA both BMI and depressed mood seem to be independently associated with knee pain and activity limitations. The contribution of BMI to activity limitations is most substantial, thereby offering a relevant target for interventions. [ABSTRACT FROM AUTHOR]
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- 2013
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37. The usability and preliminary effectiveness of a web-based physical activity intervention in patients with knee and/or hip osteoarthritis.
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Bossen, Daniel, Veenhof, Cindy, Dekker, Joost, and Bakker, Dinny de
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OSTEOARTHRITIS ,PHYSICAL activity ,STIFLE joint ,PILOT projects ,LIKERT scale - Abstract
Background: A large proportion of patients with knee and/or hip osteoarthritis (OA) do not meet the recommended levels of physical activity (PA). Therefore, we developed a web-based intervention that provides a tailored PA program for patients with knee and/or hip OA, entitled Join2move. The intervention incorporates core principles of the behaviour graded activity theory (BGA). The aim of this study was to investigate the preliminary effectiveness, feasibility and acceptability of Join2move in patients with knee and/or hip OA. Methods: A non-randomized pilot study was performed among patients with knee and/or hip OA. Primary outcomes were PA (SQUASH Questionnaire), physical function (HOOS and KOOS questionnaires) and self-perceived effect (7-point Likert scale). Baseline, 6 and 12 week follow-up data were collected via online questionnaires. To assess feasibility and acceptability, program usage (modules completed) and user satisfaction (SUS questionnaire) were measured as secondary outcomes. Participants from the pilot study were invited to be interviewed. The interviews focused on users' experiences with Join2move. Besides the pilot study we performed two usability tests to determine the feasibility and acceptability of Join2move. In the first usability test, software experts evaluated the website from a list of usability concepts. In the second test, users were asked to verbalize thoughts during the execution of multiple tasks. Results: Twenty OA patients with knee and/or hip OA between 50 and 80 years of age participated in the pilot study. After six weeks, pain scores increased from 5.3 to 6.6 (p=0.04). After 12 weeks this difference disappeared (p=0.5). Overall, users were enthusiastic about Join2move. In particular, performing exercise at one's own pace without time or travel restrictions was cited as convenient. However, some minor flaws were observed. Users perceived some difficulties in completing the entire introduction module and rated the inability to edit and undo actions as annoying. Conclusions: This paper outlines the preliminary effectiveness, feasibility and acceptability of a web-based PA intervention. Preliminary results from the pilot study revealed that PA scores increased, although differences were not statistically significant. Interviews and usability tests suggest that the intervention is feasible and acceptable in promoting PA in patients with knee and/or hip OA. The intervention was easy to use and the satisfaction with the program was high. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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38. Association of serum C-reactive protein and erythrocyte sedimentation rate with muscle strength in patients with knee osteoarthritis.
- Author
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Sanchez-Ramirez, Diana C., Van Der Leeden, Marike, Van Der Esch, Martin, Gerritsen, Martijn, Roorda, Leo D., Verschueren, Sabine, Van Dieën, Jaap, Dekker, Joost, and Lems, Willem F.
- Subjects
BLOOD testing ,BLOOD sedimentation ,C-reactive protein ,EXERCISE tests ,KNEE diseases ,MULTIVARIATE analysis ,MUSCLE contraction ,MUSCLE strength ,OSTEOARTHRITIS ,REGRESSION analysis ,RESEARCH funding ,EQUIPMENT & supplies ,BODY mass index ,DATA analysis software ,DESCRIPTIVE statistics - Abstract
Objective. To examine the association of serum CRP and ESR with muscle strength in patients with knee OA.Methods. Cross-sectional data from 285 patients with knee OA from the Amsterdam Osteoarthritis (AMS-OA) cohort were analysed. CRP (mg/l) and ESR (mm/l) were measured in serum from patients’ blood samples and the values were dichotomized for the analyses. Strength of quadriceps and hamstring muscles was assessed using an isokinetic dynamometer. Univariable and multivariable linear regression analyses were used to assess the association of CRP and ESR with muscle strength, adjusting for relevant confounders.Results. Elevated levels of serum CRP (β = −0.10; P = 0.04) and ESR (β = −0.12; P = 0.02) were associated with lower muscle strength after adjustment for age, sex, comorbidities and NSAID use. The associations were no longer significant when BMI was incorporated in the adjusted model.Conclusion. Inflammation might influence muscle strength in patients with knee OA. Moreover, the link between inflammation and obesity might explain the effect that BMI has in the associations between inflammatory markers (i.e. CRP and ESR) and muscle strength. [ABSTRACT FROM PUBLISHER]
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- 2013
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39. Restrictions and contraindications for exercise therapy in patients with hip and knee osteoarthritis and comorbidity.
