Background: Sagittal plane external flexion moment in early stance has been reported to be both higher and lower in people with medial knee OA compared to control subjects. Purpose: Sagittal plane knee joint kinetics and kinematics were compared between people with medial compartment OA and healthy subjects. Subjects with OA and low pain scores were also compared to those with OA and moderate pain scores. Subjects: Forty people with medial knee OA and 40 age and sex matched control subjects. Method: Knee alignment and OA severity were measured from radiographs. Frontal and sagittal plane moments and knee flexion angle during gait were measured using a three dimensional motion analysis system and force plates. The Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) was used to measure pain; this score was used to divide the OA group into low pain and moderate pain OA groups. The relationship between knee flexion moment in early stance and gait speed, knee flexion angle and pain was also determined. Results: Subjects with OA had lower gait speed and cadence, and higher double limb support time. Peak knee adduction moment (first 50% of the gait cycle) was higher in the OA group. The knee flexion moment in early stance did not differ between groups; however the knee extension moment in late stance was lower in the knee OA group. The moderate pain group walked more slowly than the low pain group. The knee adduction moment, sagittal plane moments and knee flexion angle in stance did not differ between OA groups. A positive correlation was found between knee flexion moment and knee flexion angle in early stance in the knee OA group; the correlations between knee flexion moment and pain and gait speed were not significant. Conclusion: No differences were found in the knee flexion moment or stance phase knee flexion angle between the groups compared in this study, and therefore the results do not contribute to resolution of the controversy in the literature. Participants with knee OA in this study had relatively mild to moderate disease severity, which may have contributed to the non-significant findings. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2009-08-27 00:37:29.466

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

Le projet se situe dans le contexte de la gonarthrose fémoro-tibiale, et plus spécifiquement de son traitement par orthèse de décharge. Du fait de la cinématique particulière de l’orthèse testée, un protocole spécifique a été mis en place dans le but d’approfondir les mécanismes d’actions de cette orthèse. Ce protocole s’est appuyé sur des outils d’investigation utilisés dans la routine clinique (système EOS® et Vicon®). Seize sujets symptomatiques ont participé à l’étude. Les objectifs principaux étaient de valider et d’utiliser des méthodes de personnalisation des modèles, support de la biomécanique, dans ce contexte spécifique, afin d’améliorer la précision de la quantification des paramètres cinématiques et dynamiques. En effet, l’état de l’art démontre que l’indicateur dynamique couramment utilisé dans l’étude de la gonarthrose, le moment articulaire externe d’adduction, souffre de résultats controversés. Les objectifs secondaires étaient de caractériser la pathologie à l’aide des indicateurs calculés ainsi que d’approfondir le mécanisme d’action de l’orthèse de décharge. Ainsi, deux méthodes principales ont été investiguées. La première porte sur l’analyse séquentielle cinématique de l’articulation fémoro-tibiale en utilisant le système EOS®. Cette analyse nécessite une étape de recalage d’objet 3D sur des vues 2D biplanaires. La fiabilité de ce recalage manuel a été quantifiée en évaluant, d’une part, la précision de la méthode grâce à des données in vitro et, d’autre part, la répétabilité de la méthode grâce à la participation de 3 opérateurs et de 6 sujets asymptomatiques dont les acquisitions ont permis d’obtenir des vues du genou dans plusieurs positions (extension et flexion 20°, 40°et 90°). La seconde méthode consiste en la fusion de données issues de deux environnements (EOS® et Vicon®) de façon à quantifier les moments articulaires externes dans le genou en définissant le point auquel sont calculés ces moments à partir du modèle 3D du fémur. Ce modèle étant recalé dans l’environnement Vicon® par l’intermédiaire des marqueurs externes détectables dans les acquisitions EOS® et Vicon®. Les résultats principaux concernent :1/ la fiabilité du recalage des modèles 3D des os sur des vues 2D de l’ordre de 0,3° et 1,6 mm dans le plan sagittal de 2,1° et 1,8mm dans le plan transversal ; 2/ la quantification d’angles