Physiotherapy management of lower limb osteoarthritis

© The Author 2017. Published by Oxford University Press. Background Osteoarthritis (OA) of the lower limb affects millions of people worldwide, and results in pain and reduced function. We reviewed guidelines and Cochrane reviews for physical therapy interventions to manage the condition. Sources of data Evidence from meta-analyses and systematic reviews was included. We also identified the recommendations from guidelines relevant to practice in the UK. Areas of agreement There is strongest evidence to support the use of exercise to improve pain, function and quality of life. Areas of controversy There is limited evidence to support the use of some commonly utilized physiotherapy interventions. National Institute for Health and Clinical Excellence do not recommend the use of acupuncture. Growing points Programmes that include single exercise type may be more beneficial than combined strengthening and aerobic interventions. Areas timely for developing research Further research is required to determine how to facilitate long-term engagement with exercise to sustain the beneficial effects on pain, function and quality of life. Studies that investigate packages of care, combining interventions require further investigation

Reference problem and how children use gesture and grammatical number to solve it

This thesis examines 2- and 3-year-olds’ understanding of social cues (specifically body orientation and pointing) and grammatical cues (specifically number marking) to reference in a series of three experiments using the Intermodal Preferential Looking Paradigm. Experiment 1 examines grammatical cues. It investigates whether 2- and 3-year-olds can follow grammatical number when the potential referents belong to the same category (e.g. one knife guard versus 14 knife guards). All previous relevant studies have involved potential referents that belong to different categories (e.g. one lemon juicer versus 14 honey spoons). It is possible that this manipulation makes the task of following grammatical number easier as the categorisation component is already done. If so, previous studies may overestimate children’s ability to follow grammatical number in the real world. In addition, Experiment 1 asks whether children follow the combination of nominal and verbal number marking (e.g. ‘There are the zoots!’) more than they follow nominal number marking alone (e.g. ‘Look at the zoot!’). One previous study shows a preference for multiple number marking, but only with familiar labels and referents. A preference of this kind is referred to as the effect of cue quantity. Experiment 2 examines social cues and asks whether 2- and 3-year-olds can follow body and head orientation in a referential context. This has not previously been tested experimentally and has implications for children’s ability to learn from observation. Experiment 2 also asks whether children follow the combination of body orientation and pointing more than body orientation alone. In the existing literature there are hints of this preference, but previous studies are inconclusive. The experiment therefore looks for the effect of cue quantity in both grammatical and social cues. Experiments 1 and 2 were designed as pre-tests for Experiment 3 to demonstrate that children could follow the targeted cues (body orientation and number marking) in isolation. Experiment 3 builds on these experiments by exploring changes in children’s use of body orientation and number marking across development. In doing so, it aims to bring evidence to bear on a possible shift from reliance on social cues to a reliance on grammatical cues. This is achieved by comparing 2- and 3-year-olds’ use of these cues in two conditions: a congruent condition (in which they point to the same referent), and an incongruous condition (in which they point to different referents). Experiment 1 showed that 2- and 3-year-olds did not follow grammatical number when the potential referents belonged to the same category. Experiment 2 showed 2- and 3- year-olds did not follow head and body orientation. Experiment 3 showed, however, that when these cues were presented together (i.e. with both pointing at the same target) children did show some sensitivity to these cues. This was only the case on singular trials (i.e. when the speaker turned to look at the individual object and produced a sentence containing a singular noun). I argue that in this condition perceptual saliency, as well as body orientation and grammatical number, pointed to the individual object being the target. I interpret this either as evidence in support of the effect of cue quantity or as evidence that 2-year-olds, but not 3-year-olds, continue to use perceptual salience as a cue to reference

Exercise for lower limb osteoarthritis : systematic review incorporating trial sequential analysis and network meta-analysis

