Thomas J. Hoogeboom

Akademische Physiotherapeuten der englischen Universität Manchester haben einen systematischen Review zur Wirksamkeit einer präoperativen Bewegungstherapie auf die Ergebnisse einer vorderen Kreuzbandplastik vorgelegt. In den Datenbanken PubMed, Ovid, Cochrane Library und Web of Science wurde mit einer Kombination von Suchbegriffen – ‘anterior cruciate ligament injury’, ‘pre-operative rehabilitation’, ‘pre-operative exercise’, ‘pre-operative protocol’, und ‘quality of life’- nach Studien gesucht, die bis Dezember 2015 in die Datenbanken aufgenommen worden waren. Die Qualität der Studienmethoden wurde mit der PEDro (=Physiotherapy Evidence Database) Skala beurteilt. Von 500 Arbeiten erfüllten 8 Studien die Einschlusskriterien und bildeten die Basis dieser Analyse. Der durchschnittliche PEDro-Score der analysierten Studie betrug 5,8 Punkte, im Sinne einer mittleren Qualität der Studienmethoden. Die acht Studien untersuchten insgesamt 451 Personen, von denen 71% (n=319) Männer waren. Das Alter der Teilnehmer in den analysierten Studien lag zwischen 15 und 57 Jahren. Die Dauer der Interventionen lag zwischen 3 und 24 Wochen. Diese systematische Studienanalyse zeigte, dass eine präoperative Bewegungstherapie die Ergebnisse nach vorderer Kreuzbandesplastik, insbesondere die Kniefunktion und die Muskelkraft verbessern kann. Obwohl es nach der Intervention zu einer deutlichen Verbesserung der Lebensqualität gegenüber dem Ausgangswert gekommen war, wurde jedoch kein signifikanter Unterschied in der Lebensqualität zwischen der Kontrolle- und Bewegungstherapie-Gruppe gefunden. Die Autoren schlussfolgern, dass es Hinweise darauf gibt, dass eine präoperative Bewegungstherapie für Patienten mit operativer Behandlung einer vorderen Kreuzbandverletzung vorteilhaft ist.

Objectives To evaluate the feasibility and potential effectiveness of a 12-week, non-pharmacological multidisciplinary intervention in patients with generalised osteoarthritis (GOA). Design A randomised, concurrent, multiple-baseline single-case design. During the baseline period, the intervention period and the postintervention period, all participants completed several health outcomes twice a week on Visual Analogue Scales. Setting Rheumatology outpatient department of a specialised hospital in the Netherlands. Participants 1 man and four women (aged 51–76 years) diagnosed with GOA. Primary outcome measures To assess feasibility, the authors assessed the number of dropouts and adverse events, adherence rates and patients' satisfaction. Secondary outcome measures To assess the potential effectiveness, the authors assessed pain and self-efficacy using visual data inspection and randomisation tests. Results The intervention was feasible in terms of adverse events (none) and adherence rate but not in terms of participants' satisfaction with the intervention. Visual inspection of the data and randomisation testing demonstrated no effects on pain (p=0.93) or self-efficacy (p=0.85). Conclusions The results of the present study indicate that the proposed intervention for patients with GOA was insufficiently feasible and effective. The data obtained through this multiple-baseline study have highlighted several areas in which the therapy programme can be optimised.

The WOMAC is the most widely used self-report measure to evaluate physical functioning in hip or knee osteoarthritis, however its ability to discriminate pain and physical functioning (i.e. discriminate validity) has repeatedly been questioned. Little to no data is available on the discriminant validity of alternative questionnaires that measure the same construct, for instance the Hip and Knee Osteoarthritis Outcome Score (HOOS and KOOS, respectively) and the Lower Extremity Function Scale (LEFS). Therefore, we translated the LEFS to Dutch and studied its psychometric properties (i.e. validity, reliability and responsiveness). In addition, we assessed the discriminate validity of the LEFS, HOOS and KOOS.

Objective: To determine the prevalence of joint‐pain comorbidities in individuals with hip or knee osteoarthritis (OA) and to assess the differences in the characteristics of people with and without joint‐pain comorbidities.Methods: In this cross‐sectional study, individuals referred to secondary care for treatment of hip/knee OA completed questionnaires to determine sociodemographic characteristics, disease‐related outcomes, and joint‐pain comorbidities. Joint‐pain comorbidity was defined as pain perceived in a joint, other than the index joint, for more than half of the days in the preceding month. To compare differences in patient‐ and disease‐related characteristics between participants with and without joint‐pain comorbidities, we performed analyses of covariance and logistic regression.Results: A total of 401 individuals, 117 with hip OA and 284 with knee OA, returned the questionnaire (82% response rate); the mean ± SD age was 58 ± 13 years and 58% of the responders were women. Fifty‐eight percent of the participants reported symptoms in ≥1 other joint. Participants with joint‐pain comorbidities were more likely to be women, less educated, and have more medical comorbidities. Individuals with joint‐pain comorbidities reported unfavorable outcomes on pain, functioning, fatigue, distress, and health‐related quality of life compared with patients without joint‐pain comorbidities (P < 0.001 for all). Moreover, use of nonsteroidal antiinflammatory drugs (P = 0.038), opioids (P = 0.010), and supplements (P = 0.019) was higher in the group with joint‐pain comorbidities.Conclusion: Our results indicate that individuals with joint‐pain comorbidities represent a clinically relevant and large subgroup of people with OA of the knee or hip. We recommend addressing joint‐pain comorbidities in both research and clinical practice.

Non-pharmacological treatment (NPT) is a useful treatment option in the management of hip or knee osteoarthritis. To our knowledge however, no studies have investigated the effect of NPT in patients with generalized osteoarthritis (GOA). The primary aim of this study is to compare the effectiveness of two currently existing health care programs with different intensity and mode of delivery on daily functioning in patients with GOA. The secondary objective is to compare the cost-effectiveness of both interventions.

Objective: To evaluate the feasibility and preliminary effectiveness of therapeutic exercise before total hip replacement in frail elderly. Design: A single-blind, randomized clinical pilot trial. Setting: Outpatient physiotherapy department. Subjects: Frail elderly with hip osteoarthritis awaiting total hip replacement. Interventions: A short (3—6 weeks) tailor-made, therapeutic exercise programme was compared with usual care. Main measures: Feasibility was assessed through patient satisfaction, adherence, occurrence of adverse events and the number of eligible non-volunteers. Preliminary preoperative effectiveness was assessed with performance and self-reported measures of pain, functioning, physical activity and quality of life. Postoperatively we measured functional recovery and length of hospital stay. Results: Sixty-two eligible patients were approached of whom 21 (mean age 76 years) agreed to participate. Exercisers (n = 10), rated the intervention as very good 8.9 (8—10) (10-point rating scale). No serious adverse events occurred. Forty-one (66%) eligible patients did not participate, mainly because of logistic considerations, resulting in selection bias. The intervention group (trainings sessions participated 91%) showed relevant preoperative improvements on the chair-rise time (delta —2.9 seconds; 95% confidence interval (CI) —6.2 to 0.4) and timed-up-and-go (delta —4.4 seconds; 95% CI —9.3 to 0.5). Postoperatively, no significant differences were seen. Conclusions: A short, tailor-made, exercise programme is well tolerated and appreciated in elderly patients awaiting total hip replacement. However, a larger randomized clinical trial in the same setting is not warranted, because of the high number of eligible non-volunteers.