A mixed methods study of knee confidence and self-efficacy: perceptions of knee osteoarthritis patients from the good life with osteoarthritis in Denmark initiative

Purpose: The Good Life with osteoArthritis in Denmark (GLA:D) Initiative is an evidence-based treatment programme for patients with knee and hip osteoarthritis (OA). It incorporates training physiotherapists to deliver care in accordance with the clinical guidelines by educating patients on their condition and by delivering supervised neuromuscular exercises to relieve pain and improve function. The importance of self-efficacy, and confidence in exercise, to exercise adherence has not been reported for the GLA:D population. In addition, worse knee confidence in people with knee OA is associated with higher pain and greater perceived knee instability. The aims of this study were to investigate the association between knee confidence and self-efficacy in patients with knee OA in the GLA:D registry; and to explore patients’ perception of their experiences with the GLA:D programme, and whether confidence and self-efficacy has a role to play in continuing with the GLA:D exercises in the long-term. Methods: This study used a mixed methods design. Patients with knee OA who were offered at least two educational sessions and six weeks of GLA:D exercise programme between January–March 2015 were identified from the GLA:D registry (n = 484) and sent an online survey. Ordinal regression analyses were performed. Knee confidence, assessed using the Knee injury and Osteoarthritis Outcomes Score (KOOS; quality of life subscale, question 3), was the dependent variable and self-reported measures for exercise self-efficacy; arthritis self-efficacy; multidimensional outcomes expectations for exercise; and KOOS pain and activities of daily living (ADL) were the independent variables. Knee confidence score ranged from 0–4 with 0 indicating higher knee confidence. The independent variables ranged from 0–10 or 0–100 with 0 indicating worse symptoms or confidence. Subsequently, semi-structured interviews (n = 4) were used to explore patients’ perceived confidence and adherence to the GLA:D exercises. Interviews were transcribed verbatim, and analysed using interpretative phenomenological analysis. Results: 200 patients (41.3%) responded to the survey. At 7–10 months following treatment initiation, 9.5% of patients were not at all troubled by lack of knee confidence; 39.5% were mildly troubled; 31.5% were moderately troubled; 15.5% were severely troubled; and 4% were extremely troubled. Patients with higher arthritis self-efficacy score were more likely to have higher knee confidence (odds ratio [OR] = 0.76; 95% confidence interval [CI] 0.63, 0.93; P = 0.007). Patients with higher KOOS ADL score were more likely to have higher knee confidence, although this association was small (OR = 0.96; 95% CI 0.93, 0.99; P = 0.006). No association was found between knee confidence and exercise self-efficacy (OR = 1.00; 95% CI 0.99, 1.01; P = 0.90). Patients reflected on seeing great improvements in their confidence, pain and mobility with the programme. They felt their symptoms got worse if they did not keep up with the exercises. Patients reflected on the importance of continued contact with their physiotherapist after the 6-week programme for further motivation and reassurance. One of the barriers that discouraged patients from continuing with the exercises in the long-term was the cost for additional GLA:D exercise classes with their physiotherapist. Conclusions: Patients are troubled by the lack of knee confidence after the GLA:D exercise programme; they reflected this was due to their negative experiences prior to entering the GLA:D programme. Arthritis self-efficacy and KOOS ADL were significantly associated with knee confidence, but no association was found with exercise self-efficacy. Patients from the interview reflected that maintaining contact with their physiotherapist was an important factor to motivate them to continue exercising

Simple advice for a simple ankle sprain? The not so benign ankle injury

Editorial. No abstract available

Collisionless Relaxation in Galactic Dynamics and the Evolution of Long Range Order

This talk provides a critical assessment of collisionless galactic dynamics, focusing on the interpretation and limitations of the collisionless Boltzmann equation and the physical mechanisms associated with collisionless relaxation. Numerical and theoretical arguments are presented to motivate the idea that the evolution of a system far from equilibrium should be interpreted as involving nonlinear gravitational Landau damping, which implies a greater overall coherence and remembrance of initial conditions than is implicit in the conventional theory of violent relaxation.Comment: 20 pages, plain latex, no macros required, no figures a talk presented at the 1997 Florida Workshop on Nonlinear Astronomy and Physics, to appear in Annals of the New York Academy of Science

Recreational Physical Activity and Risk of Incident Knee Osteoarthritis: An International Meta-Analysis of Individual Participant–Level Data