positionnels 3D du fémur et du tibia des membres inférieurs symptomatiques montrant que la surface articulaire tibiale (plateaux tibiaux) tend à demeurer horizontale contrairement à l’inclinaison plus marquée du fémur ; 3/ une variation des moments articulaires externes en fonction de l’intégration ou non d’un modèle interne pour le calcul de ce paramètre ; 4/ la quantification de la cinématique séquentielle de l’orthèse et du genou. La fiabilité des méthodes développées dans ce travail a été estimée ouvrant la voie à leurs applications et à leurs développements en clinique.Mots clés : gonarthrose fémoro-tibiale ; orthèse ; analyse séquentielle ; recalage. / The context is the knee osteoarthritis and its treatment via an unloading brace. As the evaluated brace has specific kinematics, a dedicated protocol was set up using clinical routine tools (EOS® and Vicon®). Sixteen symptomatic subjects participated to this study. The main objective was to validate and to use personalization methods of the biomechanical models to improve the accuracy kinematics and kinetics parameter computation in this specific context. Indeed, the state of the art highlights that the dynamic indicator, currently used in knee osteoarthritis studies, the external adduction joint moment is controversial. The secondary objectives were both the characterization of the pathology using indicators obtained on the acquired data and the in-depth study of the mechanical action of the unloading brace evaluated in this study. Thus, two main methods were investigated. The first one is the sequential analysis of the knee kinematics using EOS® system. This analysis required a registration step of a 3D object on 2D biplanar views. The manual registration reliability was quantified by evaluating both the method accuracy with in-vitro data and the method repeatability thanks to the participation of 3 operators and 6 asymptomatic subjects allowing the acquisition of knee images in several positions (extension and 20°, 40°, and 90° flexion). The second method consists in the fusion of data obtained in the two acquisitions environments (EOS® and Vicon®), to obtain the external knee joint moment in order to define the point where the moment is computed from the femur 3D model. This model is registered in the Vicon® environment through external markers visible in both the EOS® and Vicon® acquisitions. The main results relate to: 1/the reliability of the registration of the bone 3D model on 2D views estimated at about 0,3° and 1,6 mm in the sagittal plane and about 2,1° and 1,8 mm in the transverse plane ; 2/ the quantification of the angular relative position of the shank and tibia of the symptomatic lower limbs, showing the tibial plateau horizontality opposed to the femur emphasized inclination ; 3/ external joint moment variation according to the computation method (with or without internal model included) ; 4/ brace and knee sequential kinematic quantification. As the reliability of the methods developed in this study was estimated, further developments and clinical applications and development could now be explored using these methods.Keywords : knee osteoarthritis; brace, sequential analysis; registration.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-10-13T12:17:17Z No. of bitstreams: 1 hervaldelacerdabonfante.pdf: 995668 bytes, checksum: 748fb8eea98b5b0a025cf634a825ef38 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-10-22T12:55:33Z (GMT) No. of bitstreams: 1 hervaldelacerdabonfante.pdf: 995668 bytes, checksum: 748fb8eea98b5b0a025cf634a825ef38 (MD5) / Made available in DSpace on 2016-10-22T12:55:33Z (GMT). No. of bitstreams: 1 hervaldelacerdabonfante.pdf: 995668 bytes, checksum: 748fb8eea98b5b0a025cf634a825ef38 (MD5) Previous issue date: 2008-05-15 / Este estudo teve o objetivo de avaliar o uso de hidroxicloroquina (HCQ) em pacientes com osteoartrite (OA) primária e sintomática de joelhos analisando a resposta clínica através de índices funcionais como o Western Ontario and McMaster Universities Index (WOMAC), o índice algo funcional de Lequesne e a escala visual analógica (EVA). Por outro lado, avaliou a dosagem sérica das quimiocinas monocyte chemoattractant protein-1 (MCP-1), interleukin-8 (IL-8), interferon gamma-inducible protein-10 (IP-10) e monokyne induced by interferon-gamma (MIG) e a influência do uso da HCQ nestas dosagens. Concluíram o estudo 29 pacientes com diagnóstico de OA sintomática de joelhos que foram divididos em 2 grupos, 16 pacientes utilizaram HCQ na dosagem de 400mg/dia e 13 receberam placebo. O estudo teve a duração de 16 semanas. Dois grupos controle