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de Rooij, Mariëtte, Steultjens, Martijn P M, Avezaat, Ellis, Häkkinen, Arja, Klaver, Rob, van der Leeden, Marike, Maas, Tjieu, Roorda, Leo D, van der Velde, Hanneke, Lems, Willem F, and Dekker, Joost
- Subjects
HIP joint diseases ,KNEE disease treatment ,OSTEOARTHRITIS treatment ,BACKACHE ,CHRONIC pain ,CYSTITIS ,MENTAL depression ,EXERCISE ,HEARING disorders ,HEART diseases ,HYPERTENSION ,OBSTRUCTIVE lung diseases ,TYPE 2 diabetes ,OBESITY ,OSTEOARTHRITIS ,PHYSICAL therapy ,VISION disorders ,COMORBIDITY ,DISEASE complications ,THERAPEUTICS - Abstract
Background: Osteoarthritis (OA) has a very high rate of comorbidity. Exercise therapy is recommended in current guidelines on the management of OA of the hip and knee. Unfortunately, current protocols and guidelines for exercise therapy in OA of the hip and knee do not offer advice concerning comorbidity-associated adaptations for exercise therapy in OA patients. Because of the high prevalence of comorbidity in OA, it is important to establish when exercise therapy for OA of the hip and knee should be adapted when patients have one or more comorbidities. Objective: To identify restrictions and contraindications for exercise therapy for common comorbidities (cardiac diseases, hypertension, type 2 diabetes, obesity, chronic obstructive pulmonary disease (COPD), depression, chronic pain, low back pain (LBP), visual or hearing impairments, and chronic cystitis) in hip and knee OA patients. Major findings: Cardiac diseases, hypertension, type 2 diabetes, COPD, and chronic cystitis are associated with restrictions resulting from physiological impairments. Conversely, LBP, chronic pain syndromes, and depression are associated with psychological and behavioural restrictions to exercise therapy. Visual and hearing impairments result predominantly in environmental restrictions to exercise. Obesity is associated with restrictions resulting from physiological and psychological impairments and behavioural barriers. Several absolute contraindications exist and patient safety cannot be guaranteed when these are not taken into account during exercise therapy. Conclusion: Restrictions and contraindications for exercise in patients with OA of the hip and knee and comorbidity have been identified. This overview is helpful in decisions on the treatment of patients and will be instrumental in the development of a protocol for comorbidity related adaptations in exercise therapy for OA patients. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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- View/download PDF
40. Impact of self-reported comorbidity on physical and mental health status in early symptomatic osteoarthritis: the CHECK (Cohort Hip and Cohort Knee) study.
- Author
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Wesseling, Janet, Welsing, Paco M. J., Bierma-Zeinstra, Sita M. A., Dekker, Joost, Gorter, Kees J., Kloppenburg, Margreet, Roorda, Leo D., and Bijlsma, Johannes W. J.
- Subjects
ACADEMIC medical centers ,CHI-squared test ,LONGITUDINAL method ,MENTAL health ,OSTEOARTHRITIS ,PAIN ,PHYSICAL fitness ,REGRESSION analysis ,RESEARCH funding ,SELF-evaluation ,T-test (Statistics) ,COMORBIDITY ,SEVERITY of illness index ,DESCRIPTIVE statistics ,DISEASE complications - Abstract
Objective. To describe the relationship between comorbidity (absolute number as well as the presence of specific comorbidities) and pain, physical functioning and mental health status of participants with early symptomatic OA of the hip or knee.Methods. In the Netherlands, a prospective 10-year follow-up study was initiated by the Dutch Arthritis Association in participants with early symptomatic OA of the hip or knee: CHECK (Cohort Hip and Cohort Knee), which consists of 1002 individuals. At baseline, linear regression analysis was used to determine the influence of comorbidity on the outcome variables: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, WOMAC physical functioning, Medical Outcomes Study Short Form 36 (SF-36) Physical Component Summary and Mental Component Summary.Results. Of 979 subjects, 67% reported one or more comorbidities. After controlling for age, gender, social status and severity of radiographic OA (Kellgren and Lawrence score), back disorders have the largest effect on WOMAC pain and physical functioning, and one of the largest effects on physical status of SF-36, besides obesity. Mental status was negatively influenced by the additional presence of duodenal ulcer, thyroid disease, and migraine or chronic headache.Conclusion. In early stage of OA, the presence of additional problems in the musculoskeletal system and of obesity have a negative effect on pain and physical health status. Also mental status is affected in early symptomatic OA by the presence of specific comorbidities. Comorbidity should be assessed and treated to improve the burden of illness in patients with early symptomatic OA. [ABSTRACT FROM PUBLISHER]
- Published
- 2013
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41. Patient reported barriers and facilitators to using a self-management booklet for hip and knee osteoarthritis in primary care: results of a qualitative interview study.