Objective: To determine whether there is sufficient evidence to conclude that exercise interventions are more effective than no exercise control and to compare the effectiveness of different exercise interventions in relieving pain and improving function in patients with lower limb osteoarthritis. Data sources: Nine electronic databases searched from inception to March 2012. Study selection: Randomised controlled trials comparing exercise interventions with each other or with no exercise control for adults with knee or hip osteoarthritis. Data extraction: Two reviewers evaluated eligibility and methodological quality. Main outcomes extracted were pain intensity and limitation of function. Trial sequential analysis was used to investigate reliability and conclusiveness of available evidence for exercise interventions. Bayesian network meta-analysis was used to combine both direct (within trial) and indirect (between trial) evidence on treatment effectiveness. Results: 60 trials (44 knee, two hip, 14 mixed) covering 12 exercise interventions and with 8218 patients met inclusion criteria. Sequential analysis showed that as of 2002 sufficient evidence had been accrued to show significant benefit of exercise interventions over no exercise control. For pain relief, strengthening, flexibility plus strengthening, flexibility plus strengthening plus aerobic, aquatic strengthening, and aquatic strengthening plus flexibility, exercises were significantly more effective than no exercise control. A combined intervention of strengthening, flexibility, and aerobic exercise was also significantly more effective than no exercise control for improving limitation in function (standardised mean difference −0.63, 95% credible interval −1.16 to −0.10). Conclusions: As of 2002 sufficient evidence had accumulated to show significant benefit of exercise over no exercise in patients with osteoarthritis, and further trials are unlikely to overturn this result. An approach combining exercises to increase strength, flexibility, and aerobic capacity is likely to be most effective in the management of lower limb osteoarthritis. The evidence is largely from trials in patients with knee osteoarthritis

Identification and evaluation of self-reported physical activity instruments in adults with osteoarthritis: a systematic review.

OBJECTIVETo identify and evaluate the measurement properties of self-report physical activity (PA) instruments suitable for those with osteoarthritis (OA).METHODSA comprehensive two-stage systematic review using multiple electronic databases from inception until July 2018. Stage One sought to identify all self-reported PA instruments used in populations with joint pain attributable to OA in the foot, knee, hip or hand. Stage Two searched for and appraised studies investigating the measurement properties of the instruments identified. For both stages all articles were screened for study eligibility criteria, completed data extraction using the Qualitative Attributes and Measurement Properties of Physical Activity Questionnaires (QAPAQ) checklist, and conducted methodology quality assessments using a modified COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. Measurement properties for each physical activity instrument were evaluated and combined using narrative synthesis.RESULTSStage One identified 23 unique self-report PA instruments. Stage Two identified 53 studies that evaluated the measurement properties of 13 of the 23 instruments identified. Instrument reliability varied from inadequate to adequate (ICC==0.7). Instrument construct and criterion validity assessment demonstrated small to moderate correlations with direct measures of PA. Responsiveness was assessed in only 1 instrument and was unable to detect changes in comparison to accelerometers.CONCLUSIONWhile many instruments were identified as potentially suitable for use in individuals with OA, none demonstrated adequate measurement properties across all domains of reliability, validity and responsiveness. Further high-quality assessment of self-reported PA instruments is required before such measures can be recommended for use in OA research

Characterisation of the protein corona using tunable resistive pulse sensing: determining the change and distribution of a particle’s surface charge

The zeta potential of the protein corona around carboxyl particles has been measured using tunable resistive pulse sensing (TRPS). A simple and rapid assay for characterising zeta potentials within buffer, serum and plasma is presented monitoring the change, magnitude and distribution of proteins on the particle surface. First, we measure the change in zeta potential of carboxyl-functionalised nanoparticles in solutions that contain biologically relevant concentrations of individual proteins, typically constituted in plasma and serum, and observe a significant difference in distributions and zeta values between room temperature and 37 °C assays. The effect is protein dependent, and the largest difference between the two temperatures is recorded for the γ-globulin protein where the mean zeta potential changes from −16.7 to −9.0 mV for 25 and 37 °C, respectively. This method is further applied to monitor particles placed into serum and/or plasma. A temperature-dependent change is again observed with serum showing a 4.9 mV difference in zeta potential between samples incubated at 25 and 37 °C; this shift was larger than that observed for samples in plasma (0.4 mV). Finally, we monitor the kinetics of the corona reorientation for particles initially placed into serum and then adding 5 % (V/V) plasma. The technology presented offers an interesting insight into protein corona structure and kinetics of formation measured in biologically relevant solutions, i.e. high protein, high salt levels, and its particle-by-particle analysis gives a measure of the distribution of particle zeta potential that may offer a better understanding of the behaviour of nanoparticles in solution

