Challenges of transforming evidence-based management of osteoarthritis into clinical practice in rural central Western India. Perceptions of an educational program.

Purpose: Osteoarthritis (OA) is a major threat to public health worldwide and is predicted to increase. Existing interventions to implement clinical practice guidelines (CPGs) seem to be used mainly in the Western world. We conducted a structured educational program on the evidence-based management of OA (BOA) for Indian physical therapists (PT).

Approaches to osteoarthritis: a qualitative study among physical therapists in Maharashtra, India.

Background And Objective: Osteoarthritis (OA) is a major and growing problem in India. Better knowledge dissemination and implementation of evidence-based practice in Indian physical therapy require a better understanding of approaches to OA (i.e.

Physiotherapist or physician as primary assessor for patients with suspected knee osteoarthritis in primary care - a cost-effectiveness analysis of a pragmatic trial.

Background: Over the next decade, the number of osteoarthritis consultations in health care is expected to increase. Physiotherapists may be considered equally qualified as primary assessors as physicians for patients with knee osteoarthritis. However, economic evaluations of this model of care have not yet been described.

High self-efficacy - a predictor of reduced pain and higher levels of physical activity among patients with osteoarthritis: an observational study.

Background: Self-efficacy is considered a core component in self-management. However, there is a lack of knowledge about the association between self-efficacy and health-related outcomes in osteoarthritis. The aim of this study was to investigate whether self-efficacy at baseline was associated with change over time in pain and physical activity after a supported osteoarthritis self-management programme.

Physiotherapist as primary assessor for patients with suspected knee osteoarthritis in primary care-a randomised controlled pragmatic study.

Background: In Swedish primary care, the healthcare process for patients with knee osteoarthritis (KOA) can be initiated by a physician or physiotherapist assessment. However, it is unclear how the different assessments affect the healthcare processes and patient reported outcomes over time. The purpose of this study was to examine the differences in health-related quality of life (HrQoL), adjusted for pain and physical function, for patients with KOA when the healthcare process is initiated by a physiotherapist assessment compared to a physician assessment in primary care.

Change in self-efficacy after participation in a supported self-management program for osteoarthritis - an observational study of 11 906 patients.

Describe the change in self-efficacy after a supported osteoarthritis self-management program. An observational register-based study comprising 11 906 patients. Participants with hip or knee osteoarthritis self-reported at baseline, 3 and 12 months.

The effect of education and supervised exercise on physical activity, pain, quality of life and self-efficacy - an intervention study with a reference group.

Background: Individuals with knee and hip osteoarthritis (OA) are less physically active than people in general, and many of these individuals have adopted a sedentary lifestyle. In this study we evaluate the outcome of education and supervised exercise on the level of physical activity in individuals with knee or hip OA. We also evaluate the effect on pain, quality of life and self-efficacy.

Health enhancing physical activity in patients with hip or knee osteoarthritis - an observational intervention study.

Background: Osteoarthritis is one of the leading causes of inactivity worldwide. The recommended level of health enhancing physical activity (HEPA) is at least 150 min of moderate intensity physical activity per week. The purpose of this study was to explore how the proportion of patients, who reached the recommended level of HEPA, changed following a supported osteoarthritis self-management programme in primary care, and to explore how reaching the level of HEPA was influenced by body mass index (BMI), gender, age and comorbidity.

Osteoarthritis: Models for appropriate care across the disease continuum.

Osteoarthritis (OA) is a leading cause of pain and disability worldwide. Despite the existence of evidence-based treatments and guidelines, substantial gaps remain in the quality of OA management. There is underutilization of behavioral and rehabilitative strategies to prevent and treat OA as well as a lack of processes to tailor treatment selection according to patient characteristics and preferences.

A Web-Based Platform for Patients With Osteoarthritis of the Hip and Knee: A Pilot Study.

Background: Chronic conditions are the leading cause of disability throughout the world and the most expensive problem facing the health care systems. One such chronic condition is osteoarthritis (OA), a frequent cause of major disability.

Objective: To describe the effect on joint pain for the first users of a newly developed Web-based osteoarthritis self-managing program, Joint Academy, and to examine whether these patients would recommend other OA patients to use the program.

Better Management of Patients with Osteoarthritis: Development and Nationwide Implementation of an Evidence-Based Supported Osteoarthritis Self-Management Programme.

Background: Information and exercise are core treatments of osteoarthritis. Self-management and coping strategies with the disease are crucial to gain benefits. We developed a supported osteoarthritis self-management programme, delivered by trained physiotherapists, to facilitate patient and healthcare compliance.

Knee joint stabilization therapy in patients with osteoarthritis of the knee and knee instability: subgroup analyses in a randomized, controlled trial.

Objective: To test whether knee stabilization therapy, prior to strength/functional training, may have added value in reducing activity limitations only in patients with knee osteoarthritis who have knee instability and (i) low upper leg muscle strength, (ii) impaired knee proprioception, (iii) high knee laxity, or (iv) frequent episodes of knee instability.

Design: Subgroup analyses in a randomized controlled trial comparing 2 exercise programmes (with/without knee stabilization therapy) (STABILITY; NTR1475).

Patients: Participants from the STABILITY-trial with clinical knee osteoarthritis and knee instability (n = 159).

Dissatisfied patients after total knee arthroplasty: a registry study involving 114 patients with 8-13 years of followup.

Background And Purpose: In 2003, an enquiry by the Swedish Knee Arthroplasty Register (SKAR) 2-7 years after total knee arthroplasty (TKA) revealed patients who were dissatisfied with the outcome of their surgery but who had not been revised. 6 years later, we examined the dissatisfied patients in one Swedish county and a matched group of very satisfied patients.