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Cuperus, Nienke, Smink, Agnes J., Bierma-Zeinstra, Sita M. A., Dekker, Joost, Schers, Henk J., de Boer, Fijgje, van den Ende, Cornelia H., and Vliet Vlieland, Thea P. M.
- Subjects
HEALTH services accessibility ,HIP joint diseases ,INTERVIEWING ,KNEE diseases ,RESEARCH methodology ,OSTEOARTHRITIS ,PRIMARY health care ,HEALTH self-care ,QUALITATIVE research ,THEMATIC analysis ,DATA analysis software ,PATIENTS' attitudes - Abstract
Background: To enhance guideline-based non-surgical management of hip or knee osteoarthritis (OA), a multidisciplinary, stepped-care strategy has been implemented in primary care in a region of the Netherlands. To facilitate this implementation, the self-management booklet "Care for Osteoarthritis" was developed and introduced. The aim of the booklet was to educate patients about OA, to enhance the patient's active role in the treatment course, and to improve the communication with health care providers. To successfully introduce the booklet on a large scale we assessed barriers and facilitators for patients to using this booklet. Methods: Seventeen primary care patients with hip or knee OA who received the self-management booklet participated in this qualitative study using semi-structured interviews. Purposive sampling was used to ensure diversity of the patients' view about the booklet. The interviews were transcribed verbatim and analysed using a thematic analysis approach. Results: Three core themes with patient perceived barriers and facilitators to use the booklet emerged from the interviews: 1) the role of health care providers, 2) the patient's perceptions about OA and its manageability, and 3) the patient's perceptions about the usefulness of the booklet and patient's information needs. Regarding the first theme, a barrier was the lack of encouragement from health care providers to use the booklet in the treatment course of OA. Moreover, patients had doubts concerning the health care providers' endorsement of non-surgical treatment for OA. Barriers from the second theme were: thinking that OA is not treatable or that being pro-active during the treatment course is not important. In contrast, being convinced about the importance of an active participation in the treatment course was a facilitator. Third, patients' perceptions about the usefulness of the booklet and patients' information needs were both identified as barriers as well as facilitators for booklet use. Conclusions: This study contributes to the understanding of patient perceived barriers and facilitators to use a self-management booklet in the treatment course of OA. The results offer practical starting points to tailor the implementation activities of the booklet nationwide and to introduce comparable educational tools in OA primary care or in other chronic diseases. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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42. Self-reported knee instability and activity limitations in patients with knee osteoarthritis: results of the Amsterdam osteoarthritis cohort.