foram incluídos nesse estudo, o primeiro constituído de 10 indivíduos que não possuíam OA de joelhos, com idade superior a 60 anos (controle idoso), não apresentavam queixas álgicas, nem evidência clínica ou radiológica de OA de joelhos e o segundo formado por 10 indivíduos adultos jovens sadios com idade inferior a 40 anos (controle jovem). As quimiocinas MCP-1, IL-8, IP-10 e MIG foram dosadas no soro, utilizando o método de citometria de fluxo (cytometric bead array). A dosagem destas quimiocinas foi repetida após quatro meses nos 29 pacientes com OA. Quanto aos resultados, não houve diferença significativa entre os grupos com OA nos índices de WOMAC, Lequesne e na EVA. Com relação a dosagem de quimiocinas, não houve diferença entre os pacientes com OA antes e após o tratamento com HCQ. O grupo formado por adultos jovens apresentou dosagem menor das quimiocinas IP-10 (p = 0,02), MCP-1 (p = 0,04), MIG (p < 0.0001) e IL-8 (p < 0.0001) em relação aos dois grupos de pacientes e ao grupo controle idoso. Concluiu-se que a HCQ utilizada por 4 meses, não alterou os níveis séricos das quimiocinas MCP-1, IL-8, IP-10 e MIG em pacientes com OA sintomática de joelhos, entretanto os pacientes com OA e os indivíduos com idade superior a 60 anos apresentaram níveis séricos de todas as quimiocinas estudadas maiores que o grupo jovem, sendo mais evidente nas dosagens de MCP-1 e IL-8 no grupo com OA quando comparado com o grupo jovem, demonstrando que ocorre um aumento dos níveis séricos de quimiocinas com o envelhecimento.Ficou caracterizada a importância da obesidade na OA, não só pela grande prevalência neste estudo, como pela diferença estatisticamente significativa do índice de massa corporal (IMC) entre o grupo idoso sem evidências clínicas de OA de joelhos e o grupo com OA (p < 0.001).Este trabalho foi o primeiro a Easy PDF Creator is professional software to create PDF. If you wish to remove this line, buy it now. fazer a correlação entre OA de joelhos e quimiocinas séricas antes e após uso de HCQ. Novos estudos são necessários, inclusive com análise do líquido sinovial, devido a possibilidade de que as alterações das estruturas articulares ocorridas na OA possam estar associadas com elevação dos níveis de quimiocinas apenas na articulação e não no soro. / This study assessed the clinical and biological responses of patients with primary and symptomatic knee osteoarthritis (OA) to hydroxychloroquine. (HCQ) Clinical impact was assessed through Western Ontario and McMaster Universities Index (WOMAC), Lequesne-algofunctional index, and visual analog scale (VAS). Monocyte chemoattractant protein-1 (MCP-1), interleukin-8 (IL 8), interferon-gamma-inducible protein-10 (IP-10), and monokine induced by interferon-gamma (MIG) serum levels were obtained for assessment of the biological impact. 29 patients diagnosed with symptomatic knee OA were divided in two groups: 16 received HCQ 400mg/day and 13 received placebo. The study lasted 16 weeks. Two control groups were formed: the first one composed of 10 asymptomatic subjects over 60 years of age, without any clinico-radiological evidence of knee OA (elderly controls), and the second one composed of 10 healthy adults under 40 years of age (young controls). Serum levels of MCP-1, IL-8, IP-10, and MIG chemokines were measured through cytometry (cytometric bead array) at baseline in all groups, and after four months in the 29 OA patients. WOMAC, Lequesne, and VAS results did not significantly differ among the groups. Chemokine levels before and after treatment with chloroquine did not differ in OA patients. The young controls had lower levels of IP-10 (p = 0.02), MCP-1 (p = 0.04), MIG (p < 0.0001), and IL-8 (p < 0.0001), compared to the other two groups. Hydroxychloroquine for four months did not alter serum levels of MCP-1, IL-8, IP-10 and MIG chemokines in symptomatic patients with knee OA. However, OA patients and elderly controls had higher levels of all chemokines studied as compared to young controls (chiefly MCP-1 and IL-8 in the OA group compared with young controls), pointing to an increase in the serum levels of chemokines with aging. Obesity was shown to influence OA, not only because of the high prevalence found, but also because of the statistically significant difference in body mass index (BMI) found between elderly controls and the OA group (p < 0.001). This is the first study to correlate knee OA with serum chemokines before and after chloroquine use. Because joint damage might lead to joint limited chemokine increase without any serum change, further studies involving synovial fluid analysis are warranted.

