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Risk factors for pain and functional impairment in people with knee and hip osteoarthritis: a systematic review and meta-analysis.

ABSTRACT: OBJECTIVE:To identify risk factors for pain and functional deterioration in people with knee and hip osteoarthritis (OA) to form the basis of a future 'stratification tool' for OA development or progression. DESIGN:Systematic review and meta-analysis. METHODS:An electronic search of the literature databases, Medline, Embase, CINAHL, and Web of Science (1990-February 2020), was conducted. Studies that identified risk factors for pain and functional deterioration to knee and hip OA were included. Where data and study heterogeneity permitted, meta-analyses presenting mean difference (MD) and ORs with corresponding 95% CIs were undertaken. Where this was not possible, a narrative analysis was undertaken. The Downs & Black tool assessed methodological quality of selected studies before data extraction. Pooled analysis outcomes were assessed and reported using the Grading of Reccomendation, Assessment, Development and Evaluation (GRADE) approach. RESULTS:82 studies (41?810 participants) were included. On meta-analysis: there was moderate quality evidence that knee OA pain was associated with factors including: Kellgren and Lawrence?2 (MD: 2.04, 95%?CI 1.48 to 2.81; p<0.01), increasing age (MD: 1.46, 95%?CI 0.26 to 2.66; p=0.02) and whole-organ MRI scoring method (WORMS) knee effusion score ?1 (OR: 1.35, 95%?CI 0.99 to 1.83; p=0.05). On narrative analysis: knee OA pain was associated with factors including WORMS meniscal damage ?1 (OR: 1.83). Predictors of joint pain in hip OA were large acetabular bone marrow lesions (BML; OR: 5.23), chronic widespread pain (OR: 5.02) and large hip BMLs (OR: 4.43). CONCLUSIONS:Our study identified risk factors for clinical pain in OA by imaging measures that can assist in predicting and stratifying people with knee/hip OA. A 'stratification tool' combining verified risk factors that we have identified would allow selective stratification based on pain and structural outcomes in OA. PROSPERO REGISTRATION NUMBER:CRD42018117643.

SUBMITTER: Sandhar S

PROVIDER: S-EPMC7418691 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Risk factors for pain and functional impairment in people with knee and hip osteoarthritis: a systematic review and meta-analysis.

Sandhar Sandeep S Smith Toby O TO Toor Kavanbir K Howe Franklyn F Sofat Nidhi N

BMJ open 20200807 8

<h4>Objective</h4>To identify risk factors for pain and functional deterioration in people with knee and hip osteoarthritis (OA) to form the basis of a future 'stratification tool' for OA development or progression.<h4>Design</h4>Systematic review and meta-analysis.<h4>Methods</h4>An electronic search of the literature databases, Medline, Embase, CINAHL, and Web of Science (1990-February 2020), was conducted. Studies that identified risk factors for pain and functional deterioration to knee and ...[more]

PMID: 32771991

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Project description:To investigate knee pain prevalence, associated factors, and functional impairment among adolescents.This was a cross-sectional study conducted between May and June 2014 with a random sample of 619 adolescents aged between 10 and 17 years. Knee pain prevalence was investigated using the Nordic Questionnaire for Osteomuscular Symptoms and a number of independent variables (demographic data, nutritional status, form of carrying backpacks, and pain during and after walking) obtained by self-report questionnaires. Physical impairment of the knee was assessed using the Brazilian version of the Knee injury and Osteoarthritis Outcome Score questionnaire. Poisson regression analysis was used to estimate the ratios of crude and adjusted knee pain association with the investigated factors. ANOVA and Kruskal-Wallis tests were used to compare median functional impairment.Knee pain prevalence over the last 7 days was 22.6%. Factors having significant association with the outcome were: being between 12 and 14 years old (PR: 1.67; 95% CI: 1.07-2.58; p<0.01), being between 15 and 17 years old (PR: 2.44; 95% CI: 1.51-3.94; p=0.01), and not doing physical education at school (PR: 0.54; 95% CI: 0.35-0.82; p=0.01). Total functional capacity among adolescents with pain was significantly lower among girls (68.7 points; PD±15.1) when compared with boys (74.3 points; PD±12.7) (p=0.02). The mean value of disabling pain was lower (55.1 points; PD±12.3) among adolescents who were physically active in their leisure time compared to those who were insufficiently active (60.4 points; PD±12.4) (p=0.02).The results of this study show that knee pain among adolescents with no previous history should be investigated, particularly among older adolescents who do not have physical education at school, since it is highly prevalent and can result in functional impairment. Regarding functionality, more attention should be given to girls and adolescents who were physically active in their leisure time.