- Author
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Esch, Martin, Knoop, Jesper, Leeden, Marike, Voorneman, Ramon, Gerritsen, Martijn, Reiding, Dick, Romviel, Suzanne, Knol, Dirk, Lems, Willem, Dekker, Joost, and Roorda, Leo
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OSTEOARTHRITIS ,KNEE diseases ,COHORT analysis ,KNEE pain ,DYNAMOMETER ,REGRESSION analysis ,PATIENTS - Abstract
The objective of this study was to evaluate whether self-reported knee instability is associated with activity limitations in patients with knee osteoarthritis (OA), in addition to knee pain and muscle strength. A cohort of 248 patients diagnosed with knee OA was examined. Self-reported knee instability was defined as the perception of any episode of buckling, shifting, or giving way of the knee in the past 3 months. Knee pain was assessed using a numeric rating scale, and knee extensor and flexor strength were measured using an isokinetic dynamometer. Activity limitations were measured by using the Western Ontario and McMasters Universities Osteoarthritis Index physical function questionnaire, the timed Get Up and Go, and the timed stair climbing and three questionnaires evaluating walking, climbing stairs, and rising from a chair. Other potential determinants of activity limitations were also collected, including joint proprioception, joint laxity, age, sex, body mass index (BMI), disease duration, and radiographic disease severity. Regression analyses evaluated the effect of adding self-reported knee instability to knee pain and muscle strength, when examining associations with the activity limitations measures. Self-reported knee instability was common (65 %) in this cohort of patients with knee OA. Analyses revealed that self-reported knee instability is significantly associated with activity limitations, even after controlling for knee pain and muscle strength. Joint proprioception, joint laxity, age, sex, BMI, duration of complaints, and radiographic severity did not confound the associations. In conclusion, self-reported knee instability is associated with activity limitations in patients with knee OA, in addition to knee pain and muscle strength. Clinically, self-reported knee instability should be assessed in addition to knee pain and muscle strength. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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43. Avoidance of Activities in Early Symptomatic Knee Osteoarthritis: Results from the CHECK Cohort.
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Holla, Jasmijn, Leeden, Marike, Knol, Dirk, Peter, Wilfred, Roorda, Leo, Lems, Willem, Wesseling, Janet, Steultjens, Martijn, and Dekker, Joost
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OSTEOARTHRITIS ,PHYSICAL activity ,MUSCLE strength ,CROSS-sectional method ,KNEE pain ,PATIENTS - Abstract
Background: Pain-related avoidance of activities is hypothesized to lead to lower muscle strength and thereby activity limitations. Negative affect (e.g., low vitality, depression) is thought to strengthen the tendency to avoid activities. Purpose: The aim of this study was to assess the validity of this 'avoidance model' in patients with early symptomatic knee osteoarthritis (OA). Methods: Cross-sectional data ( n = 151) were used. The associations between pain, negative affect, avoidance, muscle strength, and activity limitations were modeled using structural equation modeling. Results: Pain and negative affect were associated with lower muscle strength via avoidance (mediation by avoidance). Avoidance was associated with activity limitations via lower muscle strength (mediation by muscle strength). There were also direct associations between pain, negative affect, avoidance, muscle strength, and activity limitations. Conclusions: The results support the validity of the avoidance model, which explains the associations between pain, negative affect, avoidance, muscle strength, and activity limitations in patients with early symptomatic knee OA. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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44. Influence of the instrumented force shoe on gait pattern in patients with osteoarthritis of the knee.
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Noort, Josien, Esch, Martin, Steultjens, Martijn, Dekker, Joost, Schepers, Martin, Veltink, Peter, and Harlaar, Jaap
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OSTEOARTHRITIS ,KNEE diseases ,GAIT disorders ,BONE plates (Orthopedics) ,BIOMECHANICS ,MEDICAL rehabilitation ,GROUND reaction forces (Biomechanics) - Abstract
Osteoarthritis (OA) of the knee is associated with alterations in gait. As an alternative to force plates, instrumented force shoes (IFSs) can be used to measure ground reaction forces. This study evaluated the influence of IFS on gait pattern in patients with knee OA. Twenty patients with knee OA walked in a gait laboratory on IFS and control shoes (CSs). An optoelectronic system and force plate were used to perform 3D gait analyses. A comparison of temporal-spatial gait parameters, kinematics, and kinetics was made between IFS and CS. Patients wearing IFS showed a decrease in walking velocity and cadence (8%), unchanged stride length, an increase in stance time (13%), stride time (11%) and step width (14%). No differences were found in knee adduction moment or knee kinematics. Small differences were found in foot and ankle kinematics (2-5°), knee transverse moments (5%), ankle frontal (3%) and sagittal moments (1%) and ground reaction force (1-6%). The gait of patients with knee OA was only mildly influenced by the IFS, due to increased shoe height and weight and a change in sole stiffness. The changes were small compared to normal variation and clinically relevant differences. Importantly, in OA patients no effect was found on the knee adduction moment. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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45. Lateral Trunk Motion and Knee Pain in Osteoarthritis of the Knee: a cross-sectional study.
