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Laotammateep C, Champaiboon J, Surarangsit T, Likhitphithak W, Boonhong J. Efficacy of high intensity laser therapy versus sham laser in symptomatic knee osteoarthritis: a double-blind randomized controlled trial. Lasers Med Sci 2025; 40:87. [PMID: 39945920 DOI: 10.1007/s10103-025-04352-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 02/06/2025] [Indexed: 05/09/2025]
Abstract
The purpose of this study is to evaluate the efficacy of six sessions of High-Intensity Laser Therapy (HILT), administered twice a week over three weeks, in reducing pain and improving function in patients with mild to moderate symptomatic osteoarthritis (OA) of the knee. Forty patients were randomly assigned to either the HILT group (n = 20) or a sham control group (n = 20). The HILT group received two initial sessions of analgesic mode HILT with a total energy of 600 J at the medial and lateral joint lines, followed by four sessions of biostimulation mode with 3000 J at the medial joint line. Both groups also participated in a supervised home exercise program. The visual analog scale (VAS) of pain, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and timed up and go test (TUG) were evaluated before treatment and at 3 and 6 weeks after the initial treatment. The VAS and the WOMAC improved significantly in both groups. However, there were no significant differences in any of the measured outcomes between the two groups. Both groups showed no significant improvement in TUG. In treating mild to moderate OA knee, integrating twice a week, 6 sessions (2 sessions of analgesic and 4 sessions of biostimulation mode) HILT to exercise program is not superior to exercise alone.
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Affiliation(s)
- Chanigan Laotammateep
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jirapa Champaiboon
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
| | - Tuangtip Surarangsit
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Wichuda Likhitphithak
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Jariya Boonhong
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Varapirom C, Kuptniratsaikul V, Yamthed R, Srisomnuek A. Efficacy of interferential current therapy plus exercise compared to sham interferential current plus exercise for pain relief in patients with knee osteoarthritis: A randomised controlled trial. Clin Rehabil 2024; 38:1622-1632. [PMID: 39257067 DOI: 10.1177/02692155241278949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
OBJECTIVE To compare the efficacy of interferential current (IFC) therapy combined with quadriceps strengthening exercise versus sham IFC plus exercise for pain relief and functional improvement in patients with knee osteoarthritis. STUDY DESIGN Double-blind randomised controlled trial. SETTING Outpatient rehabilitation clinic. SUBJECTS Knee osteoarthritis patients aged 50-85 years with a pain score ≥4/10. METHODS One hundred forty-four participants were randomly allocated into the study and control groups. The study group received 20 min of IFC therapy (carrier frequency: 4000 Hz, beat frequency: 100 Hz) five times per week for three weeks, while the control group received sham IFC following the same protocol, followed by 10 min of exercise in both groups. Outcome measures included Numeric Rating Scale for Pain, Western Ontario and McMaster Universities Index (WOMAC) score, gait speed, and EuroQol-Five Dimensions-Five Levels questionnaire assessed at baseline, Week 3, and Week 6. Adverse events and patient satisfaction were evaluated at Week 3. RESULTS At Week 3, the study group demonstrated statistical improvement compared to the control group for Numeric Rating Scale for Pain, WOMAC Total, WOMAC Pain, and WOMAC Stiffness. The mean difference (95% confidence interval) between groups was 0.76 (0.21-1.30), 0.49 (0.03-0.95), 0.63 (0.13-1.13), and 0.62 (0.04-1.20), respectively. However, the mean differences between groups were below the Minimally Clinically Important Difference values for each outcome. Additionally, there were no significant differences between groups at Week 6 for any outcome measure. CONCLUSION IFC had no effect on pain reduction and functional improvement in patients with mild to moderate knee osteoarthritis.
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Affiliation(s)
- Chalida Varapirom
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vilai Kuptniratsaikul
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rungsima Yamthed
- Division of Physical Therapy, Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ananya Srisomnuek
- Research Group and Research Network Division, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Chaiyakit P, Wattanapreechanon P. Coronal plane stability of cruciate-retaining total knee arthroplasty in valgus gonarthrosis patients: A mid-term evaluation using stress radiographs. World J Orthop 2024; 15:764-772. [PMID: 39165866 PMCID: PMC11331327 DOI: 10.5312/wjo.v15.i8.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/01/2024] [Accepted: 07/10/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) using implants with a high level of constraint has generally been recommended for patients with osteoarthritis (OA) who have valgus alignment. However, studies have reported favorable outcomes even with cruciate-retaining (CR) implants. AIM To evaluate the coronal plane stability of CR-TKA in patients with valgus OA at the mid-term follow-up. METHODS Patients with primary valgus OA of the knee who underwent TKA from January 2014 to January 2021 were evaluated through stress radiography using a digital stress device with 100 N of force on both the medial and lateral side. Gap openings and degrees of angulation change were determined. Descriptive statistical analysis was performed for both continuous and categorical variables. Inter-rater reliability of the radiographic measurements was evaluated using Cronbach's alpha. RESULTS This study included 25 patients (28 knees) with a mean preoperative mechanical valgus axis of 11.3 (3.6-27.3) degrees. The mean follow-up duration was 3.4 (1.04-7.4) years. Stress radiographs showed a median varus and valgus gap opening of 1.6 (IQR 0.6-3.0) mm and 1.7 (IQR 1.3-2.3) mm and varus and valgus angulation changes of 2.5 (IQR 1.3-4.8) degrees and 2.3 (IQR 2.0-3.6) degrees, respectively. No clinical signs of instability, implant loosening, or revision due to instability were observed throughout this case series. CONCLUSION The present study demonstrated that using CR-TKA for patients with valgus OA of the knee promoted excellent coronal plane stability.
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Affiliation(s)
- Pruk Chaiyakit
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
| | - Pichayut Wattanapreechanon
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
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Khuna L, Soison T, Plukwongchuen T, Tangadulrat N. Reliability and concurrent validity of 30-s and 5-time sit-to-stand tests in older adults with knee osteoarthritis. Clin Rheumatol 2024; 43:2035-2045. [PMID: 38634965 DOI: 10.1007/s10067-024-06969-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/28/2024] [Accepted: 04/14/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Sit-to-stand (STS) movement is fundamental in daily life. STS tasks have been used to assess lower limb muscle strength, balance control, and functional abilities in various populations, but limited information is available on their use in older individuals with knee osteoarthritis. OBJECTIVE We here examined the intra-rater, inter-rater, and test-retest reliability of the 30-s and 5-time STS tests, and calculated the standard error of measurement (SEM) and minimal detectable change (MDC). Moreover, we explored the concurrent validity of these tests by analysing their correlation with knee muscle strength, pain, stiffness, and physical function in older adults with knee osteoarthritis. METHOD This cross-sectional study included 60 older participants diagnosed with knee osteoarthritis. Baseline demographic information and data on pain, stiffness, and physical function using the modified Western Ontario and McMaster Universities Osteoarthritis (WOMAC) were obtained. Participants performed the 30-s and 5-time STS tests as well as knee muscle strength assessment using a hand-held dynamometer. After 1 week, 30 participants were reassessed to evaluate test-retest reliability. RESULTS The 30-s and 5-time STS tests had excellent intra-, inter-, and test-retest reliability (intraclass correlation coefficients: 0.990-1.000, 0.996-0.999, and 0.841-0.853, respectively) with a large SEM and MDC. Both STS tests significantly correlated with knee extensor and flexor strength and all modified WOMAC domains (Pearson's correlation coefficients: 0.28-0.61, p < 0.05). CONCLUSION The 30-s and 5-time STS tests are reliable assessment tools and correlate with knee muscle strength, pain, stiffness, and physical function in older adults with knee osteoarthritis. Key Points • The 30-s and 5-time STS test can serve as surrogate measures in various aspects of knee health, including muscle strength, pain levels, stiffness, and overall physical function, in older adults with knee osteoarthritis. • Both these STS tests are dependable tools, accessible for both experienced and inexperienced assessors to administer effectively.
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Affiliation(s)
- Lalita Khuna
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
| | - Tussaneeporn Soison
- Physical Therapy Unit, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Theardkhwan Plukwongchuen
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Napaporn Tangadulrat
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Tanariyakul Y, Kanitnate S, Tammachote N. Cementless and Cemented Total Knee Arthroplasties Have Similar Outcomes but Cementless Patellar Component Migration was Observed in a Paired Randomized Control Trial. J Arthroplasty 2024; 39:1266-1272. [PMID: 37924989 DOI: 10.1016/j.arth.2023.10.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Cementless total knee arthroplasty (TKA) has become increasingly popular. Some surgeons are concerned about pain, implant stability, and metal-backed patellar component survivorship. This study investigated the outcomes of cementless compared with cemented TKA in bilateral cases. METHODS We randomized 80 knees in 40 osteoarthritic knee patients who underwent bilateral TKA with patellar resurfacing under one anesthesia. All participants received cementless prostheses in one knee and cemented prostheses in the other. The outcomes were knee function measured by the forgotten joint scores, modified Western Ontario and McMaster Universities Osteoarthritis Index, knee ranges of motion, pain levels, operative times, radiographic outcomes, and complications. All knees were followed for a minimum of 2 years (2 to 3 years). RESULTS Cementless and cemented TKA had similar functional outcomes in forgotten joint score (97 ± 5 versus 98 ± 3 points, P = .52), modified Western Ontario and McMaster Universities Osteoarthritis Index score (3 ± 4 versus 3 ± 2 points, P = .96), and ranges of motion (134 ± 7° versus 134 ± 7°, P = .16). The postoperative pain was also similar (P > .05). There were 4 cementless patellar components had superior migration for an average of 3.5 mm (range, 1.77 to 4.16) without loosening. The mean time of migration was 4 (range, 2 to 6) weeks. CONCLUSIONS Cementless TKA had similar functional outcomes and recovery patterns compared with cemented TKA. However, there was concern of cementless component migration at patellae.
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Affiliation(s)
- Yot Tanariyakul
- Department of Orthopaedics, Thammasat University, Pathumthani, Thailand
| | - Supakit Kanitnate
- Department of Orthopaedics, Thammasat University, Pathumthani, Thailand
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Tammachote N, Kraisin T, Kanitnate S. Do we need to restore patellar thickness after total knee arthroplasty with patellar resurfacing? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3677-3682. [PMID: 37291460 DOI: 10.1007/s00590-023-03607-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE The aim of this study was to investigate whether increased patellar thickness after resurfacing decreased knee flexion angle and had any effect on functional outcomes comparing with patellar thickness restoration (patelloplasty) in patients undergoing primary total knee arthroplasty (TKA) or not. METHODS We retrospectively reviewed 220 patients undergoing primary TKA: 110 patients undergoing patelloplasty and 110 patients received overstuffed patellar resurfacing using subchondral bone cut at lateral facet technique were recruited. The mean increase in patellar thickness after resurfacing equal to 2 ± 1.2 mm. The outcomes were postoperative knee flexion angle and modified Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score at minimum 2 year after surgery. RESULTS The mean postoperative knee flexion angles were similar between overstuffed resurfacing group and patelloplasty group (132 ± 7° vs. 134 ± 8°, 95% confidence interval [CI] - 6.9-1.8°, p = 0.1). The mean increase in postoperative knee flexion was 13° in both groups (p = 0.94). The mean change of overall modified WOMAC score was also similar between the two groups (42 ± 12 vs. 39 ± 9 points, 95% CI - 1.7-9.4 points, p = 0.17). CONCLUSION This study demonstrated that increased patellar thickness has no effect on postoperative knee flexion angle and functional outcomes in TKA. The finding clarified the misunderstanding principle of native patellar thickness restoration after resurfacing which had made many surgeons to refrain from resurfacing especially in patient who had thin patella.
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Affiliation(s)
- Nattapol Tammachote
- Investigation Performed at the Orthopedic Unit, Thammasat University Hospital, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand.
