| 1. |
- Fernandes, Linda, et al.
(författare)
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EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis
- 2013
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 72:7, s. 1125-1135
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Tidskriftsartikel (refereegranskat)abstract
- The objective was to develop evidence -based recommendations and a research and educational agenda for the non-pharmacological management of hip and knee osteoarthritis (OA). The multidisciplinary task force comprised 21 experts: nurses, occupational therapists, physiotherapists, rheumatologists, orthopaedic surgeons, general practitioner, psychologist, dietician, clinical epidemiologist and patient representatives. After a preliminary literature review, a first task force meeting and five Delphi rounds, provisional recommendations were formulated in order to perform a systematic review. A literature search of Medline and eight other databases was performed up to February 2012. Evidence was graded in categories I-IV and agreement with the recommendations was determined through scores from 0 (total disagreement) to 10 (total agreement). Eleven evidence-based recommendations for the non-pharmacological core management of hip and knee OA were developed, concerning the following nine topics: assessment, general approach, patient information and education, lifestyle changes, exercise, weight loss, assistive technology and adaptations, footwear and work. The average level of agreement ranged between 8.0 and 9.1. The proposed research agenda included an overall need for more research into non-pharmacological interventions for hip OA, moderators to optimise individualised treatment, healthy lifestyle with economic evaluation and long-term follow-up, and the prevention and reduction of work disability. Proposed educational activities included the required skills to teach, initiate and establish lifestyle changes. The 11 recommendations provide guidance on the delivery of non-pharmacological interventions to people with hip or knee OA. More research and educational activities are needed, particularly in the area of lifestyle changes.
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| 2. |
- Gossec, Laure, et al.
(författare)
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OMERACT/OARSI initiative to define states of severity and indication for joint replacement in hip and knee osteoarthritis
- 2007
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Ingår i: Journal of Rheumatology. - 0315-162X. ; 34:6, s. 1432-1435
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Time to theoretical indication of joint replacement surgery has been proposed as a primary outcome for potential structure-modifying interventions for osteoarthritis (OA). The objectives of this OMERACT/OARSI Working Group were to identify pain, physical function, and structure states that represent the progression from early to late disease for individuals with OA of the hip and knee, and to create a composite measure of these 3 domains to define states of OA severity and a surrogate measure of "need for joint replacement surgery." Methods. For pain, focus groups and one-on-one interviews were used. For function, Rasch analysis was performed on existing indices - the Hip Dysfunction and Osteoarthritis Outcome Score (HOOS) and the Knee injury and Osteoarthritis Outcome Score (KOOS), each of which subsumes the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questions. For structure, a comparison of existing indices (Kellgren-Lawrence, OARSI stages, and joint space width) was performed for the hip and the knee. Results. For pain, key features of pain that are most distressing to people with OA from early to late disease were identified. For function, the reduction of the number of items based on the existing indices continues. For structure, the analysis is also ongoing. Conclusion. Preliminary results were presented at OMERACT 8; the final objective will be to combine the 3 domains (pain, function, and structure) and to create a composite index that could define states of severity and "need for total joint replacement," which could be used to evaluate treatment response to disease-modifying drugs in OA clinical trials.
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| 3. |
- Maillefert, Jean-Francis, et al.
(författare)
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Concomitant therapy : an outcome variable for musculoskeletal disorders? Part 2: total joint replacement in osteoarthritis trials
- 2005
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Ingår i: Journal of Rheumatology. - 0315-162X. ; 32:12, s. 51-2449
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Tidskriftsartikel (refereegranskat)abstract
- Interest has grown in using the requirement of total joint replacement (TJR) as a "hard" outcome measure. Limitations exist, however, in the use of such an outcome, in particular the variability in the decision to perform surgery, length of surgical waiting lists, and sensitivity to change. This special interest group is exploring ways of retaining the clinical relevance of TJR but overcoming the problems--2 alternative outcomes are being considered: "time to physician's decision to recommend surgery" and "time to fulfilling criteria for total joint replacement."
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| 4. |
- Moseng, Tuva, et al.
(författare)
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EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis : 2023 update
- 2024
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Ingår i: Annals of the Rheumatic Diseases. - 1468-2060.