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der Esch, Martin van, Steultjens, Martijn P. M., Harlaar, Jaap, van den Noort, Josien C., Knol, Dirk L., and Dekker, Joost
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OSTEOARTHRITIS ,STIFLE joint ,WALKING ,PUBLIC health research ,MEDICAL care - Abstract
Background: Patients with osteoarthritis of the knee may change their gait in an attempt to reduce loading of the affected knee, thereby reducing pain. Especially changes in lateral trunk motion may be potentially effective, since these will affect the position of the centre of mass relative to the knee, enabling minimization of the load on the knee and thereby knee pain. The aim of the study was to test the hypothesis that a higher level of knee pain is associated with higher lateral trunk motion in patients with knee OA. Methods: Fifty-two patients with OA of the knee were tested. Lateral trunk motion was measured during the stance phase of walking with an optoelectronic motion analysis system and a force plate. Knee pain was measured with the VAS and the WOMAC pain questionnaire. Regression analyses were performed to assess the relationship between lateral trunk motion and knee pain. Results: It was shown that in bivariate analyses knee pain was not associated with lateral trunk motion. In regression analyses, pain was associated with more lateral trunk motion. In addition, more lateral trunk motion was associated with younger age, being female, higher self-reported knee stiffness and higher maximum walking speed. Conclusion: Pain is associated with lateral trunk motion. This association is weak and is influenced by age, gender, self-reported stiffness and maximum walking speed. [ABSTRACT FROM AUTHOR]
- Published
- 2011
- Full Text
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46. Factors predicting the outcome of customised foot orthoses in patients with rheumatoid arthritis: a prospective cohort study.
- Author
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van der Leeden, Marike, Fiedler, Karin, Jonkman, Annelies, Dahmen, Rutger, Roorda, Leo D., van Schaardenburg, Dirkjan, and Dekker, Joost
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FOOT diseases ,PATIENTS ,RHEUMATOID arthritis ,AUTOIMMUNE diseases ,PAIN ,OSTEOARTHRITIS - Abstract
Background: Conservative management of foot problems in patients with rheumatoid arthritis (RA) may consist of the prescription of customised foot orthoses. Indications for foot orthoses are not clear and the effectiveness of the intervention is highly variable among patients. Knowledge on which patients benefit the most from foot orthoses can help to select patients eligible for this type of intervention. The objective of the present study was to determine clinical and demographic factors that predict the outcome of customised foot orthoses on pain and disability in patients with RA. Methods: A total of 135 RA patients who were supplied with customised foot orthoses were included in this prospective cohort study. Pain and disability were measured before and after the intervention period using a Numeric Rating Scale (NRS) for foot pain, the Foot Function Index (FFI), the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) and a 10-meter walking test. The intervention period consisted of one or more appointments with the podiatrist during which the foot orthoses were customised. Swollen foot joint count, foot deformity scores, forefoot peak pressure, disease duration, age, gender, body mass index and baseline values of the outcome measures were selected as potential factors predicting outcome. Multivariate linear regression analyses were performed to determine factors associated with change in pain and disability (at P < 0.05). Results: Disease duration was negatively associated with the change scores in NRS foot pain (P = 0.018), WOMAC pain (P = 0.001), FFI disability (P = 0.003) and WOMAC physical function (P = 0.002). Age was negatively associated with the change score in 10 meter walking time (P = 0.008). For all outcome measures baseline values were positively associated with the change scores (P < 0.001). Conclusions: Shorter disease duration predicted greater improvements in self-reported foot pain and disability, and younger age predicted greater improvements in walking time after intervention with foot orthoses. Also, higher baseline values of pain and disability predicted greater improvements. Referral for conservative management with foot orthoses in the early stage of RA seems important when aiming to achieve reduction in pain and improvement in daily activities. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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47. Behavioural graded activity results in better exercise adherence and more physical activity than usual care in people with osteoarthritis: a cluster-randomised trial.