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand.
| | - Teeramate Kraisin
- Investigation Performed at the Orthopedic Unit, Thammasat University Hospital, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand
| | - Supakit Kanitnate
- Investigation Performed at the Orthopedic Unit, Thammasat University Hospital, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand
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Zhang Y, Ren J, Zang Y, Guo W, Disantis A, Martin RL. Cross-Culturally Adapted Versions of Patient Reported Outcome Measures for the Lower Extremity. Int J Sports Phys Ther 2023; V18:653-686. [PMID: 37425110 PMCID: PMC10324371 DOI: 10.26603/001c.74528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/08/2023] [Indexed: 07/11/2023] Open
Abstract
Background A large number of patient reported outcome measures (PROMs) have been developed in the English language for various lower extremity orthopaedic pathologies. Twenty different PROMs were recommended for 15 specific musculoskeletal lower extremity pathologies or surgeries. However, the availability of cross-culturally adapted versions of these recommended PROMs is unknown. Purpose The purpose of this study was to identify the cross-culturally adapted versions of recommended PROMs for individuals experiencing orthopedic lower extremity pathologies or undergoing surgeries, and to identify the psychometric evidence that supports their utilization. Study design Literature Review. Methods PubMed, Embase, Medline, Cochrane, CINAHL, SPORTDisucs and Scopus were searched for cross-culturally adapted translated studies through May 2022. The search strategy included the names of the 20 recommended PROMs from previous umbrella review along with the following terms: reliability, validity, responsiveness, psychometric properties and cross-cultural adaptation. Studies that presented a non-English language version of the PROM with evidence in at least one psychometric property to support its use were included. Two authors independently evaluated the studies for inclusion and independently extracted data. Results Nineteen PROMS had cross-culturally adapted and translated language versions. The KOOS, WOMAC, ACL-RSL, FAAM, ATRS, HOOS, OHS, MOXFQ and OKS were available in over 10 different language versions. Turkish, Dutch, German, Chinese and French were the most common languages, with each language having more than 10 PROMs with psychometric properties supporting their use. The WOMAC and KOOS were both available in 10 languages and had all three psychometric properties of reliability, validity, and responsiveness supporting their use. Conclusion Nineteen of the 20 recommended instruments were available in multiple languages. The PROM most frequently cross-culturally adapted and translated were the KOOS and WOMAC. PROMs were most frequently cross-culturally adapted and translated into Turkish. International researchers and clinicians may use this information to more consistently implement PROMs with the most appropriate psychometric evidence available to support their use. Level of evidence 3a.
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Affiliation(s)
- Yongni Zhang
- Rangos School of Health Sciences Duquesne- China Health Institute
| | - Jiayi Ren
- Shuguang Hospital of Shanghai University of Traditional Chinese Medicine
| | - Yaning Zang
- Department of Kinesiology Shanghai University of Sport
| | - Wenhao Guo
- Rangos School of Health Sciences Duquesne- China Health Institute
| | - Ashley Disantis
- Department of Physical Therapy Duquesne University
- UPMC Children's Hospital of Pittsburgh
| | - Robroy L Martin
- Department of Physical Therapy Duquesne University
- UPMC Center for Sports Medicine
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Utamawatin K, Phruetthiphat OA, Apinyankul R, Chaiamnuay S. The efficacy of intra-articular triamcinolone acetonide 10 mg vs. 40 mg in patients with knee osteoarthritis: a non-inferiority, randomized, controlled, double-blind, multicenter study. BMC Musculoskelet Disord 2023; 24:92. [PMID: 36737698 PMCID: PMC9896831 DOI: 10.1186/s12891-023-06191-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Intra-articular (IA) corticosteroid injection is recommended in refractory knee osteoarthritis patients. However, 40-mg of triamcinolone IA every 3 months for 2 years reduces cartilage volume as compared to saline IA. OBJECTIVE To determine the non-inferiority of 10-mg versus 40-mg of triamcinolone acetonide (TA) for treatment of pain in symptomatic knee osteoarthritis at week 12. METHODS This was a double-blind, randomized, controlled trial conducted in 84 symptomatic knee osteoarthritis patients. The 10-mg or 40-mg of TA were 1:1 randomized and injected to the affected knees. The primary outcome was the 12-week difference from baseline in pain VAS, with a pre-specified lower margin for non-inferiority of 10 mm. The measuring instruments used were: Visual analog scale (VAS: 0-10), modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQol Group 5 Dimensions (EQ5D), Knee Injuries and Osteoarthritis Outcome Score (KOOS) questionnaire, chair standing test and 20-m walking time at baseline, at week 4, and week 12 after randomization. Adverse events were recorded. RESULTS Baseline characteristics were similar between two groups. The mean differences of pain VAS (95% confidence interval: CI) between the two groups at baseline and week 12 were 0.8 (-0.8, 2.4) with p of 0.002 for non-inferiority. There were no differences in pain reduction and quality of life improvement between 10-mg and 40-mg groups. The mean differences (95%CI) of WOMAC, KOOS pain, EQ5D and KOOS quality of life between baseline and week 12 were 0.4 (-1.1, 1.9). -8.7 (-21.3, 3.9), 1.3(-7.1, 9.6) and 1.8 (-11.5, 15.0), respectively. There were significant improvements in pain and quality of life between baseline and week 12 in both groups. CONCLUSION The 10 mg of TA is non-inferior to 40 mg TA in improving pain in patients with symptomatic knee OA. Both 10 mg and 40 mg of TA significantly improved pain and quality of life in patients with symptomatic knee OA. TRIAL REGISTRATION TCTR, I TCTR20210224002. Retrospectively registered 24 February 2021, http://www.thaiclinicaltrials.org/show/TCTR20210224002.
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Affiliation(s)
- Komchan Utamawatin
- grid.414965.b0000 0004 0576 1212Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Ong-art Phruetthiphat
- grid.414965.b0000 0004 0576 1212Department of Orthopedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Rit Apinyankul
- grid.9786.00000 0004 0470 0856Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sumapa Chaiamnuay
- grid.10223.320000 0004 1937 0490Rheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and Phramongkutklao College of Medicine, 315 Ratchawithi Road Ratchathewi District, Bangkok, 10400 Thailand
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Malaithong W, Tontisirin N, Seangrung R, Wongsak S, Cohen SP. Bipolar radiofrequency ablation of the superomedial (SM), superolateral (SL) and inferomedial (IM) genicular nerves for chronic osteoarthritis knee pain: a randomized double-blind placebo-controlled trial with 12-month follow-up. Reg Anesth Pain Med 2022; 48:rapm-2022-103976. [PMID: 36543391 PMCID: PMC9985752 DOI: 10.1136/rapm-2022-103976] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Variability in anatomy in the knees supports the use of aggressive lesioning techniques such as bipolar-radiofrequency ablation (RFA) to treat knee osteoarthritis (KOA). There are no randomized controlled trials evaluating the efficacy of bipolar-RFA. METHODS Sixty-four patients with KOA who experienced >50% pain relief from prognostic superomedial, superolateral and inferomedial genicular nerve blocks were randomly assigned to receive either genicular nerve local anesthetic and steroid injections with sham-RFA or local anesthetic and steroid plus bipolar-RFA. Participants and outcome adjudicators were blinded to allocation. The primary outcome was Visual Analog Scale pain score 12 months postprocedure. Secondary outcome measures included Western Ontario and McMaster Universities Arthritis (WOMAC) and Patient Global Improvement-Indexes (PGI-I). RESULTS Both groups experienced significant reductions in pain, with no significant differences observed at 12 months (reduction from 5.7±1.9 to 3.2±2.6 in the RFA-group vs from 5.0±1.4 to 2.6±2.4 in the control-group (p=0.40)) or any other time point. No significant changes were observed between groups for WOMAC and PGI-I at the primary endpoint, with only the control group experiencing a significant improvement in function at 12-month follow-up (mean reduction from 91.2±38.2 to 67.1±51.9 in the RFA-group (p=0.06) vs from 95.8±41.1 to 60.6±42.8 in the control group (p=0.001); p=0.85 between groups). CONCLUSION Our failure to find efficacy for genicular nerve RFA, coupled with evidence showing that a plenitude of nerves supply the knee joint and preliminary studies indicating superiority of lesioning strategies targeting more than three nerves, suggest controlled trials using more aggressive lesioning strategies are warranted. TRIAL REGISTRATION NUMBER TCTR20170130003.
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Affiliation(s)
| | - Nuj Tontisirin
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rattaphol Seangrung
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Siwadol Wongsak
- Department of Orthopedic Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Steven P Cohen
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Departments of Anesthesiology and Critical Care Medicine, Neurology, Physical Medicine & Rehabilitation, and Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Departments of Anesthesiology and Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Witoonpanich B, Jinawath A, Wongtawan T, Tawonsawatruk T. Association of synovial expression of growth and differentiation factor 5 (GDF5) with radiographic severity of knee osteoarthritis. Heliyon 2022; 8:e11798. [DOI: 10.1016/j.heliyon.2022.e11798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 09/21/2021] [Accepted: 11/14/2022] [Indexed: 11/20/2022] Open
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Short-Term Efficacy of High-Intensity Laser Therapy in Alleviating Pain in Patients with Knee Osteoarthritis: A Single-Blind Randomised Controlled Trial. Pain Res Manag 2022; 2022:1319165. [PMID: 36313402 PMCID: PMC9616657 DOI: 10.1155/2022/1319165] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022]
Abstract
Objectives The aim of the study is to evaluate the efficacy of high-intensity laser therapy (HILT) on pain reduction in patients with knee osteoarthritis (OA). Methods Forty-two patients diagnosed with primary knee OA, with a Kellgren–Lawrence classification of 2–4, were recruited into the study. The patients were randomly allocated to two groups: HILT and control. The intervention group received HILT (energy density of 22.39 J/cm2, 562.5 joule/session), while the control group received a sham laser, which was done 2–3 sessions per week for a total of 10 sessions. Both the groups also received the same conservative treatment. The main outcome measures were the visual analogue scale (VAS) and the modified Thai version of the Western Ontario and McMaster Universities Osteoarthritis Index (T-WOMAC) which were evaluated at baseline and immediately after treatment completion. Results At the end of the study, the overall analysis showed a significant decrease in VAS and T-WOMAC scores in both the groups; a greater decrease in scores was found in the HILT group than in the control group (p < 0.001). The between-group comparison also showed a significant difference in VAS, but not in the T-WOMAC score, favouring HILT (p < 0.05). Conclusion The HILT plus conservative treatment can help alleviate pain in patients with knee OA. The findings of the present study could be used in clinical practice to add HILT as another noninvasive treatment option for knee OA. This could be advantageous, particularly for individuals who are at high risk of surgery due to multiple comorbidities or older people. Trial Registration. This clinical trial registration was performed at Clinical.gov (NCT04889885).
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Kuptniratsaikul V, Chaiworapuek W, Kovintaset K, Meesawang M, Chinsawangwatanakul P, Danoi A. Pain management and strength gains compared between pneumatic partial weight support treadmill and underwater treadmill in overweight patients with knee osteoarthritis: A randomized controlled trial. Clin Rehabil 2022; 36:1214-1228. [PMID: 35506932 DOI: 10.1177/02692155221097032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the efficacy of the pneumatic partial weight support treadmill compared to the underwater treadmill (UTM) for reducing pain and increasing quadriceps strength in overweight patients with knee osteoarthritis. DESIGN Non-inferiority trial with a pre-specified 1-point range. METHODS Participants (N = 109) were randomly assigned to the study (pneumatic partial weight support treadmill) (n = 55) or control (UTM) (n = 54) groups. Patients in both groups started with 50% weight support during the first week, 40% during the second week, and 30% during the third week and until the end of the study. Both groups received exercise for 30 min, 3 times per week for 8 weeks (24 sessions). Outcome measurements, including numerical pain rating scale, Western Ontario and McMaster Universities Osteoarthritis Index pain subscale, quadriceps strength, body weight, 6-min walking test, and quality of life, were evaluated at baseline, 8 weeks, and 12 weeks. RESULTS Only 74 participants completed the study. Numerical pain rating scale and the Western Ontario and McMaster Universities Osteoarthritis Index showed non-inferiority of the study to control group. Improvement in quadriceps strength was significantly greater in the study than in control group. Adverse events were not significantly different between groups. Most subjects were satisfied and rated themselves as improved or much improved. Approximately three-quarters of participants attended more than 20 sessions, and there was no significant difference in outcomes between good and poor compliance. CONCLUSION Pneumatic partial weight support treadmill can significantly decrease pain non-inferior to UTM, and can significantly increase quadriceps strength compared to UTM.