Objetivo: verificar os efeitos de intervenções fisioterapêuticas, laser de baixa potência (LBP) e exercícios físicos (EF), de forma associada ou isolada, na osteoartrite de joelhos (OAJ). Método: Ensaio clínico randomizado, controlado, cego. Participaram da pesquisa 60 indivíduos de ambos os sexos, idade entre 45 e 75 anos, com diagnóstico radiográfico de OAJ graus 1 a 3, os quais foram randomizados em quatro grupos: 1) Grupo controle (GC, n=15): pacientes com OAJ e sem tratamento; 2) Grupo laser (GL, n=15): pacientes com OAJ e tratados com LBP (808nm, 5,6J); 3) Grupo exercício (GE, n=15): pacientes com OAJ e tratados com EF; 4) Grupo laser e exercício (GLE, n=15): pacientes com OAJ e tratados com LBP e EF. As avaliações foram realizadas no Laboratório de Avaliação e Reabilitação do Equilíbrio, no início e após dois meses, incluindo o questionário WOMAC (dor, rigidez e função física); avaliação das variáveis espaço-temporais da marcha pelo equipamento GAITRite; avaliação do torque dos músculos extensores de joelho pelo dinamômetro isocinético Biodex e a funcionalidade (teste de transpor degrau e teste de levantar-se de uma cadeira) pelo equipamento Balance Master. O tratamento foi realizado durante dois meses, 2x por semana. Na análise estatística foi utilizado o teste de Wilcoxon (dados não paramétricos) e o teste Anova Two Way seguido do teste post hoc de Tukey (dados paramétricos), com nível de significância de 5%, usando o software SPSS. Resultados: no questionário WOMAC, houve diferença apenas na comparação pré e após 2 meses (intragrupo) para o GE nas variáveis: dor (p=0,006), função (p=0,01) e na pontuação total do WOMAC (p=0,01). Na marcha, na análise intragrupo, os grupos que receberam intervenção (GL, GE e GLE) apresentaram redução significativa apenas na duração da fase de apoio direito (p=0,014; p=0,011; p=0,035, respectivamente). Na avaliação intergrupo, ocorreu um aumento significativo na velocidade da marcha dos grupos que receberam intervenção (GL, GE e GLE) comparado ao GC (p=0,03; p=0,04 e p=0,005 respectivamente), na cadência ocorreu aumento apenas no GLE em comparação ao GC (0,009). Ainda na avaliação intergrupo, na duração da fase de apoio direito, os grupos GE (p=0,035) e GLE (p=0,003) apresentaram diminuição significativa em relação ao GC e na duração da fase de apoio único direito, apenas o GLE apresentou aumento significativo (p=0,04) em relação ao GC. Na análise isocinética do torque dos extensores de joelho, apenas na avaliação intergrupo após 2 meses, o membro inferior esquerdo apresentou aumento significativo nos grupos GE (p=0,03) e GLE (p=0,04) em relação ao GC. Na avaliação intragrupo da funcionalidade, apresentaram diminuição significativa (p=0,04) apenas o GLE no teste de transpor degrau (variável: tempo de movimento do membro direito) e apenas o GE (p=0,04) no teste de levantar-se da posição sentada (variável: tempo de transferência do movimento). Conclusão: de uma maneira geral, os grupos: GE e GLE apresentaram mais benefícios quando comparados aos grupos GC e GL, o que sugere que o EF deve ser incluído no tratamento da OAJ, podendo ser acrescido do LBP. / Objective: To verify the effects of physical therapy interventions, low level laser therapy (LLLT) and physical exercises (PE), in an associated or isolated way, on knee osteoarthritis (KOA). Method: Randomized, controlled and blind clinical trial. Sixty individuals, both sexes, aged 45 to 75 years, with radiographic diagnosis of KOA, grades 1 to 3, were randomly assigned into four groups: 1) Control group (CG, n=15): patients with KOA, without treatment; 2) Laser group (LG, n=15): patients with KOA, treated with LLLT (808nm, 5.6J); 3) Exercise group (EG, n=15): patients with KOA, treated with PE; 4) Laser and Exercise group (LEG, n=15): patients with KOA, treated with LLLT and PE. The evaluations were performed at Laboratory of Assessment and Rehabilitation of Equilibrium, in the beginning and after 2 months, including the WOMAC questionnaire (pain, stiffness and physical function); evaluation