Project description:BACKGROUND:To evaluate the effectiveness and safety of technology-assisted rehabilitation following total hip/knee replacement (THR/TKR). METHODS:Six electronic databases were searched without language or time restrictions for relevant studies: MEDLINE, EMBASE, Cochrane Library, CINAHL, SPORTDiscus, Physiotherapy Evidence Database (PEDro); from inception to November 7th, 2018. Two reviewers independently applied inclusion criteria to select eligible randomised controlled trials (RCTs) that investigated the effectiveness of technology-based interventions, compared with usual care or no intervention for people undergoing THR/TKR. Two reviewers independently extracted trial details (e.g. patients' profile, intervention, outcomes, attrition and adverse events). Study methodological quality was assessed using the PEDro scale. Quality of evidence was critically appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS:We identified 21 eligible studies assessing telerehabilitation, game- or web-based therapy. There were 17 studies (N?=?2188) in post-TKR rehabilitation and 4 studies (N?=?783) in post-THR rehabilitation. Compared to usual care, technology-based intervention was more effective in reducing pain (mean difference (MD): -?0.25; 95% confidence interval (CI): -?0.48, -?0.02; moderate evidence) and improving function measured with the timed up-and-go test (MD: -7.03; 95% CI: -?11.18, -?2.88) in people undergoing TKR. No between-group differences were observed in rates of hospital readmissions or treatment-related adverse events (AEs) in those studies. CONCLUSION:There is moderate-quality of evidence showed technology-assisted rehabilitation, in particular, telerehabilitation, results in a statistically significant improvement in pain; and low-quality of evidence for the improvement in functional mobility in people undergoing TKR. The effects were however too small to be clinically significant. For THR, there is very limited low-quality evidence shows no significant effects.

Project description:MethodsWe performed a comprehensive search on PubMed, the Cochrane Library, EMBASE, and four Chinese databases for articles published prior to June 2020. We included only randomized controlled trials (RCTs) that used acupotomy therapy as the major intervention in adults with knee OA, were published in either Chinese and English, included more than 20 subjects in each group, and included pain and function in the outcome measures. Knee OA was defined by the American College of Rheumatology or Chinese Orthopedic Association criteria in all studies. We extracted the visual analogue scale (VAS) pain score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score, the total effectiveness rate, the modified Japanese Orthopedic Association (JOA) activities of daily living score, and Lysholm's score. We calculated the mean difference (MD) or risk ratio (RR) for all relevant outcomes. Meta-analyses were conducted using random-effects models when appropriate.ResultsWe identified 1317 potentially relevant studies, thirty-two of which met the eligibility criteria and were conducted in China between 2007 and 2020. A total of 3021 knee OA patients (62.96% female, median age: 57 years, and median disease duration: 33 months) were included. The treatment duration ranged from 1 week to 5 weeks (median: 3 weeks). The typical acupotomy treatment involved releasing soft tissue adhesions and was performed once a week for 1-5 weeks until the pain was relieved. The control group treatments included acupuncture (8 studies), electroacupuncture (10 studies), sodium hyaluronate (8 studies), radiofrequency electrotherapy (1 study), and nonsteroidal anti-inflammatory drugs (NSAIDs, 5 studies). The results from the meta-analysis showed that acupotomy led to superior improvements in the VAS pain score (MD = -1.11; 95% confidence interval (CI), -1.51 to -0.71; p < 0.00001) and WOMAC pain score (MD = -2.32; 95% CI, -2.94 to -1.69; p < 0.00001), a higher total effectiveness rate (RR = 1.15; 95% CI, 1.09-1.21; p < 0.00001), and superior improvements in the JOA score (MD = 6.39; 95% CI, 4.11-9.76; p < 0.00001) and Lysholm's score (MD = 12.75; 95% CI, 2.61-22.89; p = 0.01) for overall pain and function. No serious adverse events were reported.ConclusionChinese acupotomy therapy may relieve pain and improve function in patients with knee OA. Furthermore, rigorously designed and well-controlled RCTs are warranted.

Project description:BackgroundPain due to knee and / or hip osteoarthritis (HKOA) is the most common symptom for seeking healthcare. Pain interferes on daily activities, social and occupational participation in people with HKOA. The goal of this study is to estimate the prevalence of unmanageable pain levels (UPL) among people with HKOA), characterize this population and identify factors associated with UPL, and compare therapeutic strategies used by people with UPL versus manageable pain levels (MPL).MethodsWe analysed data from the EpiReumaPt study (n = 10,661), that included a representative sample of the Portuguese population. Among these, 1081 participants had a validated diagnosis of HKOA by a rheumatologist.. Sociodemographic, lifestyle and health-related data were collected in a structured interview. Pain intensity (NPRS) data were collected in a medical appointment. Painmedication (last month), physiotherapy and surgery were considered as therapies for pain management. UPL was defined as a mean pain intensity in the previous week of ≥5 points on 11-point numeric pain rating scale. The factors associated with UPL were analyzed with logistic regression (p < 0.05, 95%CI). The effect of unmanageable pain levels was assessed by the HOOS/KOOS activities of daily living and quality of life subscales. Symptoms of anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Analysis was completed with linear and logistic regression. All analysis were weighted.ResultsThe estimated prevalence of UPL among people with HKOA was 68.8%. UPL was associated with being female (odds ratio (OR) = 2.36, p < 0.001), being overweight (OR = 1.84, p = 0.035) or obese (OR = 2.26, p = 0.006), and having multimorbidity (OR = 2.08, p = 0.002). People with UPL reported worse performance in activities of daily living and lower quality of life (β = - 21.28, p < 0.001 and β = - 21.19, p < 0.001, respectively) than people with MPL. People with UPL consumed more NSAIDs (22.0%, p = 0.003), opioids (4.8%, p = 0.008), paracetamol (2.7%, p = 0.033), and overall analgesics (7.3%, p = 0.013) than people with MPL. A higher proportion of people with UPL underwent physiotherapy (17.5%, p = 0.002) than people with MPL.ConclusionTwo-thirds of people with HKOA in Portugal have poor management of their pain levels. Clinical and lifestyle factors, that are highly presented in individuals with HKOA, are associated with unmanageable pain. Our results highlighting the need for further research and implementation of effective interventions to improve pain, function and quality of life in people with HKOA.