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Affiliation(s)
- V Kuptniratsaikul
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, 65106Mahidol University, Bangkok, Thailand
| | - W Chaiworapuek
- Department of Mechanical Engineering, Faculty of Engineering, 122106Kasetsart University, Bangkok, Thailand
| | - K Kovintaset
- Division of Physical Therapy, Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, 65106Mahidol University, Bangkok, Thailand
| | - M Meesawang
- Division of Physical Therapy, Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, 65106Mahidol University, Bangkok, Thailand
| | - P Chinsawangwatanakul
- Research Group and Research Network Division, Research Department, Faculty of Medicine Siriraj Hospital, 65106Mahidol University, Bangkok, Thailand
| | - A Danoi
- Division of Surgical Nursing, Department of Nursing, Siriraj Hospital, Bangkok, Thailand
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Khruakhorn S, Chiwarakranon S. Effects of hydrotherapy and land-based exercise on mobility and quality of life in patients with knee osteoarthritis: a randomized control trial. J Phys Ther Sci 2021; 33:375-383. [PMID: 33935364 PMCID: PMC8079887 DOI: 10.1589/jpts.33.375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/30/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To determine the effects of hydrotherapy and land-based exercises on functional mobility and quality of life among patients with knee osteoarthritis. [Participants and Methods] We conducted a randomized controlled trial with knee osteoarthritis patients randomly allocated into land-based (n=17) and hydrotherapy groups (n=17). The Time-Up and Go (TUG), Five Times Sit-to-Stand (5STS), Stair Climbing Test (SCT), and Quality of Life by questionnaires including the Modified Western Ontario and McMaster Universities Osteoarthritis Index questionnaire Thai version (Thai WOMAC) were assessed at baseline and 6 weeks. The World Health Organization Quality of Life BREF Thai version (WHOQOL-BREF-THAI) questionnaire were assessed at baseline and six weeks and 6 months. [Results] There was no significant difference in outcomes between the groups after 6-weeks and 6-months of follow-up. After 6 weeks, Thai WOMAC score improved in both groups. Only 5STS was improved in the land-based group, while the hydrotherapy group showed significant TUG, 5STS, and SCT improvement. Furthermore, only hydrotherapy showed significant improvement in WHOQOL-BREF-THAI scores in the mental, social, quality of health, and total domains after six months. [Conclusion] Both exercises equally improved functional mobility and quality of life. Hydrotherapy and land-based exercise could improve functional mobility and quality of life in patients with knee osteoarthritis.
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Affiliation(s)
- Santhanee Khruakhorn
- Department of Physical Therapy, Faculty of Allied Health
Sciences, Thammasat University Rangsit Campus: 99 Moo.18 Phahonyothin Road, Khlong Nueng,
Khlong Luang, Pathum Thani 12120, Thailand
| | - Sanon Chiwarakranon
- Department of Physical Therapy, Faculty of Allied Health
Sciences, Thammasat University Rangsit Campus: 99 Moo.18 Phahonyothin Road, Khlong Nueng,
Khlong Luang, Pathum Thani 12120, Thailand
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Weick JW, Bullard J, Green JH, Gagnier JJ. Measures of Hip Function and Symptoms. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:200-218. [PMID: 33091262 DOI: 10.1002/acr.24231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/21/2020] [Indexed: 12/28/2022]
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McHugh M, Droy E, Muscatelli S, Gagnier JJ. Measures of Adult Knee Function. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:219-249. [DOI: 10.1002/acr.24235] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/21/2020] [Indexed: 12/23/2022]
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Bunsanong T, Chaimongkol N. A self-management support intervention on knee functional status and health-related quality of life among middle-age women: A randomized controlled trial. J Adv Nurs 2020; 77:376-386. [PMID: 33089537 DOI: 10.1111/jan.14600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/01/2020] [Accepted: 09/25/2020] [Indexed: 11/29/2022]
Abstract
AIM To determine the effectiveness of a self-management support intervention on knee functional status and health-related quality of life among middle-age women with knee osteoarthritis. DESIGN Randomized controlled trial. METHODS The participants were 40 middle-aged women who had been clinically diagnosed with knee osteoarthritis for more than 3 months and randomly assigned into intervention and control groups equally. After IRB approval code 02-05-2562 was obtained, data collection was carried out from July - November 2019 at the Outpatient Department of Orthorpedics, Thasala Hospital, Thailand. The modified Thai version of the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the Short Form Survey (SF-36) were used to measure knee functional status and health-related quality of life at baseline (T1), immediately after completing the intervention (T2) and 4 weeks after the intervention (T3). The participants in the intervention group received a self-management support program developed by the researcher based on the Individual and Family Self-Management Theory and a review of related literature plus routine care. The implementation consisted of eight sessions over 4 weeks. The control group received only routine care from the hospital. Two-way repeated measure ANOVAs were used to analyze the data. RESULTS The findings revealed that the participants in the intervention group had better knee functional status and HRQOL than those in the control group at follow-up. Additionally, in the intervention group, both knee functional status and HRQOL significantly improved from pre- to post-intervention and follow-up. CONCLUSIONS The findings indicate that this self-management support intervention is effective. IMPACT For women, the prevalence rate of knee OA rises dramatically post-menopause due to lower oestrogen levels. Policy makers and healthcare providers could obtain and promote this intervention as part of standard practice. This should lead to improved knee functional status and HRQOL among middle-aged women. Thai Trial Registration number: TCTR20191223003. on February 5th, 2019.
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Arunrukthavon P, Heebthamai D, Benchasiriluck P, Chaluay S, Chotanaphuti T, Khuangsirikul S. Can urinary CTX-II be a biomarker for knee osteoarthritis? ARTHROPLASTY 2020; 2:6. [PMID: 35236476 PMCID: PMC8796402 DOI: 10.1186/s42836-020-0024-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/13/2020] [Indexed: 12/04/2022] Open
Abstract
Background Early diagnosis of knee osteoarthritis (OA) remains a diagnostic challenge. Urinary C-terminal cross-linked telopeptide of type II collagen (urinary CTX-II) is one of the potential OA biomarkers. However, conclusive evidence regarding the use of this biomarker as a tool for early diagnosis is still lacking. The purposes of this study were to compare urinary CTX-II levels in patients with knee OA and in healthy controls, to evaluate the correlation between urinary CTX-II levels, radiographic severity of OA, and patient-reported outcomes and to evaluate the effect of age and gender on urinary CTX-II levels in the Asian populations. Methods Two groups were studied. The OA group included 78 patients with knee OA aged > 40 years who met the diagnostic criteria for knee OA described by the American College of Rheumatology (ACR). The control group consisted of 51 healthy participants age > 40 years without clinical or radiographic evidence of knee OA. Bilateral knee radiographs were taken and classified according to the Kellgren and Lawrence (KL) grading system. Urinary CTX-II was measured using a competitive ELISA test and Western Ontario and Mcmaster Universities Arthritis Index (WOMAC) was also recorded in all participants. Results Urinary CTX-II was significantly higher in the OA group than in the control group (p < 0.001). The severe knee OA group (KL grade 3 and 4) had higher urinary CTX-II levels than mild knee OA group (KL grade 2) but the difference did not reach statistical significance (p = 0.2). There was a moderate correlation between urinary CTX-II levels and KL grades (r = 0.405, p < 0.001) and a weak correlation between urinary CTX-II levels and WOMAC index scores (r = 0.367, p < 0.001). Multiple regression analysis showed that urinary CTX-II was independently associated with KL grades. Whereas age, gender, and WOMAC index had no statistically significant influence on the urinary CTX-II levels. Conclusions Patients with knee OA had higher urinary CTX-II levels than healthy controls. Moreover, levels of urinary CTX-II were independently correlated with radiographic severity of knee OA. Age, gender, and patient-reported outcomes exerted no effect on the urinary CTX-II levels. Level of evidence Diagnostic Level III.
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Intravenous Dexamethasone Injection Reduces Pain From 12 to 21 Hours After Total Knee Arthroplasty: A Double-Blind, Randomized, Placebo-Controlled Trial. J Arthroplasty 2020; 35:394-400. [PMID: 31587982 DOI: 10.1016/j.arth.2019.09.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/07/2019] [Accepted: 09/02/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Pain after total knee arthroplasty (TKA) affects postoperative recovery and patient satisfaction. The analgesic benefits of corticosteroids have not been well studied. We, therefore, investigated the analgesic effects of intravenous (IV) dexamethasone (DEX) in patients undergoing a TKA. METHODS This was a randomized, double-blind, placebo-controlled trial of 0.15 mg/kg of IV DEX vs saline placebo in unilateral TKA. Fifty patients/arm were recruited. Primary outcomes were pain level, determined by a visual analog scale, and the amount of morphine consumption (mg) ≤48 hours post-TKA. Secondary outcomes were rates of nausea and vomiting, C-reactive protein concentrations, and functional outcomes. RESULTS The DEX group had a significantly lower mean visual analog scale score both at rest and during motion at 12, 15, 18, and 21 hours (P < .05). At 21 hours, the mean difference (Δ) in pain at rest was -11 points (95% confidence interval [CI], -21 to -2 points; P = .02) while the mean difference in pain during motion was -15 points (95% CI, -25 to -5 points; P = .004). The DEX group also had lower rates of nausea and vomiting: 29/50 (58%) vs 42/50 (84%) (P = .008) and lower mean C-reactive protein level: 89 vs 167, Δ = -78 mg/L (95% CI, -100 to -58 mg/L, P < .0001). There were no significant differences in mean morphine consumption by 48 hours, modified Western Ontario and McMaster University Osteoarthritis Index scores, and range of motion of the knee at 3-month follow-up (P > .05). CONCLUSION IV DEX relieves postoperative pain between 12 to 21 hours after TKA and may be a useful adjunct for controlling pain in patients undergoing TKA.
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Nakarmi S, Haq SA, Vaidya B. Translation, validation and cross-cultural adaptation of the Nepali version of WOMAC ® LK 3.1. Int J Rheum Dis 2019; 22:1877-1883. [PMID: 31496056 DOI: 10.1111/1756-185x.13690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/07/2019] [Accepted: 08/08/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Among many self-reported outcome measures, Western Ontario and McMaster Universities Arthritis Index (WOMAC) is one of the commonly used indexes for osteoarthritis patients. Despite high prevalence of musculoskeletal problems in Nepal, there is no validated tool available in the local language. Thus, this study aimed to translate the English WOMAC® into Nepali, and validate it for use in the future. METHODS Guidelines by Beaton et al were followed for translation and cross-cultural adaptation of the original WOMAC into Nepali language. Diagnosed cases of knee osteoarthritis (OA) attending the rheumatology outpatient department of National Center for Rheumatic Diseases, Kathmandu were enrolled in the study. These patients were interviewed with the Nepali version. Internal consistency was measured by Cronbach's alpha and test-retest reliability by intra-class correlation coefficient (ICC). Correlation between domains of WOMAC was tested with visual analog scale (VAS) and numerical rating scale (NRS) of pain and stiffness. RESULTS The test-retest reliability was good with ICC of >0.75 for all domains and items. Internal consistency was acceptable with Cronbach's alpha scores of 0.852, 0.704 and 0.955 for pain, stiffness and physical function domains, respectively. Strong correlation was observed between WOMAC stiffness domain and VAS for stiffness and NRS for stiffness with rho (ρ) values of 0.750 and 0.759, respectively. Moderate correlation was seen between WOMAC pain and VAS for pain and NRS for pain with ρ of 0.658 and 0.584, respectively. CONCLUSIONS Nepali WOMAC is a reliable and valid instrument for assessment of disease severity and its impact in Nepali-speaking patients with OA.