of spatiotemporal gait variables was performed on GAITRite equipment; evaluation of knee extensor muscle torque using the Biodex isokinetic dynamometer and the functionality (step up/over and sit-to-stand test) through the Balance Master equipment. The treatment was performed for 2 months, twice a week. In the statistical analysis, Wilcoxon test (non-parametric data), and Anova Two Way followed Tukey\'s post hoc test (parametric data) were used, with significance level of 5%, using SPSS software. Results: in the WOMAC questionnaire, mean difference only in the comparison intragroup for the EG in the variables: pain (p=0.006), physical function (p=0.01) and total WOMAC (p=0.01). Regarding gait variables, in the intragroup analysis, the only variable that presented a significant difference was the duration of the right support phase, and the LG, EG and LEG had a significant decrease in this variable (p=0.014, p=0.011, p=0.035, respectively) in relation to the pre-treatment period. In the intergroup evaluation, a significant increase in gait speed occurred in the groups: GL, GE and GLE compared to the CG (p=0.03, p=0.04 and p=0.005, respectively). In the cadence there was a significant increase only in the LEG compared to the CG (0.009). In the duration of the right support phase, the GE and GLE groups presented a significant decrease (p=0.035 and p=0.003, respectively) in relation to the CG. In the analysis of the duration of single right limb support, only the LEG presented a significant increase (p=0.04) in relation to the CG. In the isokinetic analysis of the torque of knee extensors, only in the intergroup evaluation after 2 months, the left lower limb presented significant increase in the EG (p=0.03) and LEG (p=0.04) groups in relation to the CG. In the step up/over test, in the intragroup evaluation, only the LEG showed a significant decrease (p=0.04) in the transfer time variable in the intragroup comparison. In the sit-to-stand test, in the variable of time of transfer, only the EG showed a significant decrease (p=0.04) in the intragroup comparison. Conclusion: in general, the groups: EG and LEG presented more benefits when compared to the GC and GL groups, this suggests that EF should be included in the treatment of KOA, and may be added to LLLT.

A dor crônica de joelho secundária a osteoartrite é uma patologia comum com a progressão da idade e que vem aumentando sua prevalência a medida que se elevam a expectativa de vida e os índices de obesidade e sobrepeso. A consequência desses sintomas se reflete de maneira direta sobre a capacidade de realização de atividades diárias, a qualidade do sono e a capacidade laboral do indivíduo. O impacto psicológico, social e econômico da dor crônica de joelho representam um desafio de saúde pública, demandando tratamento eficiente e custo-efetivo. As terapias farmacológicas com frequência apresentam benefício limitado associado a diversos efeitos colaterais. Os procedimentos invasivos não cirúrgicos, como a injeção intraarticular de ácido hialurônico, representam uma alternativa em casos refratários ao tratamento clínico, sendo utilizados como terapia complementar, entretanto apresentam benefício limitado e insuficiente para o controle da dor em casos severos. Os procedimentos cirúrgicos, como a artroplastia total do joelho, habitualmente apresentam resultados satisfatórios na doença avançada, contudo são limitadas pelo seu alto custo, risco cirúrgico inerente e pequena capacidade resolutiva diante da alta prevalência. O bloqueio dos nervos geniculados é uma técnica recentemente descrita, de fácil realização e com mínima invasão necessitando ser estudada para que possa ser aplicada no manejo clínico. Neste estudo foram selecionados pacientes com osteoartrite moderada e severa, que apresentavam dor refratária ao tratamento clínico otimizado. Foram selecionados 16 pacientes e um total de 22 joelhos foram avaliados. Inicialmente todos os pacientes foram submetidos a um pré-teste que avaliava: 1) a intensidade da dor; 2) a