Objective: The effect of physical activity on the risk of developing knee osteoarthritis (OA) is unclear. We undertook this study to examine the relationship between recreational physical activity and incident knee OA outcomes using comparable physical activity and OA definitions. Methods: Data were acquired from 6 global, community-based cohorts of participants with and those without knee OA. Eligible participants had no evidence of knee OA or rheumatoid arthritis at baseline. Participants were followed up for 5–12 years for incident outcomes including the following: 1) radiographic knee OA (Kellgren-Lawrence [K/L] grade ≥2), 2) painful radiographic knee OA (radiographic OA with knee pain), and 3) OA-related knee pain. Self-reported recreational physical activity included sports and walking/cycling activities and was quantified at baseline as metabolic equivalents of task (METs) in days per week. Risk ratios (RRs) were calculated and pooled using individual participant data meta-analysis. Secondary analysis assessed the association between physical activity, defined as time (hours per week) spent in recreational physical activity and incident knee OA outcomes. Results: Based on a total of 5,065 participants, pooled RR estimates for the association of MET days per week with painful radiographic OA (RR 1.02 [95% confidence interval (95% CI) 0.93–1.12]), radiographic OA (RR 1.00 [95% CI 0.94–1.07]), and OA-related knee pain (RR 1.00 [95% CI 0.96–1.04]) were not significant. Similarly, the analysis of hours per week spent in physical activity also showed no significant associations with all outcomes. Conclusion: Our findings suggest that whole-body, physiologic energy expenditure during recreational activities and time spent in physical activity were not associated with incident knee OA outcomes

Constructing chronologies in Viking Age Iceland: Increasing dating resolution using Bayesian approaches

yesPrecise chronologies underpin all aspects of archaeological interpretation and, in addition to improvements in scientific dating methods themselves, one of the most exciting recent developments has been the use of Bayesian statistical analysis to reinterpret existing information. Such approaches allow the integration of scientific dates, stratigraphy and typological data to provide chronologies with improved precision. Settlement period sites in Iceland offer excellent opportunities to explore this approach, as many benefit from dated tephra layers and AMS radiocarbon dates. Whilst tephrochronology is widely used and can provide excellent chronological control, this method has limitations; the time span between tephra layers can be large and they are not always present. In order to investigate the improved precision available by integrating the scientific dates with the associated archaeological stratigraphy within a Bayesian framework, this research reanalyses the dating evidence from three recent large scale excavations of key Viking Age and medieval sites in Iceland; Aðalstræti, Hofstaðir and Sveigakot. The approach provides improved chronological precision for the dating of significant events within these sites, allowing a more nuanced understanding of occupation and abandonment. It also demonstrates the potential of incorporating dated typologies into chronological models and the use of models to propose sequences of activities where stratigraphic relationships are missing. Such outcomes have considerable potential in interpreting the archaeology of Iceland and can be applied more widely to sites with similar chronological constraints.British Academy (MD120020) awarded to C. Batt. Rannís PhD funding for M.Schmid.The full text was made available at the end of the publisher's embargo

Processos de democracia direta: sim ou não? Os argumentos clássicos à luz da teoria e da prática

Regularmente surgem controvérsias sobre os processos de democracia direta, dos quais os mecanismos mais frequentes são a iniciativa popular, o plebiscito e o referendo. Por um lado, há autores que defendem a posição de que essas instituições tornam o jogo político mais lento, caro, confuso e ilegítimo; outros defendem a posição contrária e argumentam que processos de democracia direta são fundamentais para os cidadãos e a qualidade da democracia. O presente estudo analisa esse tema em torno de sete questões, baseadas em considerações teóricas e pesquisas empíricas: 1. A questão entre o minimalismo e o maximalismo democrático; 2. A concorrência entre maioria e minoria; 3. A concorrência entre as instituições representativas e os processos de democracia direta; 4. A questão da competência dos cidadãos; 5. A questão dos efeitos colaterais dos processos de democracia direta; 6. A questão do tamanho do eleitorado; 7. A questão dos custos dos processos de democracia direta. As sete questões são analisadas a partir de uma revisão bibliográfica que considera tanto fontes nacionais como internacionais. O estudo mostra que os processos de democracia direta podem ser um complemento para as instituições representativas em um sistema democrático. O bom desempenho dos plebiscitos, referendos e iniciativas populares depende tanto da regulamentação destes como também do desempenho das outras instituições políticas e da situação socioeconômica de um país. O estudo permite ampliar e aprofundar o debate sobre processos de democracia direta no Brasil

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

The prevalence and factors associated with knee pain in Great Britain's Olympians aged 40 years and older.

Purpose: affecting approximately one in four adults over the age of 40 years in the UK, knee pain is the most common presenting feature of osteoarthritis (OA). Despite the plethora of studies that have investigated the factors associated with the onset of knee pain in the sedentary population, relatively little is known about the prevalence and occupational factors associated with knee pain in an athletic sporting population. This study aimed to determine in Great Britain’s (GB) Olympians, aged 40 years and older, (1) the individual factors