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Affiliation(s)
- Shweta Nakarmi
- National Center for Rheumatic Diseases, Kathmandu, Nepal
| | - Syed Atiqul Haq
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Binit Vaidya
- National Center for Rheumatic Diseases, Kathmandu, Nepal
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Tammachote N, Raphiphan R, Kanitnate S. High-dose (3 g) topical tranexamic acid has higher potency in reducing blood loss after total knee arthroplasty compared with low dose (500 mg): a double-blind randomized controlled trial. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1729-1735. [PMID: 31359178 DOI: 10.1007/s00590-019-02515-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Topical intra-articular tranexamic acid (IA-TXA) has been proven to be safe and effective in reducing postoperative blood loss after primary total knee arthroplasty (TKA). The objective of this study was to investigate the efficacy of high dose (3 g) compared with low dose (500 mg) of IA-TXA in postoperative blood loss after primary TKA. METHODS A double-blind randomized controlled trial was conducted in 80 patients who had undergone primary TKA. The patients were divided into two groups according to intra-articular TXA doses: high-dose group (3 g IA-TXA) and low-dose group (500 mg IA-TXA). The drug was injected into the joint capsule after fascial closure without suction drainage. The primary outcomes were maximum hemoglobin drop (g/dL) and calculated total blood loss (mL). Postoperative blood transfusions, thromboembolic events and functional outcomes were also recorded. RESULTS The mean maximum hemoglobin drop was 1.3 g/dL lower in 3 g IA-TXA group compared to the 500 mg IA-TXA group [1.7 vs 3.0 g/dL, 95% confidence interval (CI) 0.9-1.7 g/dL, P < 0.001]. The 3 g IA-TXA group had 370 mL less calculated total blood loss compared to the 500 mg IA-TXA group (551 vs 921 mL, 95% CI 252-489 mL, P < 0.001). One patient in the 500 mg IA-TXA group required transfusion, while no patient in the 3 g IA-TXA group received transfusion (P = 0.31). Any thromboembolic event was not found, and functional outcome was similar between the two groups. CONCLUSIONS Application of high-dose, 3 g topical IA-TXA was 43% more effective in reducing postoperative blood loss compared with low dose of 500 mg in primary TKA. Optimal doses in between the above two doses may be a worthwhile further investigation.
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Affiliation(s)
- Nattapol Tammachote
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120, Thailand.
| | - Raphi Raphiphan
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120, Thailand
| | - Supakit Kanitnate
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120, Thailand
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Chughtai M, Shah NV, Sultan AA, Solow M, Tiberi JV, Mehran N, North T, Moskal JT, Newman JM, Samuel LT, Bhave A, Mont MA. The role of prehabilitation with a telerehabilitation system prior to total knee arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:68. [PMID: 30963063 DOI: 10.21037/atm.2018.11.27] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background The purpose of the current study was to evaluate the usage of prehabilitation on a telehealth platform prior to total knee arthroplasty (TKA) and its impact on short-term outcomes. Specifically, the study examined whether patients participating in a prehabilitation program impacted length of stay (LOS) and discharge disposition. Methods A total of 476 consecutive patients who underwent TKA at three institutions were included. The average age of the 476 patients was 65.1 years (range, 35 and 93 years). There was a total of 114 patients who utilized the novel prehabilitation program that provided exercises, nutritional advice, education regarding home safety and reducing medical risks, and pain management skills prior to surgery. A group of 362 patients who did not utilize the program formed the control cohort. The outcomes evaluated were LOS and discharge disposition to home, home with health aide (HHA), or skilled nursing facility (SNF). Results The average LOS in the prehabilitation group was significantly shorter than in the control group (2.0 vs. 2.7 days, P<0.001). Additionally, prehabilitation patients had more favorable discharge disposition status in comparison to the control group. In the prehabilitation patients, 77.2% went home without assistance, compared to 42.8% in the control group (P<0.001). Also, significantly fewer patients in the prehabilitation group were discharged to a SNF when compared to the control group (1.8% vs. 21.8%, P<0.0001). Conclusions Prehabilitation preceding TKA in the current study showed early benefits in LOS and discharge disposition. This study will help expand the current literature and educate orthopaedic surgeons on a novel technology. To truly appreciate the role of telerehabilitation in the setting of TKA, further investigation is needed to investigate long-term outcomes, cost analysis, and patient and clinician satisfaction.
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Affiliation(s)
- Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Neil V Shah
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Maximillian Solow
- St. George's University School of Medicine, Grenada, West Indies, USA
| | - John V Tiberi
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, CA, USA
| | - Nima Mehran
- Southern California Permanente Medical Group, Los Angeles, CA, USA
| | | | - Joseph T Moskal
- Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Jared M Newman
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anil Bhave
- Rubin Institute for Advanced Orthopaedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York, USA
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Taechaarpornkul W, Suvapan D, Theppanom C, Chanthipwaree C, Chirawatkul A. Comparison of the Effectiveness of Six and Two Acupuncture Point Regimens in Osteoarthritis of the Knee: A Randomised Trial. Acupunct Med 2018; 27:3-8. [DOI: 10.1136/aim.2008.000067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Although substantial data have supported the effectiveness of acupuncture for treating knee osteoarthritis (OA), the number of points used has varied. The objective of this study was to compare the effectiveness of six and two acupuncture points in the treatment of knee OA. Methods A randomised trial of knee OA patients was conducted. Patients were randomly allocated into two groups of 35. The “six point group” received treatment at six acupuncture points, ST35, EX-LE4 ( Neixiyan), ST36, SP9, SP10 and ST34, while the “two point group” received treatment at just the first pair of points, ST35 and EX-LE4. Both groups received twice weekly electroacupuncture on 10 occasions. Electrical stimulation was carried out at low-frequency of 3 Hz to all points, with the intensity as high as tolerable. Both groups were allowed to take a 200 mg celecoxib capsule per day for intolerable pain. Patients were assessed at baseline, week 5, week 9 and week 13, using a Thai language version of the Western Ontario and McMaster Osteoarthritis Index (WOMAC). Global assessment of change after 10 treatments was also recorded. Results Acupuncture at both six and two acupuncture points was associated with significant improvement. Mean total WOMAC score at weeks 5 and 13 of patients in both groups showed no significant difference statistically (p = 0.75 and p = 0.51). Moreover, the number of celecoxib capsules taken, global assessment of global change and body weight change of both groups also showed no statistical difference. Conclusion This evidence suggests that electroacupuncture to two local points may be sufficient to treat knee OA, but in view of some limitations to this study further research is necessary before this can be stated conclusively.
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Affiliation(s)
| | - Daranee Suvapan
- Sirindhorn National Medical Rehabilitation Center, Nonthaburi, Thailand
| | - Chaniya Theppanom
- Sirindhorn National Medical Rehabilitation Center, Nonthaburi, Thailand
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Irzhanski AA, Kulyaba TA, Kornilov NN. VALIDATION AND CROSS-CULTURAL ADAPTATION OF RATING SYSTEMS WOMAC, KSS AND FJS-12 IN PATIENTS WITH KNEE DISORDERS AND INJURIES. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2018. [DOI: 10.21823/2311-2905-2018-24-2-70-79] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The purposeof the work — is validation and cultural adaptation of the english-language rating systems for knee function assessment for use in scientific, medical and educational institutions of the Russian Federation.Materials and Methods.The english versions of rating systems WOMac® 3.1 Index, The knee Society clinical Rating System©, FjS-12® were translated to Russian language by orthopedic surgeon with advanced level of english and the professional translator specializing in the translation of medical texts. Reverse translation was provided by third independent translator born in the english-speaking country (native speaker). a printed version of the various translations of the questionnaires was filled by patients with an interval of two days. The study group included 150 patients with Stage III knee osteoarthritis (90 women and 60 men aged 48 to 75 years, an average of 62.5 years) hospitalized in Vreden Research Institute of Traumatology and Orthopedics from February to april 2017 for total knee arthroplasty.Results.good and very good retest reliability of WOMac (α = 0.87 and α = 0.9), kSS (α = 0.89 and α = 0.86) and FjS-12 (α = 0.94 and α = 0.96) was revealed. The study revealed a strong correlation between the results of the questionnaires performed by different translators: WOMac (Icc = 0.89), kSS (Icc = 0.86), FjS-12 (Icc = 0.92). The correlation dependence between subsections of WOMac (stiffness – Icc = 0.98, pain – Icc = 0.87, daily functions – Icc = 0.89) and kSS (knee score – Icc = 0.94, function score – Icc = 0.88), which indicates a good constructive validity.Conclusion. The results of the study of criterial and constructive validity, as well as the retest reliability of the Russian versions of the WOMac, kSS and FjS-12 scales, indicate that they are a reliable and sensitive tool for assessing the function of knee joint, which can be widely used by Russian researchers in practical and scientific activities.
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Electric cautery does not reduce blood loss in primary total knee arthroplasty compared with scalpel only surgery a double-blinded randomized controlled trial. INTERNATIONAL ORTHOPAEDICS 2018; 42:2755-2760. [PMID: 29968137 DOI: 10.1007/s00264-018-4048-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study was to systematically compare blood loss between the electric cautery and scalpel used in primary total knee arthroplasty (TKA). METHODS We performed a double-blind trial randomizing osteoarthritic knee patients undergoing unilateral TKA done by either using scalpel (group S) or cautery (group C). Primary outcomes were total blood loss calculated from maximum haemoglobin drop and blood loss collected in drain. Secondary outcomes were systemic inflammatory response (serum C-reactive protein), wound complications, and functional outcomes assessed over three months. RESULTS A total of 80 patients were recruited. Group S had similar calculated total blood loss compared to group C (1070 (S) vs 1128 (C) mL, 95% CI - 219 to 103, p = 0.47). There was no difference in the mean drain-collected blood loss between the two groups (443 (S) vs 486 (C) mL, 95% CI - 128 to 47, p = 0.36). Group C had higher serum C-reactive protein level at 48 hours after TKA compare to group S (105 vs 140 mg/dL, 95% CI - 66 to - 4, p = 0.03). Wound complications and functional outcomes at three months were also similar between the two groups. CONCLUSIONS Using electric cautery does not reduce total blood loss as we thought it would be in primary TKA compare to scalpel only surgery and it is also associated with a greater systemic inflammatory response. Cautery used in TKA which operated under tourniquet may not be worthwhile for the risk of hazardous smoke and the increasing cost.