qualidade do sono; 3) a capacidade de realização de atividades diárias. Aleatoriamente 2 grupos foram formados, o primeiro submetido ao bloqueio intra-articular e o segundo ao bloqueio dos nervos geniculados. A solução formada por: lidocaína 1% sem vasoconstrictor - 9 mL - 90 mg adicionada de Dexametasona - 1mL - 10 mg era padrão e utilizada nos dois grupos de intervenção. Após um seguimento semanal por 12 semanas consecutivas, os paciente foram reconvocados e submetidos ao outro procedimento proposto, dessa forma todos os pacientes atuaram como o seu próprio controle (desenho de estudo \"crossover\"). Nos seguimentos semanais, assim como no pré-teste, eram avaliados a intensidade da dor, a qualidade do sono e a capacidade de realização de atividades diárias. Os resultados mostraram que o bloqueio intra-articular e o bloqueio dos nervos geniculados apresentam redução importante da dor (p < 0,01), melhora na capacidade de realização de atividades diárias (p < 0,01) e melhora na qualidade do sono (p < 0,01), no entanto não houve diferença significativa no resultado entre os grupos estudados (p > 0,05). Conclui-se que o bloqueio dos nervos geniculados surge como uma alternativa segura, minimamente invasiva e de alta eficácia, apresentando resultados semelhantes ao bloqueio intra-articular. / Chronic pain of the knee secondary to osteoarthritis is a common pathology, progressive with age and which increases its prevalence as life expectancy is raised together with obesity and overweight. A consequence of these symptoms is reflected directly on the capacity of undertaking daily activities, the quality of sleep and the work capacity of each individual. The psychological, social and economic impact of chronic knee pain represents a challenge to public health, demanding efficient treatment at a worthwhile cost. Pharmaceutical therapies frequently present a limited benefit associated with various side effects. Non-surgical invasive procedures such as an injection intra-articular of hyaluronic acid, represents an alternative in refractory cases to clinical treatment, being used as a complementary therapy, however, presenting limited and insufficient benefit for the control of pain in severe cases. Surgical procedures such as complete arthroplasty of the knee, usually presents satisfactory results in patients with an advanced osteoarthritis, but are limited by their high cost, inherent surgical risk and small resolving capability facing a high prevalence. Blocking the genicular nerves is a recently described technique, easily applied by clinical management. Patients were selected in this study with moderate and severe osteoarthritis, with refractory pain in optimized clinical treatment. 16 patients were selected and a total of 22 knees were evaluated. Initially all the patients were submitted to a pre-test which evaluated: 1) the intensity of pain; 2) the quality of sleep; 3) the capacity to undertake daily activities. Two groups were formed randomly, the first submitted to intra-articular blocking and the second to blocking the genicular nerves. A solution of lidocaine 1% without a vasoconstrictor - 9 mL - 90 mg and Dexametasona - 1 mL - 10 mg was standard and used for intervention in both groups. After a weekly appraisal for 12 consecutive weeks, the patients were recalled and submitted to another proposed procedure and in this way all the patients acted as their own control (a \"crossover\" study design). In the following weeks, as also in the pretest, the intensity of pain, the quality of sleep and the capacity of undertaking daily activities were evaluated. The results showed that the intra-articular block and the blocking of the genicular nerves presented an important reduction of pain (p<0,01) but there was no significant difference in the result between the groups studied (p>0,05). It is therefore concluded that the blocking of the genicular nerves appears as a safe alternative, minimally invasive and highly efficient, presenting results similar to the intra-articular blocking.

