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- Sandal, L. F., et al.
(författare)
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Exploring the effect of space and place on response to exercise therapy for knee and hip pain-a protocol for a double-blind randomised controlled clinical trial: the CONEX trial
- 2015
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Ingår i: BMJ Open. - : BMJ. - 2044-6055 .- 2044-6055. ; 5:3
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Context effects are described as effects of a given treatment, not directly caused by the treatment itself, but rather caused by the context in which treatment is delivered. Exercise is a recommended core treatment in clinical guidelines for musculoskeletal disorders. Although moderately effective overall, variation is seen in size of response to exercise across randomised controlled trial (RCT) studies. Part of this variation may be related to the fact that exercise interventions are performed in different physical environments, which may affect participants differently. The study aims to investigate the effect of exercising in a contextually enhanced physical environment for 8 weeks in people with knee or hip pain. Methods and analysis: The study is a double-blind RCT. Eligible participants are 35 years or older with persisting knee and/or hip pain for 3 months. Participants are randomised to one of three groups: (1) exercise in a contextually enhanced environment, (2) exercise in a standard environment and (3) waiting list. The contextually enhanced environment is located in a newly built facility, has large windows providing abundant daylight and overlooks a recreational park. The standard environment is in a basement, has artificial lighting and is marked by years of use; that is, resembling many clinical environments. The primary outcome is the participant's global perceived effect rated on a seven-point Likert scale after 8 weeks exercise. Patient-reported and objective secondary outcomes are included. Ethics and dissemination: The Regional Scientific Ethical Committee for Southern Denmark has approved the study. Study findings will be disseminated in peer-reviewed publications and presented at national and international conferences.
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- Sandal, L. F., et al.
(författare)
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Room for improvement: A randomised controlled trial with nested qualitative interviews on space, place and treatment delivery
- 2019
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Ingår i: British Journal of Sports Medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 53:6, s. 359-367
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Tidskriftsartikel (refereegranskat)abstract
- Objective Healthcare-oriented design in hospitals can promote better clinical outcomes. Creating optimal facilities may increase treatment effects. We investigated the influence of the treatment room on effects of exercise therapy. Methods In a mixed-method randomised controlled double-blind trial, middle-aged individuals reporting knee or hip pain performed 8 weeks of exercise therapy in (1) a newly built physically enhanced environment, (2) a standard environment or (3) were waitlisted, receiving no intervention. Participants and therapists were blind to study aim. Primary outcome was participants' Global Perceived Effect (GPE; seven-point Likert scale). Six nested focus group interviews with participants (n=25) and individual interviews with therapists (n=2) explored experiences of the environments. Results 42 people exercised in the physically enhanced environment, 40 in the standard environment, 21 were waitlisted. Contrary to our hypothesis, the treatment response seemed greater in the standard environment for GPE (0.98, 95% CI0.5 to 1.4) than for the physically enhanced environment (0.37, 95% CI -0.2 to 0.9), between-group difference (0.61, 95% CI -0.1 to 1.3) did not reach statistical significance (p=0.07). Waitlist group reported no improvement (-0.05 95% CI -0.5 to 0.4). In interviews, participants from the standard environment expressed greater social cohesion and feeling at home. Qualitative themes identified; reflection, sense of fellowship and transition. Secondary patient-reported outcomes and qualitative findings supported the primary finding, while improvements in muscle strength and aerobic capacity did not differ between exercise groups. Conclusion Results suggest that the physical environment contributes to treatment response. Matching patients' preferences to treatment rooms may improve patient-reported outcomes. Trial registration number ClinicalTrials. gov identifier: NCT02043613.
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- Thorlund, Jonas Bloch, et al.
(författare)
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Vibratory perception threshold in young and middle-aged patients at high risk of knee osteoarthritis compared to controls
- 2012
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Ingår i: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 64:1, s. 144-148
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Tidskriftsartikel (refereegranskat)abstract
- Objective Vibratory perception threshold (VPT) is impaired in patients with knee osteoarthritis (OA). It is, however, not known if sensory deficits precede or follow as a consequence of OA. The aim of this study was to investigate VPT in 2 independent groups of patients with high risk of future OA (young anterior cruciate ligament [ACL]-injured patients and middle-aged meniscectomized patients) and compare them to age-matched controls. Methods. VPT was assessed at the medial malleolus (MM) and medial femoral condyle (MFC) in 2 independent groups of patients and matched controls: ACL- injured patients (n = 39, mean +/- SD age 24.0 +/- 5.2 years, mean +/- SD BMI 24.0 +/- 2.9 kg/m(2), mean +/- SD time since injury 21.9 +/- 21.6 months) and controls (n = 28, mean +/- SD age 25.6 +/- 4.4 years, mean +/- SD BMI 23.6 +/- 2.2 kg/m(2)), and meniscectomized patients (n = 22, mean +/- SD age 49.6 +/- 4.8 years, mean +/- SD BMI 24.7 +/- 2.7 kg/m(2), mean +/- SD time since surgery 49.6 +/- 5.0 months) and controls (n = 25, mean +/- SD age 49.4 +/- 5.2 years, mean +/- SD BMI 25.2 +/- 4.9 kg/m(2)). Results. ACL- injured patients had a better VPT than controls at the MM (P = 0.030), which persisted after adjusting for age and sex (P = 0.034). At the MFC, there was a similar trend in favor of ACL injured patients (unadjusted P = 0.093, adjusted P = 0.122). No differences were seen in VPT at theMMbetween meniscectomized patients and controls, whereas there was a tendency for better VPT in meniscectomized patients at the MFC (unadjusted P = 0.085, adjusted P = 0.092). Conclusion. Impaired vibratory sensation could not be confirmed in 2 independent groups of patients compared to age-matched controls, suggesting that impaired vibratory sense is not present in knee- injured patients at high risk or in the very early phase of knee OA.
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