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Tammachote N, Seangleulur A, Kanitnate S. Lumbar Epidural Corticosteroid Injection Reduces Subacute Pain and Improves Knee Function in the First Six Weeks After Total Knee Arthroplasty: A Double-Blinded Randomized Trial. J Bone Joint Surg Am 2018; 100:950-957. [PMID: 29870446 DOI: 10.2106/jbjs.17.00578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pain control immediately following total knee arthroplasty (TKA) has been a focus for orthopaedists. However, control of subacute pain, which may persist up to 3 months, is usually not optimized. The efficacy of epidural corticosteroids in reducing pain after surgery is documented, but data on their efficacy in controlling subacute pain after TKA are lacking. Our aim was to investigate the efficacy of an epidural corticosteroid in controlling pain in the first 3 months following TKA using a double-blinded randomized clinical trial. METHODS One hundred and eight patients with osteoarthritis of the knee who underwent TKA and received analgesic drugs through an epidural catheter for 48 hours were randomized to receive either 40 mg (1 mL) of triamcinolone acetonide plus 5 mL of 1% lidocaine, or 6 mL of 1% lidocaine alone before catheter removal. The outcomes of interest were pain level during motion and at rest, knee function, and range of motion, which were recorded up to 3 months after surgery. Multilevel regression models were used to estimate the differences between groups. RESULTS The corticosteroid + lidocaine group had a lower average level of pain during motion compared with the lidocaine-only group, as measured by a visual analog scale (VAS), from day 3 to 7 weeks postoperatively (p < 0.05). At 7 weeks, the mean difference was -7 points (95% confidence interval [CI], -12.8 to -1.0 points; p = 0.033). The corticosteroid + lidocaine group also had a better mean overall modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 6 weeks postoperatively (28 compared with 33 points; 95% CI, -8.6 to -0.6 points; p = 0.03). There was no difference between the groups in the level of pain at rest and knee range of motion during the 3-month period (p > 0.05). CONCLUSIONS Lumbar epidural corticosteroid injection reduced pain during motion for 7 weeks and provided better knee function at 6 weeks postoperatively compared with lidocaine alone. There was no difference detected with respect to pain at rest and knee range of motion during the 3-month follow-up. Epidural corticosteroids could improve patient satisfaction during the early weeks of recovery after TKA. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nattapol Tammachote
- Departments of Orthopedics (N.T. and S.K.) and Anesthesiology (A.S.), Thammasat University, Pathumthani, Thailand
| | - Alisa Seangleulur
- Departments of Orthopedics (N.T. and S.K.) and Anesthesiology (A.S.), Thammasat University, Pathumthani, Thailand
| | - Supakit Kanitnate
- Departments of Orthopedics (N.T. and S.K.) and Anesthesiology (A.S.), Thammasat University, Pathumthani, Thailand
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Unnanuntana A, Ruangsomboon P, Keesukpunt W. Validity and Responsiveness of the Two-Minute Walk Test for Measuring Functional Recovery After Total Knee Arthroplasty. J Arthroplasty 2018; 33:1737-1744. [PMID: 29454556 DOI: 10.1016/j.arth.2018.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/28/2017] [Accepted: 01/08/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The 2-minute walk test (2mwt) is a performance-based test that evaluates functional recovery after total knee arthroplasty (TKA). This study evaluated its validity compared with the modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), modified Knee Score, Numerical Pain Rating Scale, and Timed Up and Go test, and its responsiveness in assessing functional recovery in TKA patients. METHODS This prospective cohort study included 162 patients undergoing primary TKA between 2013 and 2015. We used patient-reported outcome measures (modified WOMAC, OKS, modified Knee Score, Numerical Pain Rating Scale) and performance-based tests (2mwt and Timed Up and Go test) at baseline and 3, 6, and 12 months postoperatively. The construct validity of 2mwt was determined between the 2mwt distances walked and other outcome measurements. To assess responsiveness, effect size and standardized response mean were analyzed. Minimal clinically important difference of 2mwt at 12 months after TKA was also calculated. RESULTS All outcome measurements improved significantly from baseline to 3, 6, and 12 months postoperatively. Bivariate analysis revealed mild to moderate associations between the 2mwt and modified WOMAC function subscales, and moderate to strong associations with OKS. Mild to moderate correlations were found for pain and stiffness between 2mwt and other outcome measurements. The effect size and standardized response mean at 12 months were large, with a minimal clinically important difference of 12.7 m. CONCLUSION 2mwt is a validated performance-based test with responsiveness properties. Being simple and easy to perform, it can be used routinely in clinical practice to evaluate functional recovery after TKA.
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Affiliation(s)
- Aasis Unnanuntana
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pakpoom Ruangsomboon
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Tammachote N, Panichkul P, Kanitnate S. Comparison of Customized Cutting Block and Conventional Cutting Instrument in Total Knee Arthroplasty: A Randomized Controlled Trial. J Arthroplasty 2018; 33:746-751.e3. [PMID: 29108794 DOI: 10.1016/j.arth.2017.09.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/25/2017] [Accepted: 09/25/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Customized cutting block (CCB) was designed to ensure the accurate alignment of knee prostheses during total knee arthroplasty. Given the paucity of CCB efficacy data, we compare CCB with conventional cutting guide using a randomized controlled trial. METHODS One hundred eight osteoarthritic knee patients underwent total knee arthroplasty by one experienced surgeon were randomized to receive CCB (n = 54) or conventional cutting instrument (CCI) surgery (n = 54). The primary outcomes were limb alignment, prostheses position, and operative time. The secondary outcomes were hemodynamic alteration after surgery, functional outcomes (modified Western Ontario and McMaster University Osteoarthritis Index) and range of motion at 2 years after surgery. RESULTS Mean hip-knee-ankle angle in the CCB group was 179.4° ± 1.8° vs 179.1° ± 2.4° in the CCI group, Δ = 0 (95% confidence interval [CI] -0.6 to 1.1, P = .55). Mean operative time was faster in the CCB arm: 93 ± 12 vs 104 ± 12 minutes, Δ = 11 (95% CI -16.7 to -7.2, P < .0001). There were no differences in hemodynamic parameters, mean blood loss (446 [CCB] vs 514 mL [CCI], Δ = -68 [95% CI -138 to 31 mL, P = .21]), postoperative hemoglobin changes, incidence of hypotension (systolic <90 mm Hg), oliguria, and rates of blood transfusion. Functional outcomes and range of motion were also similar. CONCLUSION There was no improvement in alignment, hemodynamic changes, blood loss, and knee functional outcomes. CCB reduced surgical time by 11 minutes in our population. CCB cost-effectiveness should be further investigated.
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Affiliation(s)
- Nattapol Tammachote
- Department of Orthopaedics, Thammasat University, Khlong Luang, Pathum Thani, Thailand
| | - Phonthakorn Panichkul
- Department of Orthopaedics, Thammasat University, Khlong Luang, Pathum Thani, Thailand
| | - Supakit Kanitnate
- Department of Orthopaedics, Thammasat University, Khlong Luang, Pathum Thani, Thailand
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Periarticular multimodal drug injection is better than single anesthetic drug in controlling pain after total knee arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:667-675. [DOI: 10.1007/s00590-017-2110-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 12/15/2017] [Indexed: 01/24/2023]
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Areeudomwong P, Buttagat V. Reliability and Validity of the Cross-Culturally Adapted Thai Version of the Tampa Scale for Kinesiophobia in Knee Osteoarthritis Patients. Malays J Med Sci 2017; 24:61-67. [PMID: 28894405 DOI: 10.21315/mjms2017.24.2.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/26/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The aim of this study was to develop a cross-culturally adapted Thai version of the Tampa Scale for Kinesiophobia (TSK) and investigate its reliability and validity among patients with knee osteoarthritis. METHODS The TSK was translated into Thai language and culturally adapted in line with the international standards. The Thai TSK questionnaire was then tested for internal consistency, test-retest reliability, and convergent validity by comparing it with the visual analogue scale, Western Ontario and McMaster Universities Osteoarthritis Index, State-Trait Anxiety Inventory, and Timed Up and Go Test. RESULTS Eighty patients with knee osteoarthritis were included in the study. The Thai version of the TSK was easily comprehended and completed within 6 minutes. The questionnaire showed a good internal consistency (α = 0.90) and high test-retest reliability {ICC (2,1) = 0.934}. Convergent validity showed high correlations with the visual analogue scale, Western Ontario and McMaster Universities Osteoarthritis Index, and State-Trait Anxiety Inventory (r = 0.741, 0.856, and 0.817, respectively). However, there was no significant correlation between the Thai version of the TSK scores and the Timed Up and Go Test results. CONCLUSION The Thai version of the TSK has satisfactory reliability and validity for the evaluation of pain-related fear of movement/(re)injury in patients with knee osteoarthritis.
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Affiliation(s)
- Pattanasin Areeudomwong
- Department of Physical Therapy, School of Health Science, Mae Fah Luang University, Chiang Rai, Thailand 57100.,Research Center of Back, Neck, Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, Thailand 40002
| | - Vitsarut Buttagat
- Department of Physical Therapy, School of Health Science, Mae Fah Luang University, Chiang Rai, Thailand 57100.,Research Center of Back, Neck, Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, Thailand 40002
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Tantavisut S, Tanavalee A, Honsawek S, Suantawee T, Ngarmukos S, Adisakwatana S, Callaghan JJ. Effect of vitamin E on oxidative stress level in blood, synovial fluid, and synovial tissue in severe knee osteoarthritis: a randomized controlled study. BMC Musculoskelet Disord 2017; 18:281. [PMID: 28662656 PMCID: PMC5492918 DOI: 10.1186/s12891-017-1637-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 06/21/2017] [Indexed: 11/19/2022] Open
Abstract
Background This study was performed to evaluate the antioxidative and anti-inflammatory effects of vitamin E on oxidative stress in the plasma, synovial fluid, and synovial tissue of patients with knee osteoarthritis. Methods Seventy-two patients with late-stage knee osteoarthritis scheduled for total knee arthroplasty were randomized to take oral placebo (Group A) or 400 IU of vitamin E (Group B) once a day for 2 months before undergoing surgery. The blood levels of endpoints indicating oxidative stress or antioxidant capacity, Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index score (WOMAC), and adverse effects were compared before and after the intervention between the two groups. At surgery, these redox endpoints and histological findings were compared between the synovial fluid and synovial tissue. Results In blood samples, the pre-intervention of oxidative stress and antioxidative capacity were not different between Group A and Group B. In post-intervention blood samples, the Malondialdehyde (Group A 1.34 ± 0.10, Group B 1.00 ± 0.09, p < 0.02), Alpha tocopherol (Group A 15.92 ± 1.08, Group B 24.65 ± 1.47, p < 0.01) and Trolox equivalent antioxidant capacity (Group A 4.22 ± 0.10, Group B 5.04 ± 0.10, 0 < 0.01) were significantly different between Group A and Group B. In synovial fluid samples, the Malondialdehyde (Group A 1.42 ± 0.12, Group B 1.06 ± 1.08, p 0.01), Alphatocopherol (Group A 4.51, Group B 7.03, p < 0.01), Trolox equivalent antioxidant capacity (Group A, 1.89 ± 0.06, Group B 2.19 ± 0.10) were significantly different between Group A and Group B. The pre-intervention WOMAC score and KSS score were not different between Group A and Group B. The post-intervention WOMAC score was significantly improved in all categories in Group B (Pain: Group A 27.26 ± 0.89, Group B 19.19 ± 1.43, p < 0.01; Stiffness: Group A 8.23 ± 0.79, Group B 5.45 ± 0.73, p 0.01; Function: Group A 94.77 ± 4.22, Group B 72.74 ± 6.55, p < 0.01). The post-intervention KSS score was significantly improved in all categories in Group B (Clinical: Group A 25.31 ± 14.33, Group B 33.52 ± 16.96, p < 0.01; Functional: Group A 41.43 ± 16.11, Group B 51.61 ± 19.60, p 0.02). Significantly fewer synovial tissue cells were stained with nitrotyrosine and hematoxylin–eosin in Group B than in Group A. There were no differences in adverse effects or surgical complications between the groups. Conclusion Vitamin E is an effective antioxidant that can improve clinical symptoms and reduce oxidative stress conditions in patients with late-stage knee osteoarthritis. Trial registration This research project had been approved for registration at Thai Clinical Trials Registry (TCTR) since 2016–08-28 11:26:32 (Retrospective registered). The TCTR identification number is TCTR20160828001.