Background: Knee osteoarthritis (OA) is the most common type of OA and is a major cause of pain and thus results in disability for daily activities among persons living in the community. OA currently has no cure. In addition to the conflicting recommendations from clinical guidelines, evidence about the extent to which long-term use of intra-articular injections improves patient outcomes is also lacking. Methods: Using data from the Osteoarthritis Initiative (OAI), marginal structural models (MSMs) applying inverse probability treatment weights (IPTW) were used to examine the effectiveness of intra-articular injections and changes in symptoms over time. The specific aims of this dissertation were to: 1) evaluate longitudinal use of intra-articular injections after treatment initiation among persons with radiographic knee OA; 2) quantify the extent to which intra-articular injection relieves symptoms among persons with radiographic knee OA; and 3) evaluate the performance of missing data techniques under the setting of MSMs. Results: Of those initiating injections, ~19% switched, ~21% continued injection type, and ~60% did not report any additional injections. For participants initiating corticosteroid (CO) injections, greater symptoms post-initial injection rather than changes in symptoms over time were associated with continued use compared to one-time use. Among participants with radiographic evidence of knee OA, initiating treatments with either CO or hyaluronic acid (HA) injections was not associated with reduced symptoms compared to non-users over two years. Compared to inverse probability weighting (IPW), missing data techniques such as multiple imputation (MI) produced less biased marginal causal effects (IPW: -2.33% to 15.74%; -1.88% to 4.24%). For most scenarios, estimates using MI had smaller mean square error (range: 0.013 to 0.024) than IPW (range: 0.027 to 0.22). Conclusions: Among participants with radiographic evidence of knee OA living in the community, the proportion of those switching injection use and one-time users was substantial after treatment initiation. In addition, initiating injection use was not associated with reduced symptoms over time. With respect to issues of missing data, using MI may confer an advantage over IPW in MSMs applications. The results of this work highlight the importance of using comparative effectiveness research with non-experimental data to study these commonly used injections and may help to understand the usefulness of these treatments for patients with knee OA.

BakgrundKnäledsartros är en av de vanligaste orsakerna till funktionsnedsättning. Träning är en viktig del i grundbehandlingen och behandlingseffekten av träning har ansetts vara liten till moderat. Att identifiera subgrupper för att anpassa behandlingen har rekommenderats. Mekanisk Diagnostik och Terapi enligt McKenzie (MDT) är en metod för att klassificera och anpassa behandling utifrån mekanisk respons. Derangement är en klassifikation som innebär en direkt och varaktig positiv respons på smärta och/eller funktion till följd av statiska eller upprepade rörelser. Syfte Syftet med denna studie var att undersöka påverkan på smärta och aktivitetsförmåga vid omhändertagande enligt MDT för personer med knäledsartros vars besvär kunde klassificeras som derangement i knä. Metod En reversal single-case design användes. Utfallsmått var smärta i vila och i rörelse enligt Numeric Rating Scale (NRS) och aktivitetsförmåga enligt Knee injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS). Data analyserades visuellt och med två standarddeviationsmetoden (2 SD). Resultat Två deltagare med knäledsartros vars besvär kunde klassificeras som derangement i knä deltog i studien. Ingen genomgående påverkan på smärta i vila visades för någon av deltagarna. Minskning av smärta i rörelse visades till viss del för båda deltagarna. Ökad aktivitetsförmåga visades för deltagare 2, men inte genomgående för deltagare 1. Slutsats Få deltagare gjorde det svårt att dra några tydliga slutsatser. Studien visade en tendens till förbättring av smärta i rörelse och aktivitetsförmåga. Ingen påverkan på smärta i vila visades. / Introduction Knee osteoarthritis is one of the most common causes of disability. Exercise is an important part of management and the treatment effect of exercise has been considered to be small to moderate. It has been recommended to identify subgroups to adapt the treatment. The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) is a method for assessment and treatment based on mechanical response. Derangement is a classification where sustained or repeated movements cause a direct and lasting positive response on pain and/or function. Objective The objective of this study was to investigate the impact on pain and disability for management according to MDT for people with knee osteoarthritis whose condition could be classified as derangement in knee. Method A reversal single-case design was used. Outcome measures were pain at rest and pain in movement according to the Numeric Rating Scale (NRS) and disability according to the Knee injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOSPS). Data was analyzed visually and with the two standard deviation band method (2 SD). Results Two participants with knee osteoarthritis whose condition could be classified as derangement in knee participated in the study. No effect on pain at rest was shown altogether for any of the participants. An improvement on pain in movement was shown to some extent for both participants. An improvement on disability was shown for participant 2, but not altogether for participant 1. Conclusions Few participants made it difficult to draw any clear conclusions. The study showed a tendency to improvement on pain in movement and disability. No impact on pain at rest was shown.