Patients And Methods: 118 TKAs in 114 patients, all of whom had had their surgery between 1996 and 2001, were examined in 2009-2010.

Is knee osteoarthritis a symmetrical disease? Analysis of a 12 year prospective cohort study.

Background: The aim of this study was to document the development of bilateral knee osteoarthritis over a 12 year period using a middle-aged population-based cohort with knee pain at inclusion.

Methods: One hundred and forty three patients aged 35 to 54 were recruited from a population based cohort of 279 subjects who had knee pain at baseline and assessed with clinical and radiographic data, with 5 and 12 year follow up. The data was analysed with regard to the development and progression of uni- and bilateral knee osteoarthritis over 12 years.

Risk of sick leave and disability pension in working-age women and men with knee osteoarthritis.

Objectives: To investigate sick leave and disability pension in working-age subjects with knee osteoarthritis (OA) compared with the general population.

Methods: Population-based cohort study: individual-level inpatient and outpatient Skåne Health Care Register data were linked with data from the Swedish Social Insurance Agency. In 2009 all working-age (16-64 years) Skåne County residents who in 1998-2009 had been diagnosed with knee OA (International Classification of Diseases-10 code M17) were identified and their sick leave and disability pension in 2009 related to those of the general working-age population (n=789 366) standardised for age.

Association of lower muscle strength with self-reported knee instability in osteoarthritis of the knee: results from the Amsterdam Osteoarthritis cohort.

Objective: To determine whether muscle strength, proprioceptive accuracy, and laxity are associated with self-reported knee instability in a large cohort of knee osteoarthritis (OA) patients, and to investigate whether muscle strength may compensate for impairment in proprioceptive accuracy or laxity, in order to maintain knee stability.

Methods: Data from 283 knee OA patients from the Amsterdam Osteoarthritis cohort were used. Univariable and multivariable logistic regression analyses were performed to assess the association between muscle strength, proprioceptive accuracy (motion sense), frontal plane varus-valgus laxity, and self-reported knee instability.

Identification of phenotypes with different clinical outcomes in knee osteoarthritis: data from the Osteoarthritis Initiative.

Objective: To identify subgroups or phenotypes of knee osteoarthritis (OA) patients based on similarities of clinically relevant patient characteristics, and to compare clinical outcomes of these phenotypes.

Methods: Data from 842 knee OA patients of the Osteoarthritis Initiative were used. A cluster analysis method was performed, in which clusters were formed based on similarities in 4 clinically relevant, easily available variables: severity of radiographic OA, lower extremity muscle strength, body mass index, and depression.

Sickness absence in musculoskeletal disorders - patients' experiences of interactions with the social insurance agency and health care. A qualitative study.

Background: Sickness absence has represented a growing public health problem in many Western countries over the last decade. In Sweden disorders of the musculoskeletal system cause approximately one third of all sick leave. The Social Insurance Agency (SIA) and the health care system are important actors in handling the sickness absence process.

Help-seeking behaviour among people living with chronic hip or knee pain in the community.

Background: A large proportion of people living with hip or knee pain do not consult health care professionals. Pain severity is often believed to be the main reason for help seeking in this population; however the evidence for this is contradictory. This study explores the importance of several potential risk factors on help seeking across different practitioner groups, among adults living with chronic hip or knee pain in a large community sample.

Choosing surgery: patients' preferences within a trial of treatments for anterior cruciate ligament injury. A qualitative study.

Background: The objective was to understand patients' views of treatment after acute anterior cruciate ligament (ACL) injury, and their reasons for deciding to request surgery despite consenting to participate in a randomised controlled trial (to 'cross-over').

Methods: Thirty-four in-depth qualitative interviews were conducted with young (aged 18-35), physically active individuals with ACL rupture who were participating in a RCT comparing training and surgical reconstruction with training only. 22/34 were randomised to training only but crossed over to surgery.

Cooperation between gatekeepers in sickness insurance - the perspective of social insurance officers. A qualitative study.

Background: Objective was to describe variations in how social insurance officers conceive the cooperation with the health care in their daily work with sick leave.

Methods: Fifteen social insurance officers (SIOs) working with administration of sickness benefits were interviewed. They were purposefully recruited to represent different parts of the social insurance office organization, different ages, gender, education, and work experience.

Serum levels of cartilage oligomeric matrix protein (COMP) increase temporarily after physical exercise in patients with knee osteoarthritis.

Background: COMP (Cartilage oligomeric matrix protein) is a matrix protein, which is currently studied as a potential serum marker for cartilage processes in osteoarthritis (OA). The influence of physical exercise on serum COMP is not fully elucidated. The objective of the present study was to monitor serum levels of COMP during a randomised controlled trial of physical exercise vs.

How do middle-aged patients conceive exercise as a form of treatment for knee osteoarthritis?

Purpose: To describe conceptions, as registered by a semi-structured interview, of exercise as treatment among sixteen middle-aged patients with moderate to severe knee osteoarthritis.

Method: Sixteen patients (aged 39-64) with symptomatic, radiographic knee osteoarthritis and previous participants in an exercise intervention, were interviewed. The qualitative data obtained were analysed using phenomenographic approach.

Six-week high-intensity exercise program for middle-aged patients with knee osteoarthritis: a randomized controlled trial [ISRCTN20244858].

Background: Studies on exercise in knee osteoarthritis (OA) have focused on elderly subjects. Subjects in this study were middle-aged with symptomatic and definite radiographic knee osteoarthritis. The aim was to test the effects of a short-term, high-intensity exercise program on self-reported pain, function and quality of life.