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Affiliation(s)
- Saran Tantavisut
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 road, Pathumwan, Bangkok, 10330, Thailand
| | - Aree Tanavalee
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 road, Pathumwan, Bangkok, 10330, Thailand.
| | - Sittisak Honsawek
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tanyawan Suantawee
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Srihatach Ngarmukos
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 road, Pathumwan, Bangkok, 10330, Thailand
| | | | - John J Callaghan
- Department of Orthopaedics, Faculty of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Gaffey A, Slater H, Porritt K, Campbell JM. The effects of curcuminoids on musculoskeletal pain: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:486-516. [PMID: 28178024 DOI: 10.11124/jbisrir-2016-003266] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Western countries are increasingly using complementary and alternative medicine (CAM) to assist with relieving ailments. Turmeric, from the ginger family Zingiberaceae, has a history of use for medicinal purposes. The polyphenols found in turmeric (curcuminoids) have demonstrated anti-inflammatory and pain relieving properties. With the use of CAMs increasing, it is important for the effectiveness of curcuminoids to be established. OBJECTIVES To identify the effectiveness of the use of curcuminoids for the amelioration of musculoskeletal pain. INCLUSION CRITERIA TYPES OF PARTICIPANTS Persons experiencing musculoskeletal pain, including experimentally induced musculoskeletal pain. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST The current review considered studies that evaluated the use of curcuminoids. TYPES OF CONTROLS Any form including placebo, treatment as usual or before and after measurements. TYPES OF STUDIES Both experimental and epidemiological study designs including randomized controlled trials (RCTs), non-RCTs, quasi-experimental and before and after studies were eligible for consideration in this review. Studies published in English were considered without date restriction. OUTCOMES The current review considered studies that included measurement of pain. Outcome measures included visual analog scales, and/or pain questionnaires. Secondary outcome measures of functionality (activities of daily living and range of motion) were included. Any data provided on adverse events were considered. SEARCH STRATEGY The databases PubMed, CINAHL, Embase and ProQuest were searched in March 2015 (and updated in April 2016) using the Joanna Briggs Institute (JBI) three-step search strategy. The reference lists of identified articles were reviewed for additional studies. METHODOLOGICAL QUALITY Papers selected were assessed by two independent reviewers using standardized instruments from the JBI Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA EXTRACTION Data were extracted using the data extraction tool from JBI-MAStARI. Data extracted included details about the populations, interventions, study methods and outcomes. DATA SYNTHESIS Narrative and tabular synthesis was conducted. Meta-analysis was precluded due to methodological and clinical heterogeneity across all included studies. RESULTS Thirteen studies with a combined total of 1101 participants were included. Three studies of limited sample size examined the effects of curcuminoids compared with the use of placebo on musculoskeletal pain, with one study showing a statistically significant effect. Four studies examined the effects of curcuminoids compared with non-selective non-steroidal anti-inflammatory drugs on musculoskeletal pain. Two of these four studies were non-inferiority studies showed that the use of both curcuminoids and ibuprofen were associated with a similar significant reduction in pain over the study durations of four and six weeks, respectively, with curcuminoid use non-inferior to the use of ibuprofen over the study durations. Six studies investigated presentations of curcuminoid-containing herbomineral mixtures versus placebo or active controls. CONCLUSION There is insufficient evidence to recommend that curcuminoids be considered for relieving pain and improving function in musculoskeletal pain conditions. This finding needs to be considered in the context of limitations imposed by the variability in the quality of studies, small sample sizes, short duration of interventions, a gender-bias toward females, absence of long-term data extraction and small number of relevant studies.
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Affiliation(s)
- Andrew Gaffey
- 1The Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia 2School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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Turmeric (Curcuma longa): Effects of Curcuma longa Extracts Compared With Ibuprofen for Reduction of Pain and Functional Improvement in Patients With Knee Osteoarthritis. Holist Nurs Pract 2017; 30:183-6. [PMID: 27078813 DOI: 10.1097/hnp.0000000000000152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khuangsirikul S, Lekkreusuwan K, Chotanaphuti T. 10-Year patient satisfaction compared between computer-assisted navigation and conventional techniques in minimally invasive surgery total knee arthroplasty. Comput Assist Surg (Abingdon) 2016; 21:172-175. [PMID: 27973967 DOI: 10.1080/24699322.2016.1249959] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Both minimally invasive surgery (MIS) and computer-assisted surgery (CAS) in total knee arthroplasty have been scientifically linked with surgical benefits. However, the long-term results of these techniques are still controversial. Most surgeons assessed the surgical outcomes with regard to knee alignment and range of motion, but these factors may not reflect subjective variables, namely patient satisfaction. PURPOSE To compare satisfaction and functional outcomes between two technical procedures in MIS total knee arthroplasty, namely computer-assisted MIS and conventional MIS procedure, operated on a sample group of patients after 10 years. METHODS Seventy cases of posterior-stabilized total knee prostheses were implanted using a computer-assisted system and were compared to 74 cases of matched total knee prostheses of the same implant using conventional technique. Both groups underwent arthrotomy by 2 cm limited quadriceps exposure minimally invasive surgery (2 cm Quad MIS). At an average of 10 years after surgery, self-administered patient satisfaction and WOMAC scales were administered and analyzed. RESULTS Demographic data of both groups including sex, age, preoperative WOMAC and post-operative duration were not statistically different. Post-operative WOMAC for the computer-assisted group was 38.94 ± 5.68, while the conventional one stood at 37.89 ± 6.22. The median of self-administered patient satisfaction scales of the computer-assisted group was 100 (min37.5-max100), while the conventional one was 100 (min25-max100). p Value was 0.889. There was one re-operative case in the conventional MIS group due to peri-prosthetic infection which was treated with debridement, polyethylene exchanged and intravenous antibiotics. CONCLUSIONS The 10-year outcomes of computer-assisted MIS total knee arthroplasty are not superior to that of the conventional MIS technique in function and patient satisfaction. 10 years may not be enough to show the difference between these two techniques.
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Affiliation(s)
- Saradej Khuangsirikul
- a Orthopaedic surgery department , Phramongkutklao College of Medicine , Bangkok , Thailand
| | - Kreangsak Lekkreusuwan
- a Orthopaedic surgery department , Phramongkutklao College of Medicine , Bangkok , Thailand
| | - Thanainit Chotanaphuti
- a Orthopaedic surgery department , Phramongkutklao College of Medicine , Bangkok , Thailand
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Kongtharvonskul J, Woratanarat P, McEvoy M, Attia J, Wongsak S, Kawinwonggowit V, Thakkinstian A. Efficacy of glucosamine plus diacerein versus monotherapy of glucosamine: a double-blind, parallel randomized clinical trial. Arthritis Res Ther 2016; 18:233. [PMID: 27729073 PMCID: PMC5059980 DOI: 10.1186/s13075-016-1124-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/16/2016] [Indexed: 12/27/2022] Open
Abstract
Background Patented crystalline glucosamine sulfate (pCGS) and diacerein monotherapy have been recommended for treatment of mild to moderate osteoarthritis (OA), but evidence of efficacy for combined treatments is lacking. Therefore, the aim of this study was to compare clinical outcomes (i.e., pain and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] score) at 6 months as well as the safety profile of treatment with combined pCGS and diacerein versus pCGS alone. Methods A double-blind, parallel randomized controlled superiority trial was conducted between August 2013 and August 2014 at Ramathibodi Hospital, Bangkok, Thailand. A total of 148 patients (74 patients in each group) was randomly allocated to receive pCGS plus diacerein or pCGS plus placebo daily. Adult patients with OA were eligible if they had a Kellgren-Lawrence grade of 2–3. The primary outcomes were visual analogue scale score (VAS) for pain and WOMAC subscores measured at 24 weeks after receiving treatment, using the intention-to-treat principle (nonresponder imputation). Results Among the 148 patients in the study, mean age and body mass index were 60 years and 28.1 kg/m2, respectively. Mean VAS and minimal joint space width at baseline were 5.1 and 2.5 mm, respectively. The mean VAS values measured at 24 weeks were 2.97 and 2.88 in the pCGS plus diacerein and pCGS plus placebo groups, respectively. The estimated mean difference was 0.09 (95 % CI −0.75 to 0.94), which was not statistically significant (P = 0.710). In addition, the mean WOMAC total, pain, function, and stiffness scores for both groups were not significantly different, with corresponding means of 48.59, 12.02, 32.74, and 3.85 for the pCGS plus diacerein group and 48.69, 11.76, 32.47, and 4.16 for the pCGS plus placebo group. The risk of diarrhea and dyspepsia was very similar between the two groups, with risk ratios of 1.03 (95 % CI 0.56–1.89) and 0.91 (95 % CI 0.43–1.92), respectively. Conclusions This study did not demonstrate that coadministration of diacerein with pCGS improves pain and WOMAC score compared with pCGS monotherapy in patients with mild to moderate OA of the knee. Trial registration ClinicalTrials.gov identifier: NCT01906801. Registered on 20 July 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1124-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jatupon Kongtharvonskul
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Patarawan Woratanarat
- Department of Orthopedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Mark McEvoy
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, NSW, Australia
| | - John Attia
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Siwadol Wongsak
- Department of Orthopedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Viroj Kawinwonggowit
- Department of Orthopedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Tammachote N, Kanitnate S, Yakumpor T, Panichkul P. Intra-Articular, Single-Shot Hylan G-F 20 Hyaluronic Acid Injection Compared with Corticosteroid in Knee Osteoarthritis: A Double-Blind, Randomized Controlled Trial. J Bone Joint Surg Am 2016; 98:885-92. [PMID: 27252432 DOI: 10.2106/jbjs.15.00544] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of knee osteoarthritis with hyaluronic acid or corticosteroid injection has been widely used. The purpose of this study was to compare the efficacy of hyaluronic acid (hylan G-F 20) with triamcinolone acetonide as a single intra-articular injection for knee osteoarthritis. METHODS This study was a prospective, randomized, double-blind clinical trial. Participants with symptomatic knee osteoarthritis were recruited. They were randomized to receive a single-shot, intra-articular injection of either 6 mL of hylan G-F 20 or 6 mL of a solution comprising 1 mL of 40-mg triamcinolone acetonide and 5 mL of 1% lidocaine with epinephrine. The primary outcomes were knee pain severity, knee function, and range of motion at 6 months. Ninety-nine patients were assessed before injection and underwent a 6-month follow-up. Patients and evaluators were blinded. Multilevel regression models were used to estimate differences between the groups. RESULTS At the 6-month follow-up, compared with patients who took hylan G-F 20, patients who took triamcinolone acetonide had similar improvement in knee pain, knee function, and range of motion. The difference in mean outcome scores between groups was, with regard to knee pain, a visual analog scale (VAS) score of 3 points (95% confidence interval [95% CI], -6 to 11 points); with regard to knee function, a modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score of 0 points (95% CI, -8 to 6 points); and, with regard to range of motion, flexion of -1° (95% CI, -5° to 2°) and extension of 0° (95% CI, -0.5° to 0.5°). However, patients who took triamcinolone acetonide had better pain improvement from 24 hours until 1 week after injection; the mean difference between groups with regard to the VAS score was 12 points (95% CI, 5 to 20 points; p = 0.002) at 24 hours and 9 points (95% CI, 1 to 15 points; p = 0.018) at 1 week. At 2 weeks after injection, patients who took triamcinolone acetonide also had better knee functional improvement; the mean difference between groups for the modified WOMAC score was 6 points (95% CI, 0.7 to 12 points; p = 0.03). Both groups had improvement in pain, knee function, and range of motion during the 6-month follow-up (p < 0.0001). CONCLUSIONS Triamcinolone acetonide provided similar improvement in knee pain, function, and range of motion compared with hylan G-F 20 at the 6-month follow-up, with better pain control in the first week and better knee functional improvement in the second week. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nattapol Tammachote
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Khlong Nueng, Khlong Luang, Pathumthani, Thailand Orthopaedic Outpatient Unit, Thammasat University Hospital, Khlong Nueng, Khlong Luang, Pathumthani, Thailand
| | - Supakit Kanitnate
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Khlong Nueng, Khlong Luang, Pathumthani, Thailand Orthopaedic Outpatient Unit, Thammasat University Hospital, Khlong Nueng, Khlong Luang, Pathumthani, Thailand
| | - Thanasak Yakumpor
- Orthopaedic Outpatient Unit, Thammasat University Hospital, Khlong Nueng, Khlong Luang, Pathumthani, Thailand Department of Orthopaedics, Faculty of Medicine, Burapha University, Saen Sook Sub-district, Mueang District, Chonburi, Thailand
| | - Phonthakorn Panichkul
- Orthopaedic Outpatient Unit, Thammasat University Hospital, Khlong Nueng, Khlong Luang, Pathumthani, Thailand Hip and Knee Center, Bangkok Hospital Medical Center, Bangkok, Thailand
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Symonds T, Hughes B, Liao S, Ang Q, Bellamy N. Validation of the Chinese Western Ontario and McMaster Universities Osteoarthritis Index in Patients From Mainland China With Osteoarthritis of the Knee. Arthritis Care Res (Hoboken) 2016; 67:1553-60. [PMID: 26018634 DOI: 10.1002/acr.22631] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 05/12/2015] [Accepted: 05/19/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To establish the reliability, validity, and sensitivity to change of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) among Chinese subjects with osteoarthritis (OA) of the knee, living in mainland China. METHODS A multicenter, randomized, double-blind, placebo-controlled, parallel-group study was conducted for validation of the electronic personal digital assistant version of the WOMAC Numerical Rating Scale (NRS) 3.1 Index in China. A total of 287 subjects with OA of the knee were randomized to receive either meloxicam (15 mg) or placebo. Psychometric properties of the WOMAC were evaluated by estimating the reliability, validity, and sensitivity to change. Equivalence of the electronic version was also compared with the paper version. RESULTS Intraclass correlation coefficients for the WOMAC pain, stiffness, and physical function subscales were 0.81, 0.76, and 0.85, respectively, indicating good test-retest reliability. Similarly, internal consistency was strong (Cronbach's alpha for the 3 WOMAC subscales was 0.84, 0.86, and 0.96, respectively). Pearson's correlation coefficients for WOMAC pain and Short Form 36 health survey (SF-36) bodily pain, as well as WOMAC physical function and SF-36 physical functioning domains were >0.4, indicating convergent validity, whereas the coefficients for all 3 WOMAC domains with SF-36 mental health and mental health component scores were <0.4, indicating divergent validity. There was strong discriminant validity between healthy volunteers and OA patients. The effect sizes of change from baseline to week 12 in WOMAC subscale scores were large, demonstrating sensitivity to change. Equivalence between paper and electronic versions was very high. CONCLUSION The culturally and linguistically validated Chinese version of the WOMAC NRS 3.1 for mainland China is psychometrically robust in its validity, reliability, and sensitivity to change for patients with OA of the knee.