Gait, pain, and self-efficacy alterations in osteoarthritis (OA) patients may be precursors for pathological alterations and are important variables to examine in an aquatic therapy study aimed at improving mobility. A greater understanding of these alterations will be useful for the treatment of OA and the prevention of OA progression. The purpose of this thesis was twofold: to review the effects of certain land and aquatic therapies on gait kinematics and mobility of people with osteoarthritis, and to examine the effects of short-term aquatic treadmill exercise on gait kinematics, perception of pain, and mobility in OA patients. A direct comparison of water versus land treadmill exercise was used to determine the acute effectiveness of aquatic therapy on gait kinematics, pain, and self-efficacy. Fourteen participants diagnosed with osteoarthritis of the knee performed three consecutive exercise sessions for each mode of exercise. Gait kinematics, pain, and self-efficacy were measured before and after each intervention. Angular velocity gain score during stance for left knee extension was significantly higher for aquatic treadmill exercise compared to land treadmill exercise by 38.1% (p = 0.004). Similarly, during swing, the gain scores for angular velocity were also greater for left knee internal rotation and extension by 65% and 20%, respectively (p = 0.004, p = 0.008). During stance, the joint angle gain score for left hip flexion was greater for land exercise by 7.23% (p = 0.007). Similarly, during swing, the angular velocity gain score for right hip extension was significantly greater for aquatic exercise by 28% (p = 0.01). Only the joint angle gain score for left ankle abduction during stance was significantly higher for land exercise by 4.72% (p = 0.003). No other joint angle gain scores for either stance or swing were significantly different for either aquatic or land treadmill exercise (p = 0.06-0.96). Perceived pain was 100% greater for land than aquatic treadmill exercise (p = 0.02) and self-efficacy gain scores were not different between conditions (p = 0.37). The present study demonstrated that an acute training period on an aquatic treadmill did influence joint angular velocity and arthritis-related joint pain. Although acute effects of training (i.e., pain, angular velocity) improve after aquatic rather than land training, it is unclear whether or not aquatic exercise is a better long-term alternative to land exercise, and further longitudinal research is needed to examine gait kinematic changes after an increased training period of aquatic exercise.

abstract: Falls are the leading cause of fatal and non-fatal injuries in the older adult population with more than 27,000 fall related deaths reported every year[1]. Adults suffering from lower extremity arthritis have more than twice the likelihood of experiencing multiple falls resulting in increased fall-related injuries compared to healthy adults. People with lower extremity end-stage osteoarthritis(KOA), experience a number of fall risk factors such as knee instability, poor mobility, and knee pain/stiffness. At end-stage knee OA, the space between the bones in the joint of the knee is significantly reduced, resulting in bone to bone frictional wearing causing bone deformation. In addition, an impaired stepping response during a postural perturbation is seen in people with OA related knee instability. The most common treatment for end-stage knee osteoarthritis is a surgical procedure called, total knee replacement (TKR). It is known that TKR significantly reduces pain, knee stiffness, and restores musculoskeletal functions such as range of motion. Despite studies concluding that knee OA increases fall-risk, it remains unknown if standard treatments, such as TKR, can effectively decrease fall-risk. Analyzing the compensatory step response during a fall is a significant indicator of whether a fall or a recovery will occur in the event of a postural disturbance and is key to determining fall risk among people. Studies have shown reduced trunk stability and step length, as well as increased trunk velocities, correspond to an impaired compensatory step. This study looks at these populations to determine whether TKR significantly enhances compensatory stepping response by analyzing trunk velocities and flexions among other kinematic/kinetic variable analysis during treadmill induced perturbations and clinical assessments. / Dissertation/Thesis / Masters Thesis Biomedical Engineering 2019