Zoekresultaten

Moderators of the effect of therapeutic exercise for knee and hip osteoarthritis

Background: Many international clinical guidelines recommend therapeutic exercise as a core treatment for knee and hip osteoarthritis. We aimed to identify individual patient-level moderators of the effect of therapeutic exercise for reducing pain and improving physical function in people with knee osteoarthritis, hip osteoarthritis, or both. Methods: We did a systematic review and individual participant data (IPD) meta-analysis of randomised controlled trials comparing therapeutic exercise with non-exercise controls in people with knee osteoathritis, hip osteoarthritis, or both. We searched ten databases from March 1, 2012, to Feb 25, 2019, for randomised controlled trials comparing the effects of exercise with non-exercise or other exercise controls on pain and physical function outcomes among people with knee osteoarthritis, hip osteoarthritis, or both. IPD were requested from leads of all eligible randomised controlled trials. 12 potential moderators of interest were explored to ascertain whether they were associated with short-term (12 weeks), medium-term (6 months), and long-term (12 months) effects of exercise on self-reported pain and physical function, in comparison with non-exercise controls. Overall intervention effects were also summarised. This study is prospectively registered on PROSPERO (CRD42017054049). Findings: Of 91 eligible randomised controlled trials that compared exercise with non-exercise controls, IPD from 31 randomised controlled trials (n=4241 participants) were included in the meta-analysis. Randomised controlled trials included participants with knee osteoarthritis (18 [58%] of 31 trials), hip osteoarthritis (six [19%]), or both (seven [23%]) and tested heterogeneous exercise interventions versus heterogeneous non-exercise controls, with variable risk of bias. Summary meta-analysis results showed that, on average, compared with non-exercise controls, therapeutic exercise reduced pain on a standardised 0–100 scale (with 100 corresponding to worst pain), with a difference of –6·36 points (95% CI –8·45 to –4·27, borrowing of strength [BoS] 10·3%, between-study variance [τ2] 21·6) in the short term, –3·77 points (–5·97 to –1·57, BoS 30·0%, τ2 14·4) in the medium term, and –3·43 points (–5·18 to –1·69, BoS 31·7%, τ2 4·5) in the long term. Therapeutic exercise also improved physical function on a standardised 0–100 scale (with 100 corresponding to worst physical function), with a difference of –4·46 points in the short term (95% CI –5·95 to –2·98, BoS 10·5%, τ2 10·1), –2·71 points in the medium term (–4·63 to –0·78, BoS 33·6%, τ2 11·9), and –3·39 points in the long term (–4·97 to –1·81, BoS 34·1%, τ2 6·4). Baseline pain and physical function moderated the effect of exercise on pain and physical function outcomes. Those with higher self-reported pain and physical function scores at baseline (ie, poorer physical function) generally benefited more than those with lower self-reported pain and physical function scores at baseline, with the evidence most certain in the short term (12 weeks). Interpretation: There was evidence of a small, positive overall effect of therapeutic exercise on pain and physical function compared with non-exercise controls. However, this effect is of questionable clinical importance, particularly in the medium and long term. As individuals with higher pain severity and poorer physical function at baseline benefited more than those with lower pain severity and better physical function at baseline, targeting individuals with higher levels of osteoarthritis-related pain and disability for therapeutic exercise might be of merit. Funding: Chartered Society of Physiotherapy Charitable Trust and the National Institute for Health and Care Research.

Cost-effectiveness of interventions for medically unexplained symptoms

A new submaximal rowing test to predict 2,000-m rowing ergometer performance

The purpose of this study was to assess predictive value of a new submaximal rowing test (SmRT) on 2,000-m ergometer rowing time-trial performance in competitive rowers. In addition, the reliability of the SmRT was investigated. Twenty-four competitive male rowers participated in this study. After determining individual HRmax, all rowers performed an SmRT followed by a 2,000-m rowing ergometer time trial. In addition, the SmRT was performed 4 times (2 days in between) to determine the reliability. The SmRT consists of two 6-minute stages of rowing at 70 and 80% HRmax, followed by a 3-minute stage at 90% HRmax. Power was captured during the 3 stages, and 60 seconds of heart rate recovery (HRR60s) was measured directly after the third stage. Results showed that predictive value of power during the SmRT on 2,000-m rowing time also increased with stages. CVTEE% is 2.4, 1.9, and 1.3%. Pearson correlations (95% confidence interval [95% CI]) were −0.73 (−0.88 to −0.45), −0.80 (−0.94 to −0.67), and −0.93 (−0.97 to −0.84). 2,000-m rowing time and HRR60s showed no relationship. Reliability of power during the SmRT improved with the increasing intensity of the stages. The coefficient of variation (CVTEM%) was 9.2, 5.6, and 0.4%. Intraclass correlation coefficients (ICC) and 95% CI were 0.91 (0.78–0.97), 0.92 (0.81–0.97), and 0.99 (0.97–1.00). The CVTEM% and ICC of HRR60s were 8.1% and 0.93 (0.82–0.98). In conclusion, the data of this study shows that the SmRT is a reliable test that it is able to accurately predict 2,000-m rowing time on an ergometer. The SmRT is a practical and valuable submaximal test for rowers, which can potentially assist with monitoring, fine-tuning and optimizing training prescription in rowers.

Skeletalmuscle training for spinalmuscular atrophy type 3

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of skeletal muscle training on functional performance in people with spinal muscular atrophy (SMA) type 3 and to identify any adverse effects

Consensus statement on physical rehabilitation in children and adolescents with osteogenesis imperfecta

Content and Quality of Motor Initiatives in the Support of People With Profound Intellectual and Multiple Disabilities

Motor activation is rarely integrated into the support of people with profound intellectual and multiple disabilities (PIMD), which might be the result of the limited evidence-based knowledge in this field. Practitioners have recently been developing several motor initiatives for people with PIMD, but it remains unclear about what core elements the motor initiatives actually consist of and towhat level of quality it is implemented in practice. This study aims to offer an overview and analysis of the content and quality of motor initiatives actually in use for people with PIMD. Motor initiatives were explored by asking practitioners to complete an online inventory form. Documents, expert knowledge, and observations were used to collect data about the characteristics of themotor initiatives. The quality of the motor initiatives which met our eligibility criteria, was analyzed on the basis of the level of evidencefor their effectiveness. The inventory yielded 118 motor initiatives of which 17 met the eligibility criteria. We identified four motor initiatives reflecting an approach to motorically activate people with PIMD within various activities, three including powerassisted exercises, three with aquatic exercises, two frameworks which integrated motor activities into their daily programs, two methods which included small-scale activities, two rhythmic movement therapies, and one program including gross motor activities. We found limited indications for descriptive evidence from 17 initiatives, limited or no indications for theoretical evidence from 12 and five initiatives respectively, and none of the initiatives provided a causal level of evidence for effectiveness. A wide variety of motor initiatives is used in current practice to activate persons with PIMD, although their effectiveness is actually unproven.Science and practice should cooperate to develop an evidence-based understanding to ensure more evidence-based support for themotor activation of people with PIMD in the future.