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Affiliation(s)
| | | | - Shanmei Liao
- Pfizer Research and Development, Shanghai, China
| | - Qiuqing Ang
- Pfizer Research and Development, Shanghai, China
| | - Nicholas Bellamy
- School of Medicine, University of Queensland, Herston, Queensland, Australia
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Gandek B. Measurement properties of the Western Ontario and McMaster Universities Osteoarthritis Index: a systematic review. Arthritis Care Res (Hoboken) 2015; 67:216-29. [PMID: 25048451 DOI: 10.1002/acr.22415] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 07/15/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To conduct a systematic review of the measurement properties of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and to evaluate the quality of WOMAC measurement studies using COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) criteria. METHODS A search was conducted in the MEDLINE, CINAHL, Embase, PsycINFO, Scopus, and SPORTDiscus databases through September 2013. Data that assessed the WOMAC measurement model, reliability, validity, respondent burden, and equivalence across methods of administration were extracted. Overall study quality was rated following COSMIN criteria. RESULTS A total of 76 articles from 22 countries were included. Internal consistency reliability was consistently high (≥0.90) for the function scale and acceptable (≥0.70) for the pain and stiffness scales. Test-retest reliability was acceptable. Score equivalence was demonstrated across paper and electronic methods of data collection. Floor and ceiling effects were low except for notable (24-38%) proportions of patients achieving the best possible scores on the pain and stiffness scales 1-23 years after arthroplasty. Five exploratory factor analyses did not support a measurement model in which the pain and function items were distinct. Correlations between the WOMAC pain and function scales were high (median 0.79). The WOMAC pain and function scales had similar correlations with other pain measures, and therefore the WOMAC pain scale did not show divergent validity. COSMIN criteria were not fully met in most studies. CONCLUSION The WOMAC scales were reliable, but its pain scale was highly related to physical function. Further research into joint-specific pain measures that have broader content validity is needed.
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Development, linguistic and clinimetric validation of the WOMAC VA3.01 Bangla for Bangladesh Index. Rheumatol Int 2014; 35:997-1003. [PMID: 25510291 DOI: 10.1007/s00296-014-3192-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
Abstract
The aim of this study was to develop and to validate a Bengali version of the Western Ontario and McMaster Osteoarthritis (WOMAC) index in Bangladesh. The WOMAC was translated into the local language of Bangladesh (Bengali) and adapted in the local sociocultural context, following the standard guidelines by Beaton et al. Content validity of the preliminary Bengali version was assessed by using the index of content validity (ICV) and floor and ceiling effects. Patients were assessed at the Department of Rheumatology of Bangabandhu Sheikh Mujib Medical University and were diagnosed to have knee OA by American College of Rheumatology criteria and recruited according to the requirements of the validation study. Convergent and divergent validity were measured by comparing with Health Assessment Questionnaire (HAQ) and the Short Form-36 (SF-36), and internal consistency was assessed using Cronbach's alpha coefficient. The questionnaire was readministered to 40 patients within a week for assessing reliability by using intra-class correlation coefficient (ICC) and Spearman's rank correlation coefficient. In addition, factor analysis of Bengali WOMAC questionnaire was performed to examine the number of factors influencing a common set of items. A Bengali version was developed with changes in three items to suit local practices. The ICV of the content validity was 1 for all items. The Bengali WOMAC had similar construct validity when compared to the HAQ (ρ 0.74, n = 70) and SF-36 bodily pain and physical functioning. It had dissimilar construct validity to SF-36 mental health domain except WOMAC pain. Factor analysis revealed five factors with eigenvalues of more than 1.0. Cronbach's alpha and ICC exceeded 0.7 in all domains. In the test-retest reliability testing, Spearman's ρ for all items exceeded 0.4 (n = 40). This study has demonstrated that the Bengali version of WOMAC is a valid tool for assessing quality of life of patients with knee osteoarthritis in Bangladesh and is reliable.
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Islam MN, Ferdous N, Ten Klooster PM, Uddin MSG, Nasrin S, Pal B, Rasker JJ. Translation, cultural adaptation and validation of the WHO fracture risk assessment tool (FRAX(®) ) into Bengali. Int J Rheum Dis 2014; 18:360-5. [PMID: 24965880 DOI: 10.1111/1756-185x.12425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To develop a translated and culturally adapted Bengali version of the WHO Fracture Risk Assessment Tool (FRAX(®) ) and to test its feasibility, content validity and reliability. METHOD The English FRAX was translated and culturally adapted for use in Bangladeshi populations following established forward-backward translation methods and being extensively field-tested. The final version was interviewer-administered to 130 consecutive osteoporotic patients between 40 and 90 years of age. For test-retest reliability, the questionnaire was re-administered after 14 days in 60 odd serial-numbered patients. RESULTS To better match with the Bengali culture, several adaptations were made to the FRAX items, including replacements and additions for tobacco, prednisolone and alcohol use. The response rate of the pre-final Bengali version of FRAX was 100% and all patients could understand the questions. Test-retest reliability (Pearson's r) in osteoporotic patients was > 0.93 for all items. CONCLUSION The culturally adapted Bengali version of the FRAX appears to be an acceptable and reliable instrument. Further studies are needed to confirm the ability of the tool to accurately predict the 10-year probability of hip and major osteoporotic fractures in the Bengali population.
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Affiliation(s)
- Md Nazrul Islam
- Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; Modern One Stop Arthritis Care and Research Center® (MOAC&RC®), Dhaka, Bangladesh
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Papathanasiou G, Stasi S, Oikonomou L, Roussou I, Papageorgiou E, Chronopoulos E, Korres N, Bellamy N. Clinimetric properties of WOMAC Index in Greek knee osteoarthritis patients: comparisons with both self-reported and physical performance measures. Rheumatol Int 2014; 35:115-23. [PMID: 24871159 DOI: 10.1007/s00296-014-3043-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 05/12/2014] [Indexed: 12/12/2022]
Abstract
This observational study aimed to examine the clinimetric properties of the Greek for Greece translation of the Western Ontario and McMaster Osteoarthritis Index (WOMAC(®)). One hundred and twenty-three patients with knee osteoarthritis (mean age 69.5 years) participated in the study. An extensive reliability study was carried out to assess WOMAC's internal consistency and repeatability (8-day interval). In addition, we examined the construct (convergent, nomological and known-groups) and criterion-related (concurrent and predictive) validity of the index against both self-report [SF-36 and combined visual analog/faces pain scale-revised (VAS/FPS-R)] and physical performance measures [timed up and go test (TUG)]. The internal consistency of the WOMAC subscales ranged from high (0.804) to excellent (0.956). Intra-class correlation coefficients for test-retest reliability were excellent, ranging from 0.91 to 0.95. Partial correlation analysis, adjusted for age and use of an assistive device, showed that WOMAC scores were significantly associated with all validation criteria, presenting fair to strong (-0.33 to -0.86) correlation coefficients. WOMAC-function was strongly associated with SF36-function (-0.86) and TUG (0.71), WOMAC-pain to VAS/FPS-R (0.71) and SF36-pain (-0.67). Of all WOMAC outcomes, stiffness subscale had the lowest, though still significant, correlations with all validation criteria. Multiple linear regression analyses indicated that WOMAC-function was a significant factor for TUG, WOMAC-pain for VAS/FPS-R and both for SF36-function and SF36-pain. The WOMAC LK3.1 Greek for Greece Index is a reliable and valid assessment tool for the evaluation of individuals with knee osteoarthritis, showing excellent reliability and significant validity properties.
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Affiliation(s)
- George Papathanasiou
- Physiotherapy Department, Technological Educational Institute of Athens, 24 Mitrodorou St., 10441, Athens, Greece,
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Kuptniratsaikul V, Dajpratham P, Taechaarpornkul W, Buntragulpoontawee M, Lukkanapichonchut P, Chootip C, Saengsuwan J, Tantayakom K, Laongpech S. Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study. Clin Interv Aging 2014; 9:451-458. [PMID: 24672232 PMCID: PMC3964021 DOI: 10.2147/cia.s58535] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine the efficacy and safety of Curcuma domestica extracts in pain reduction and functional improvement. METHODS 367 primary knee osteoarthritis patients with a pain score of 5 or higher were randomized to receive ibuprofen 1,200 mg/day or C. domestica extracts 1,500 mg/day for 4 weeks. The main outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total, WOMAC pain, WOMAC stiffness, and WOMAC function scores. Adverse events (AEs) were also recorded. RESULTS 185 and 182 patients were randomly assigned into C. domestica extracts and ibuprofen groups, respectively. The baseline characteristics were no different between groups. The mean of all WOMAC scores at weeks 0, 2, and 4 showed significant improvement when compared with the baseline in both groups. After using the noninferiority test, the mean difference (95% confidence interval) of WOMAC total, WOMAC pain, and WOMAC function scores at week 4 adjusted by values at week 0 of C. domestica extracts were noninferior to those for the ibuprofen group (P=0.010, P=0.018, and P=0.010, respectively), except for the WOMAC stiffness subscale, which showed a trend toward significance (P=0.060). The number of patients who developed AEs was no different between groups. However, the number of events of abdominal pain/discomfort was significantly higher in the ibuprofen group than that in the C. domestica extracts group (P=0.046). Most subjects (96%-97%) were satisfied with the treatment, and two-thirds rated themselves as improved in a global assessment. CONCLUSION C. domestica extracts are as effective as ibuprofen for the treatment of knee osteoarthritis. The side effect profile was similar but with fewer gastrointestinal AE reports in the C. domestica extracts group.