Project description:BackgroundGlobally osteoarthritis of the knee is a leading cause of disability. Hip abductor strength and activation are essential for maintaining postural balance during transfers and are related to joint loading and progression during weight-bearing activities. Strength deficits in the hip abductors might cause a reduction in the lower extremity force generation, thereby causing stress on the medial tibiofemoral joint. The aim of this systematic review is to assess the effectiveness of hip abductor strengthening on knee joint loading, knee pain and functional outcome measures in patients with knee osteoarthritis.MethodsDatabase such as Scopus, PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) database and PEDro were reviewed to recognize the trials published in English from inception to December 2020. Randomized controlled trials that studied the effectiveness of hip abductor strengthening in subjects with knee osteoarthritis and its impact on knee joint loading, knee pain and functional outcome measures were included. RevMan 5.4 was used for meta-analysis and forest plot construction. Quality assessment of the included studies was carried out using the PEDro scale.Results and discussionThe search yielded 260 results of which 29 full-text articles were screened. The review includes 7 randomized controlled trials and 3 studies with good methodological quality were included for meta-analysis. The meta-analysis of the articles favored hip abductor strengthening intervention over the control group. Hip abductor strengthening had significantly reduced the VAS [ SMD = -0.60[-0.88, -0.33] p < 0.0001]at 95% CI and improved the WOMAC scores [SMD - 0.75[-1.05,-0.45] p < 0.0001] at 95% CI. All of the included studies concluded that strengthening the hip abductor muscle had a positive impact on knee pain and functional outcomes.ConclusionThe current study found high-quality evidence to support the use of hip abductor muscle strengthening exercises as a rehabilitative treatment for subjects with knee osteoarthritis.Trial registrationCRD42021256251 .

Project description:BackgroundThe aim of this study was to identify modifiable clinical factors associated with radiographic osteoarthritis progression over 1 to 2 years in people with painful medial knee osteoarthritis.MethodsA longitudinal study was conducted within a randomised controlled trial, the "Long-term Evaluation of Glucosamine Sulfate" (LEGS study). Recruitment occurred in 2007-2009, with 1- and 2-year follow-up assessments by blinded assessors. Community-dwelling people with chronic knee pain (≥4/10) and medial tibiofemoral narrowing (but retaining >2mm medial joint space width) on radiographs were recruited. From 605 participants, follow-up data were available for 498 (82%, mean [sd] age 60 [8] years). Risk factors evaluated at baseline were pain, physical function, use of non-steroidal anti-inflammatory drugs (NSAIDs), statin use, not meeting physical activity guidelines, presence of Heberden's nodes, history of knee surgery/trauma, and manual occupation. Multivariable logistic regression analysis was conducted adjusting for age, sex, obesity, high blood pressure, allocation to glucosamine and chondroitin treatment, and baseline structural disease severity (Kellgren and Lawrence grade, joint space width, and varus alignment). Radiographic osteoarthritis progression was defined as joint space narrowing ≥0.5mm over 1 to 2 years (latest follow-up used where available).ResultsRadiographic osteoarthritis progression occurred in 58 participants (12%). Clinical factors independently associated with radiographic progression were the use of NSAIDs, adjusted odds ratios (OR) and 95% confidence intervals (CI) 2.05 (95% CI 1.1 to 3.8), and not meeting physical activity guidelines, OR 2.07 (95% CI 0.9 to 4.7).ConclusionsAmong people with mild radiographic knee osteoarthritis, people who use NSAIDs and/or do not meet physical activity guidelines have a greater risk of radiographic osteoarthritis progression.Trial registrationClinicalTrials.gov , NCT00513422 . This original study trial was registered a priori, on August 8, 2007. The current study hypothesis arose before inspection of the data.

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Risk factors for pain and functional impairment in people with knee and hip osteoarthritis: a systematic review and meta-analysis.

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Risk factors for pain and functional impairment in people with knee and hip osteoarthritis: a systematic review and meta-analysis.

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