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Hip and knee osteoarthritis (OA) are increasingly common with a significant impact on individuals and society. Non-pharmacological treatments are considered essential to reduce pain and improve function and quality of life. EULAR recommendations for the non-pharmacological core management of hip and knee OA were published in 2013. Given the large number of subsequent studies, an update is needed.METHODS: The Standardised Operating Procedures for EULAR recommendations were followed. A multidisciplinary Task Force with 25 members representing 14 European countries was established. The Task Force agreed on an updated search strategy of 11 research questions. The systematic literature review encompassed dates from 1 January 2012 to 27 May 2022. Retrieved evidence was discussed, updated recommendations were formulated, and research and educational agendas were developed.RESULTS: The revised recommendations include two overarching principles and eight evidence-based recommendations including (1) an individualised, multicomponent management plan; (2) information, education and self-management; (3) exercise with adequate tailoring of dosage and progression; (4) mode of exercise delivery; (5) maintenance of healthy weight and weight loss; (6) footwear, walking aids and assistive devices; (7) work-related advice and (8) behaviour change techniques to improve lifestyle. The mean level of agreement on the recommendations ranged between 9.2 and 9.8 (0-10 scale, 10=total agreement). The research agenda highlighted areas related to these interventions including adherence, uptake and impact on work.CONCLUSIONS: The 2023 updated recommendations were formulated based on research evidence and expert opinion to guide the optimal management of hip and knee OA.
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| 5. |
- Persson, Johan K, et al.
(författare)
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Ultrasound nucleolysis: an in vitro study.
- 2002
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Ingår i: Ultrasound in Medicine and Biology. - 0301-5629. ; 28:9, s. 1189-1197
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Tidskriftsartikel (refereegranskat)abstract
- Thermal intradiscal therapy for chronic low back pain, using a catheter inserted into the intervertebral disc, is becoming more popular in the treatment of low back pain. The aim of this study was to investigate the possibility of heating the nucleus pulposus of the intervertebral disc with high-intensity focused ultrasound (US) or HIFU. Two specific situations were considered, invasive transducers that would be in contact with the annulus fibrosus of the disc, and noninvasive transducers that could be used externally. Theoretical simulations were performed to find the optimal parameters of US transducers and then experimental studies were done using transducers made to these specifications. These experiments confirmed that it was possible to heat the discs with HIFU. Two orthogonal transducers resulted in a superior temperature distribution than using just one transducer. It is, therefore, feasible to consider thermal treatment of the nucleus pulposus of the disc using noninvasive US. (E-mail: Johan.Persson@ort.lu.se)
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| 6. |
- Zanoli, Gustavo, et al.
(författare)
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Introduction: e_Musk1.
- 2003
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Ingår i: Acta Orthopaedica Scandinavica. - 0001-6470. ; 73:Suppl 305, s. 1-1
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Tidskriftsartikel (refereegranskat)
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| 7. |
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| 8. |
- Zanoli, Gustavo
(författare)
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Outcome Assessment in Lumbar Spine Surgery
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- No consensus regarding outcomes assessment in spine patients exists. Health-Related Quality of Life (HRQoL) questionnaires are increasingly used. The objective of this thesis was the evaluation of HRQoL measures before and after lumbar spine surgery, and their relation to other evaluation parameters as well as relevance of differences. The patients included were operated on for lumbar spine disorders at the Lund University, Department of Orthopedics and included in the Swedish National Lumbar Spine Registry. Baseline (before surgery) data include age, sex, smoking habits, duration of preoperative back and leg pain as well as sick leave, number of previous operations, and working status. Pre- and postoperatively VAS pain scores and the SF-36 questionnaire on HRQoL are registered as well as analgesic intake, walking distance and at follow-up change in leg and back pain as well as patient satisfaction. The number of proposed outcome instruments is too high and a consensus on best HRQoL is required. The data collection protocol of the Swedish National Lumbar Spine Registry can reliably detect postoperative improvements between large groups of patients. Pain intensity measured on the VAS scale correlates significantly to other indicators of perceived pain. HRQoL as measured by SF-36 showed a pronounced reduction compared to healthy and LBP population preoperatively. One year after surgery improvement in all domains of the SF-36 except general health was seen. The global effect of lumbar spine surgery in the sample is similar to effect sizes of other successful orthopaedic interventions. The use of standardized outcome measures allows international comparisons, although caution should be used in the interpretation of differences.
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