Biomechanical mechanisms underlying treatment effects of exercise therapy in patients with knee osteoarthritis: data from a randomized controlled trial

The aim of this paper is to briefly show the importance of the spatial organisation and of the temporal evolution of road transport in Belgium (freight, passengers). Attention is particularly put on the negative externalities produced by this transportation mode type (pollution, road damages, road accidents).L'objectif de cet article est de montrer brièvement l'importance de l'organisation spatiale et de l'évolution temporelle du transport routier de marchandises et de passagers en Belgique. Une attention particulière est portée aux externalités négatives produites par ce mode de transport (pollution, dégradations routières, accidents de la route).Het opzet van deze bijdrage bestaat erin om op een beknopte wijze het belang aan te tonen van de ruimtelijke organisatie en evolutie doorheen de tijd van het wegtransport in België (perso-nen zowel als vracht). Er is ook aandacht besteed aan negatieve externaliteiten veroorzaakt door dit type van transportmodus.Thomas Isabelle, Verhetsel Ann. Transport routier et mobilité durable : un état de la question pour la Belgique. In: Hommes et Terres du Nord, 1999/3. La Belgique. pp. 198-204

The Association Between Self-reported Low Back Pain and Radiographic Lumbar Disc Degeneration of the Cohort Hip and Cohort Knee (CHECK) Study

Abstract Study design. Cross-sectional study, nested in a prospective cohort (Cohort Hip and Knee, CHECK). Objective.Low back pain (LBP) is very common and the main cause of activity limitations and work absence throughout the world. Although lumbar disc degeneration (LDD) is suggested as a cause of LBP, this association remains debatable. Therefore, this study assessed the association between the radiographic features of LDD and the presence of self-reported LBP, LBP persisting longer than three months, the perceived severity of LBP and presence of neuropathic pain. Summary of Background Data. Previous literature suggest an association between LBP and both the LDD definitions osteophytes and disc space narrowing. There are no studies that have explored the association between LDD and neuropathic pain. Methods. Associations between the radiographic LDD using two definitions (i.e. osteophytes, disc space narrowing) versus the presence of LBP, LBP > 3 months, severe LBP and neuropathic pain,were analyzed with logistic regression models. Results. A total of 699 participantscompleted the questionnaire and had a lumbar radiograph. Radiographs were scored by two independent observers. Osteophytes were present in 98% of the population and disc space narrowing in 67%. Osteophytes were not significantly associated with LBP (OR=1.2, 95% CI 0.9-1.7).Disc space narrowing was significantly associated with the presence of LBP and neuropathic pain.(OR=1.7, 95% CI=1.2-2.4 and OR 1.7, 95% CI 1.1-2.7, respectively). The presence of a LBPseverity score of ≥4, and LBP persisting >3 months were not significantly associated with the two definitions of LDD. Conclusions.This study shows the presence of an association between disc space narrowing, whereas no association was found between osteophytes and LBP. We are the first t

Impact of self-reported comorbidity on physical and mental health status in early symptomatic osteoarthritis: the CHECK (Cohort Hip and Cohort Knee) study

Pathophysiology and treatment of rheumatic disease

Mind the MIC: large variation among populations and methods

Objective: There is no consensus on the best method to determine the minimal important change (MIC) of patient-reported outcomes. Recent publications recommend the use of multiple methods. Our aim was to assess whether different methods lead to consistent values for the MIC. Study Design and Setting: We used two commonly used anchor-based methods and three commonly used distribution-based methods to determine the MIC of the subscales: pain and physical functioning of the Western Ontario and McMaster University Osteoarthritis Index questionnaire in five different studies involving patients with hip or knee complaints. We repeated the anchor-based methods using relative change scores, to adjust for baseline scores. Results: We found large variation in MIC values by the same method across studies and across different methods within studies. We consider it unlikely that this variation can be explained by differences between disease groups, disease severity, or lengths of follow-up. The variation persisted when using relative change scores. It was not possible to conclude whether this variation is because of true differences in MIC values between populations or to conceptual and methodological problems of the MIC methods. Conclusion: To better disentangle these two possible explanations, the MIC methodology should be improved and standardized. In the meantime, caution is needed when interpreting and using published MIC values. (C) 2010 Elsevier Inc. All rights reserved.

Three trajectories of activity limitations in early symptomatic knee osteoarthritis: a 5-year follow-up study

Objectives Knee osteoarthritis (OA) is a leading cause of activity limitations. The knee OA population is likely to consist of subgroups. The aim of the present study was to identify homogeneous subgroups with distinct trajectories of activity limitations in patients with early symptomatic knee OA and to describe characteristics of these subgroups. Methods Follow-up data over a period of 5 years of 697 participants with early symptomatic knee OA from the Cohort Hip and Cohort Knee (CHECK) were used. Activity limitations were measured yearly with the Western Ontario and McMaster Universities Osteoarthritis Index. Latent class growth analyses identified homogeneous subgroups with distinct trajectories of activity limitations. Multivariable regression analyses examined differences in characteristics between the subgroups. Results Three subgroups were identified. Participants in Subgroup 1 (?egood outcome?f; n=330) developed or displayed slight activity limitations over time. Participants in Subgroup 2 (?emoderate outcome?f; n=257) developed or displayed moderate activity limitations over time. Participants in subgroup 3 (?epoor outcome?f; n=110) developed or displayed severe activity limitations over time. Compared with the ?egood outcome?f subgroup, the ?emoderate outcome?f and ?epoor outcome?f subgroups were characterised by: younger age, higher body mass index, greater pain, bony tenderness, reduced knee flexion, hip pain, osteophytosis, .3 comorbidities, lower vitality or avoidance of activities. Conclusions Based on the 5-year course of activity limitations, we identified homogeneous subgroups of knee OA patients with good, moderate or poor outcome. Characteristics of these subgroups were consistent with existing knowledge on prognostic factors regarding activity limitations, which supports the validity of this classification

The ability of systemic biochemical markers to reflect presence, incidence, and progression of early-stage radiographic knee and hip osteoarthritis: Data from CHECK

Objective: To relate systemic biochemical markers of joint metabolism to presence, incidence, and progression of early-stage radiographic knee and/or hip osteoarthritis (OA). Method: The cartilage markers uCTX-II, sCOMP, sPIIANP, and sCS846, bone markers uCTX-I, uNTX-I, sPINP, and sOC, and synovial markers sHA and sPIIINP were assessed by enzyme-linked immunosorbent assay or radioactive immunoassay in baseline samples of CHECK (Cohort Hip and Cohort Knee), a cohort study of early-stage symptomatic knee and/or hip OA. Knee and hip radiographs were obtained at baseline and 5-year follow-up. Presence of OA at baseline was defined as Kellgren and Lawrence (K&L)=1 (maximum observed). Incidence of OA was defined as K&L=0 at baseline and K&L≥1 at 5-year follow-up. Progression of OA was defined as K&L=1 at baseline and K&L≥2 at 5-year follow-up. Results: Data were available for 801 subjects at baseline and for 723 subjects at both baseline and 5-year follow-up. Multiple cartilage and synovial markers showed positive associations with presence and progression of knee and hip OA and with incidence of hip OA, except for negative associations of uCTX-II and sCOMP with incidence of knee OA. uCTX-II and sCOMP showed multiple interactions with other biomarkers in their associations with knee and hip OA. Bone markers were positively associated with presence of radiographic knee OA, but negatively associated with progression of radiographic hip OA. Conclusion: Especially metabolism in cartilage and synovial matrix appear to be of relevance in knee and hip OA. The role of bone metabolism appears to differ between knee and hip OA