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Affiliation(s)
- Vilai Kuptniratsaikul
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Piyapat Dajpratham
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wirat Taechaarpornkul
- Sirindhorn National Medical Rehabilitation Center, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Pranee Lukkanapichonchut
- Department of Rehabilitation Medicine, Ratchaburi Hospital, Ministry of Public Health, Ratchaburi, Thailand
| | - Chirawan Chootip
- Department of Rehabilitation Medicine, Songkhla Hospital, Ministry of Public Health, Songkhla, Thailand
| | - Jittima Saengsuwan
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kesthamrong Tantayakom
- Department of Rehabilitation Medicine, Rajvithi Hospital, Ministry of Public Health, Bangkok, Thailand
| | - Supphalak Laongpech
- Department of Rehabilitation Medicine, Vachira Phuket Hospital, Ministry of Public Health, Phuket, Thailand
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Tammachote N, Kanitnate S, Manuwong S, Yakumpor T, Panichkul P. Is pain after TKA better with periarticular injection or intrathecal morphine? Clin Orthop Relat Res 2013; 471:1992-9. [PMID: 23397315 PMCID: PMC3706684 DOI: 10.1007/s11999-013-2826-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 01/25/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Postoperative pain after TKA is a major concern to patients. The best technique to control pain is still controversial. Intrathecal morphine or periarticular multimodal drug injection are both commonly used and both appear to provide better pain control than placebo, but it is unclear whether one or the other provides better pain control. QUESTIONS/PURPOSES We asked whether intrathecal morphine or periarticular multimodal drug injection provides better pain control with fewer adverse events. METHODS In a prospective, double-blind, randomized controlled trial we randomized 57 patients with osteoarthritic knees who underwent TKAs into two groups. Group M (n = 28) received 0.2 mg intrathecal morphine while Group I (n = 29) received periarticular multimodal drug injection. Postoperative pain was managed with patient-controlled analgesia using ketorolac. The outcomes were pain levels, the amount of analgesic drug used, and drug-related side effects. Patients and evaluators were blinded. All patients were followed up to 3 months. RESULTS We found no difference in postoperative pain level, analgesia drug consumption, blood loss in drain, and knee function. More patients in Group M required antiemetic (19 [69%] versus 10 [34%]) and antipruritic drugs (10 [36%] versus three [10%]) than patients in Group I. CONCLUSIONS The two techniques provide no different pain control capacity. The periarticular multimodal drug injection was associated with lower rates of vomiting and pruritus.
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Affiliation(s)
- Nattapol Tammachote
- />Department of Orthopaedic Surgery, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120 Thailand
| | - Supakit Kanitnate
- />Department of Orthopaedic Surgery, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120 Thailand
| | - Sudsayam Manuwong
- />Department of Anesthesiology, Thammasat University, Pathumthani, Thailand
| | - Thanasak Yakumpor
- />Department of Orthopaedic Surgery, Burapha University, Chonburi, Thailand
| | - Phonthakorn Panichkul
- />Department of Orthopaedic Surgery, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120 Thailand
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Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken) 2012; 63 Suppl 11:S208-28. [PMID: 22588746 DOI: 10.1002/acr.20632] [Citation(s) in RCA: 859] [Impact Index Per Article: 66.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Collins NJ, Roos EM. Patient-reported outcomes for total hip and knee arthroplasty: commonly used instruments and attributes of a "good" measure. Clin Geriatr Med 2012; 28:367-94. [PMID: 22840304 DOI: 10.1016/j.cger.2012.05.007] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Although the effectiveness of THA and TKA as interventions for end-stage degenerative joint disease has been well established, the use of instruments that measure outcome from the patient's perspective are relatively poorly investigated. Considering the increasing prevalence, associated risks, and high personal and financial cost associated with THA and TKA, patient-reported outcomes are required to ensure optimal selection of patients, and that postoperative outcomes outweigh the burden associated with surgical procedures. It is clear from the information presented that clinicians need to consider a number of factors when selecting a "good" patientreported outcome for use in their TJA patients. Not only does the instrument need to measure dimensions appropriate for THA and TKA patients, but it also needs to have minimal administrative burden, accessibility to a variety of clinicians and patients, reliability, validity, and responsiveness to change. Furthermore, knowledge regarding the minimal score that patients deem to be meaningful is useful in interpreting whether a patient has experienced real improvement in their condition after surgery. It is clear that further studies are required, particularly to fill some of the gaps regarding known psychometric properties of patient-reported outcomes for THA and TKA. Based on data acquired in THA and TKA patients for the instruments reviewed, it appears that OA-specific and TJA-specific measures for which patients have been involved in the developmental process (HOOS, KOOS, WOMAC, Oxford Hip and Knee Scores) can more consistently be considered "good" patient-reported outcomes for THA and TKA. Clinicians wishing to evaluate a broader range of dimensions may choose to complement these with one of the generic measures evaluated, bearing in mind the practical issues and psychometric limitations of these instruments when applied to THA and TKA patients.
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Affiliation(s)
- Natalie J Collins
- Department of Mechanical Engineering, The University of Melbourne, Victoria, Australia
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Nadrian H, Moghimi N, Nadrian E, Moradzadeh R, Bahmanpour K, Iranpour A, Bellamy N. Validity and reliability of the Persian versions of WOMAC Osteoarthritis Index and Lequesne Algofunctional Index. Clin Rheumatol 2012; 31:1097-102. [PMID: 22526476 DOI: 10.1007/s10067-012-1983-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 03/02/2012] [Accepted: 03/26/2012] [Indexed: 12/19/2022]
Abstract
The WOMAC Osteoarthritis Index and Lequesne Algofunctional Index have not been translated and validated for Iranian patients with osteoarthritis (OA) of the knee or hip. The aim of this study was to validate the Persian form of WOMAC OA Index and Lequesne Algofunctional Index and to assess their test-retest reliability and convergent validity. Forward/backward translations and consensus panels were conducted to obtain the Persian versions of WOMAC OA Index and Lequesne Algofunctional Index. A non-probability sample of 116 patients with knee/hip osteoarthritis was asked to complete the WOMAC OA Index and Lequesne Algofunctional Index as well as Medical Outcomes Study-20-Item Short Form (SF-20) questionnaires, a visual analogue scales (VAS) of pain and demographic information form. Internal consistency (using Cronbach's alpha) and convergent validity (by examining the Pearson's correlation coefficients) were evaluated to determine the psychometric properties of the questionnaires. In order to evaluate test-retest reliability, 20 randomly selected patients completed the questionnaires, on a second occasion, 7-10 days later. Cronbach's alpha coefficients and intraclass correlation coefficients for the WOMAC OA Index and Algofunctional Index subscales ranged from 0.63 to 0.94 and from 0.53 to 0.96, respectively. Statistically significant correlations were found between WOMAC OA Index, Algofunctional Index and SF-20 subscales and VAS for pain. The Persian version of WOMAC demonstrated a more acceptable validity, internal consistency and reliability compared with the Lequesne Algofunctional Index. However, both indices are valid and reliable instruments for evaluating the OA severity of knee/hip in Iran.
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Affiliation(s)
- Haidar Nadrian
- School of Nursing, Islamic Azad University-Sanandaj Branch, Pasdaran Street, Sanandaj, Iran 6617777541.
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Association of dynamic joint power with functional limitations in older adults with symptomatic knee osteoarthritis. Arch Phys Med Rehabil 2009; 90:1821-8. [PMID: 19887204 DOI: 10.1016/j.apmr.2009.07.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 06/30/2009] [Accepted: 07/04/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine which lower-limb joint moments and powers characterize the level of gait performance of older adults with symptomatic knee osteoarthritis (OA). DESIGN Cross-sectional observational study. SETTING University motion analysis laboratory. PARTICIPANTS Community-dwelling adults (N=60; 27 men, 33 women; age 50-79y) with symptomatic knee OA. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Physical function was measured using the long-distance corridor walk, the Short Physical Performance Battery, and the Late Life Function and Disability Instrument (LLFDI Function). Joint moments and power were estimated using an inverse dynamics solution after 3-dimensional computerized motion analysis. RESULTS Subjects aged 64.2+/-7.4 years were recruited. Ranges (mean +/- SD) for the 400-m walk time and the LLFDI Advanced Lower-Limb Function score were 215.3 to 536.8 (304.1+/-62.3) seconds and 31.5 to 100 (57.0+/-14.9) points, respectively. In women, hip abductor moment (loading response), hip abductor power (midstance), eccentric hamstring moment (terminal stance), and power (terminal swing) accounted for 41%, 31%, 14%, and 48% of the variance in the 400-m walk time, respectively (model R(2)=.61, P<.003). In men, plantar flexor and hip flexor power (preswing) accounted for 19% and 24% of the variance in the 400-m walk time, respectively (model R(2)=.32, P=.025). CONCLUSIONS There is evidence that men and women with higher mobility function tend to rely more on an ankle strategy rather than a hip strategy for gait. In higher functioning men, higher knee extensor and flexor strength may contribute to an ankle strategy, whereas hip abductor weakness may bias women with lower mobility function to minimize loading across the knee via use of a hip strategy. These parameters may serve as foci for rehabilitation interventions aimed at reducing mobility limitations.
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Validation of Chinese Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in patients scheduled for total knee replacement. Qual Life Res 2008; 17:595-601. [PMID: 18415706 DOI: 10.1007/s11136-008-9340-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Accepted: 03/30/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Our aim was to cross-culturally validate Chinese Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in patients with knee osteoarthritis (OA) scheduled for total knee replacement in Singapore. METHODS Chinese WOMAC was translated from the original English version following standard guidelines. Patients were asked to complete a questionnaire containing the WOMAC (twice within 6 days), the Short Form 36 (SF-36), and the EuroQoL EQ-5D. Reliability was assessed using Cronbach's alpha and intraclass correlation coefficients (ICC), dimensionality using item-to-domain correlations and factor analyses. Convergent and discriminant construct validity was assessed using six each a priori hypotheses. RESULTS Chinese WOMAC was well accepted by the patients in the pilot test. The Chinese and English versions were therefore administered to a consecutive sample of 131 Chinese- and 127 English-speaking subjects, respectively, with knee OA. Cronbach's alpha exceeded 0.7 for all domains except for Chinese pain domain, whereas the ICC exceeded 0.7 for all domains. Hypothesized item-to-domain correlations were observed for all items except for four items in Chinese physical function domain. The factor analyses yielded seven and five factors with eigenvalues of more than 1.0 in the Chinese and English versions, respectively. A total of 10/12 a priori construct validity hypotheses were satisfied for the Chinese version. Weak correlations between WOMAC pain and SF-36 bodily pain and moderate correlation between WOMAC pain and EQ-5D anxiety/depression were observed. CONCLUSIONS Chinese WOMAC was well accepted and demonstrated acceptable psychometric properties in Singaporean patients with severe knee OA.
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Bibliography. Current world literature. Systemic lupus erythematosus and Sjögren's syndrome. Curr Opin Rheumatol 2008; 20:631-2. [PMID: 18698190 DOI: 10.1097/bor.0b013e3283110091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rattanachaiyanont M, Kuptniratsaikul V. No additional benefit of shortwave diathermy over exercise program for knee osteoarthritis in peri-/post-menopausal women: an equivalence trial. Osteoarthritis Cartilage 2008; 16:823-8. [PMID: 18178111 DOI: 10.1016/j.joca.2007.10.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 10/15/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the benefit of shortwave diathermy (SWD) supplemented to an exercise program for knee osteoarthritis (OA) in peri-/post-menopausal women. METHODS A double-blind randomized placebo-controlled equivalence trial was conducted in a university hospital. Participants including 113 women aged 50-85 years with primary knee OA were instructed to do regular quadriceps exercise, and randomized to control (n=60) and treatment (n=53) groups receiving sham SWD and therapeutic SWD, respectively. The treatment being evaluated was continuous SWD, 20 min/session, 3 sessions/week for 3 weeks. The outcomes including Thai Western Ontario and McMaster Universities OA (WOMAC) index, 100-m walking speed, stair ascent-and-descent time, global assessment, patient's satisfaction, and adverse events were assessed at baseline and end of treatment. RESULTS At the end of treatment, both groups had trivial but statistical improvement in all outcomes. Intention-to-treat analysis showed no statistically significant difference between the two groups in all outcomes. Per protocol analysis demonstrated the equivalence in Thai WOMAC total score, as the 95% confidence interval of difference (-0.62, 0.92) was within confidence limits of +/-1cm. CONCLUSION The addition of SWD to an exercise program for knee OA in peri-/post-menopausal women is not superior to the exercise program alone.
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Affiliation(s)
- M Rattanachaiyanont
- Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand.
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