- Author
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Pisters, Martijn F., Veenhof, Cindy, de Bakker, Dinny H., Schellevis, François G., and Dekker, Joost
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PHYSICAL activity ,PHYSICAL fitness ,OSTEOARTHRITIS ,CLINICAL trials ,JOINTS (Anatomy) ,CONTROL groups ,DISEASE risk factors - Abstract
Question: Does behavioural graded activity result in better exercise adherence and more physical activity than usual care in people with osteoarthritis of the hip or knee? Design: Analysis of secondary outcomes of a cluster-randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Participants: Two hundred patients with hip and/or knee osteoarthritis. Intervention: Experimental group received 18 sessions of behavioural graded activity over 12 weeks and up to 7 booster sessions over the next year. The control group received 18 sessions of usual care over 12 weeks according to the Dutch physiotherapy guideline. Outcome measures: Exercise adherence was measured using a questionnaire and physical activity was measured using the SQUASH questionnaire at baseline, 13, and 65 weeks. Results: Adherence to recommended exercises was significantly higher in the experimental group than in the control group at 13 weeks (OR 4.3, 95% CI 2.1 to 9.0) and at 65 weeks (OR 3.0, 95% CI 1.5 to 6.0). Significantly more of the experimental than the control group met the recommendations for physical activity at 13 weeks (OR 5.3, 95% CI 1.9 to 14.8) and at 65 weeks (OR 2.9, 95% CI 1.2 to 6.7). Conclusion: Behavioural graded activity results in better exercise adherence and more physical activity than usual care in people with osteoarthritis of the hip or knee, both in the short- and long-term. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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48. Prognosis of Limitations in Activities in Osteoarthritis of the Hip or Knee: A 3-Year Cohort Study.
- Author
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van Dijk, Gabriella M., Veenhof, Cindy, Spreeuwenberg, Peter, Coene, Napoleon, Burger, Bart J., van Schaardenburg, Dirkjan, van den Ende, Cornelia H., Lankhorst, Guus J., and Dekker, Joost
- Abstract
Abstract: van Dijk GM, Veenhof C, Spreeuwenberg P, Coene N, Burger BJ, van Schaardenburg D, van den Ende CH, Lankhorst GJ, Dekker J, on behalf of the CARPA Study Group. Prognosis of limitations in activities in osteoarthritis of the hip or knee: a 3-year cohort study. Objective: To describe the course of limitations in activities in elderly patients with osteoarthritis (OA) of the hip or knee over a follow-up period of 3 years, and to identify prognostic factors of the course of limitations in activities, focusing on body functions, comorbidity, and cognitive functioning. Design: A longitudinal cohort study with 3 years of follow-up. Measurements were conducted annually. Statistical analyses included t tests, univariate regression analyses, and multivariate regression analyses. Setting: Rehabilitation centers and hospitals (Departments of Orthopedics, Rheumatology, and Rehabilitation) in The Netherlands. Participants: Patients (N=237) with hip or knee OA. Interventions: Not applicable. Main Outcome Measures: Patient-perceived change, self-reported limitations in activities measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and observed limitations in activities (timed walking test). Prognostic factors: demographic data, clinical data, body function (pain, muscle strength, range of motion [ROM]), comorbidity, and cognitive functioning (cognitive decline, memory, attention). Results: Self-reported limitations in activities measured by the WOMAC improved slightly after 3-year follow-up. In knee OA, reduced ROM at 1-year follow-up (β=.120), increased pain at 1-year follow-up (β=−.177), and higher morbidity count (β=−.180) predicted worsening of self-reported limitations in activities. In hip OA, reduced ROM at 1-year follow-up (β=.201 for hip external rotation and β=.144 for knee extension), increased pain at 1-year follow-up (β=−.134), higher morbidity count (β=−.220), or the presence of moderate to severe cardiac disease (β=−.214) and poorer cognitive functioning (β=.181) predicted worsening of self-reported limitations in activities. Performance-based limitations in activities measured by the timed walking test did not change after 3 years of follow-up. In knee OA, decreased muscle strength at 1-year follow-up (β=−.272) and higher morbidity count (β=.199) predicted worsening of performance-based limitations in activities. In hip OA, better ROM (β=.182), higher morbidity count (β=.232), or the presence of moderate to severe cardiac and eye-ear-nose-throat disease (β=.210 and β=.188, respectively) and older age (β=.355) predicted worsening of performance-based limitations in activities. Conclusions: Overall, at the group level, limitations in activities of patients with OA of the hip or knee recruited from hospitals and rehabilitation centers seem fairly stable during the first 3 years of follow-up. However, at the level of individual patients, considerable variation occurs. Prognostic factors for worsening of limitations in activities include increased pain, reduced ROM, and decreased muscle strength at 1-year follow-up; higher morbidity count; and to a lesser extent poor cognitive functioning. [Copyright &y& Elsevier]