Erratum to: Characterisation of the protein corona using tunable resistive pulse sensing: determining the change and distribution of a particle’s surface charge

Erratum to: Characterisation of the protein corona using tunable resistive pulse sensing: determining the change and distribution of a particle’s surface charg

Characterisation of the protein corona using tunable resistive pulse sensing: determining the change and distribution of a particle’s surface charge

The zeta potential of the protein corona around carboxyl particles has been measured using tunable resistive pulse sensing (TRPS). A simple and rapid assay for characterising zeta potentials within buffer, serum and plasma is presented monitoring the change, magnitude and distribution of proteins on the particle surface. First, we measure the change in zeta potential of carboxyl-functionalised nanoparticles in solutions that contain biologically relevant concentrations of individual proteins, typically constituted in plasma and serum, and observe a significant difference in distributions and zeta values between room temperature and 37 °C assays. The effect is protein dependent, and the largest difference between the two temperatures is recorded for the γ-globulin protein where the mean zeta potential changes from −16.7 to −9.0 mV for 25 and 37 °C, respectively. This method is further applied to monitor particles placed into serum and/or plasma. A temperature-dependent change is again observed with serum showing a 4.9 mV difference in zeta potential between samples incubated at 25 and 37 °C; this shift was larger than that observed for samples in plasma (0.4 mV). Finally, we monitor the kinetics of the corona reorientation for particles initially placed into serum and then adding 5 % (V/V) plasma. The technology presented offers an interesting insight into protein corona structure and kinetics of formation measured in biologically relevant solutions, i.e. high protein, high salt levels, and its particle-by-particle analysis gives a measure of the distribution of particle zeta potential that may offer a better understanding of the behaviour of nanoparticles in solution

The attitudes towards, and beliefs about, physical activity in people with osteoarthritis and comorbidity: A qualitative investigation

OBJECTIVE: To investigate the attitudes towards, and beliefs about, physical activity (PA) in older adults with osteoarthritis (OA) and comorbidity to understand experiences and seek ways to improve PA participation. METHODS: Semi-structured interviews with adults aged =45, with self-reported OA and comorbidity (N = 17). Face-to-face interviews explored participant perspectives regarding; (1) attitudes and beliefs about PA in the context of OA and comorbidity and (2) how people with OA and comorbidity could be encouraged to improve and maintain PA levels. Data were transcribed verbatim and inductive thematic analysis was undertaken using a framework approach. RESULTS: Participants did not conceptualise multiple long-term conditions (LTCs) together and instead self-prioritised OA over other LTCs. Barriers to PA included uncertainty about both the general management of individual LTCs and the effectiveness of PA for their LTCs; and, negative perceptions about their health, ageing and PA. Participants experienced dynamic and co-existing barriers to PA, and problematized this as a multi-level process, identifying a barrier, then a solution, followed by a new barrier. Facilitators of PA included social support and support from knowledgeable healthcare professionals (HCPs), together with PA adapted for OA and comorbidity and daily life. PA levels could be increased through targeted interventions to increase self-efficacy for managing OA alongside other LTCs and self-efficacy for PA. CONCLUSION: People with OA and comorbidity experience complicated PA barriers. To increase PA levels, tailored PA interventions could include HCP and social support to anticipate and overcome multi-level PA barriers and target increased self-efficacy for LTC management and PA