- Published
- 2010
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- View/download PDF
49. Comorbidity, limitations in activities and pain in patients with osteoarthritis of the hip or knee.
- Author
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van Dijk, Gabriella M., Veenhof, Cindy, Schellevis, Francois, Hulsmans, Harry, Bakker, Jan P. J., Arwert, Henk, Dekker, Jos H. M., Lankhorst, Guus J., and Dekker, Joost
- Subjects
COMORBIDITY ,OSTEOARTHRITIS ,PAIN in old age ,DISEASES in older people ,ACTIVITIES of daily living - Abstract
Background: This study aims to contribute to the knowledge of the influence of comorbidity in OA. The objectives of the study were (i) to describe the prevalence of comorbidity and (ii) to describe the relationship between comorbidity (morbidity count, severity and the presence of specific diseases) and limitations in activities and pain in elderly patients with knee or hip OA using a comprehensive inventory of comorbidity. Methods: A cross-sectional cohort study was conducted, in which 288 elderly patients with hip or knee osteoarthritis were included. Apart from demographic and clinical data, information about comorbidity, limitations in activities (WOMAC, SF-36 and timed walking test) and pain (VAS) was collected by questionnaires and tests. Statistical analyses included descriptive statistics, multivariate regression techniques, t-tests and one-way ANOVA. Results: Almost all patients suffered from at least one comorbid disease, with cardiac diseases, diseases of eye, ear, nose, throat and larynx, other urogenital diseases and endocrine/metabolic diseases being most prevalent. Morbidity count and severity index were associated with more limitations in activities and with more pain. The presence of most of the moderate or severe diseases and obesity was associated with limitations in activities or with pain. Conclusion: The results of this study emphasize the importance of comorbidity in the rehabilitation of elderly patients with osteoarthritis of the hip or knee. Clinical practitioners should be aware of the relationship of comorbidity with functional problems in OA patients. [ABSTRACT FROM AUTHOR]
- Published
- 2008
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- View/download PDF
50. A comparison of the OARSI response criteria with patient's global assessment in patients with osteoarthritis of the hip treated with a non-pharmacological intervention.
- Author
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Hoeksma, Hugo L., van den Ende, Cornelia H.M., Breedveld, Ferdinand C., Ronday, H. Karel, and Dekker, Joost
- Subjects
OSTEOARTHRITIS ,HIP joint diseases ,PHYSIOLOGICAL therapeutics ,EXERCISE therapy ,CLINICAL trials ,OSTEOARTHRITIS treatment ,COMPARATIVE studies ,HIP joint ,RANGE of motion of joints ,MANIPULATION therapy ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH ,EVALUATION research ,PAIN measurement ,TREATMENT effectiveness ,THERAPEUTICS - Abstract
Objective: To compare the Osteoarthritis Research Society International (OARSI) response criteria for clinical trials with patient's global assessment in patients with osteoarthritis (OA) of the hip receiving a non-pharmacological intervention, i.e., manual therapy or exercise therapy.Methods: Data of a randomized clinical trial on manual therapy and exercise therapy in patients with OA of the hip (n = 109) were used. Change scores of measures of hip function, range of joint motion and pain were compared between patients who were differently classified by the OARSI response criteria and the patient's global assessment (using a t test, 95% CI). Furthermore, risk ratios (with 95% CI) were calculated for the contrast between treatment outcome, using the OARSI criteria or patient's global assessment.Results: Few patients were classified as improved (i.e., responders) with the OARSI response criteria as compared to patient's global assessment. Significantly worse outcome for hip function and pain was observed in patients who were classified as non-responders (OARSI criteria), but who considered themselves as improved (patient's global assessment). Risk ratios for the contrast between the two treatment programs (manual therapy vs exercise therapy) were similar, when using the OARSI criteria or patient's global assessment.Conclusion: The validity of the OARSI response criteria has been previously demonstrated in OA patients treated with pharmacological interventions. The present study demonstrates the validity of the OARSI response criteria in OA patients treated with a non-pharmacological intervention, i.e., manual therapy and exercise therapy. [ABSTRACT FROM AUTHOR]- Published
- 2006
- Full Text
- View/download PDF
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