Feasibility and Preliminary Efficacy of a Physical Activity Counseling Intervention Using Fitbit in People With Knee Osteoarthritis: The TRACK-OA Study Protocol

Background Physical activity (PA) reduces pain and improves functioning in people with knee osteoarthritis (OA), but few people with the condition meet recommended PA guidelines. Successful intervention strategies to increase PA include goal setting, action planning, self-monitoring, and follow-up feedback from a healthcare professional. Recently developed consumer wearable activity trackers allow users to set activity goals, self-monitor daily goal-progress, and provide feedback on goal attainment. It is hypothesized that a multi-component physiotherapist-led intervention that includes a short (40-min) education module, guided goal-setting and action planning, the use of a wristband activity tracker, and weekly follow-up phone calls will lead to increased PA outcomes. Methods/design Thirty-six participants will be recruited from the community for a two-group pilot randomized controlled trial with a stepped-wedge design using an intention-to-treat analysis. Computer-generated block randomization will be performed using varying block sizes and a 1:1 allocation ratio. The 4-week intervention will be delivered immediately (immediate-intervention group) or after a 5-week delay (delayed-intervention group). Outcome measures of pain and disability (Knee Injury and OA Outcome Score), disease self-management ability (Partners in Health Scale), and objective bouted moderate-to-vigorous PA and sedentary time (BodyMedia SenseWear Mini Armband) will be collected at baseline (week 0) and two follow-ups (weeks 5 and 10), for a total study duration of 11 weeks. Feasibility data relating to process, resource, management, and scientific elements of the trial will be collected. Outcome measure and feasibility data will be summarized, and an estimate of intervention efficacy will be obtained by regression model with planned comparisons. The trial began recruiting in February 2015. To date, 34 subjects have been recruited. Discussion This study will evaluate the feasibility and preliminary efficacy of a novel intervention to promote PA in people living with knee OA. The results will provide valuable information to inform a larger randomized trial to assess intervention effectiveness

Consensus on exercise reporting template (Cert): Modified delphi study

© 2016 American Physical Therapy Association. Background. Exercise interventions are often incompletely described in reports of clinical trials, hampering evaluation of results and replication and implementation into practice. Objective. The aim of this study was to develop a standardized method for reporting exercise programs in clinical trials: the Consensus on Exercise Reporting Template (CERT). Design and Methods. Using the EQUATOR Network’s methodological framework, 137 exercise experts were invited to participate in a Delphi consensus study. A list of 41 items was identified from a meta-epidemiologic study of 73 systematic reviews of exercise. For each item, participants indicated agreement on an 11-point rating scale. Consensus for item inclusion was defined a priori as greater than 70% agreement of respondents rating an item 7 or above. Three sequential rounds of anonymous online questionnaires and a Delphi workshop were used. Results. There were 57 (response rate=42%), 54 (response rate=95%), and 49 (response rate=91%) respondents to rounds 1 through 3, respectively, from 11 countries and a range of disciplines. In round 1, 2 items were excluded; 24 items reached consensus for inclusion (8 items accepted in original format), and 16 items were revised in response to participant suggestions. Of 14 items in round 2, 3 were excluded, 11 reached consensus for inclusion (4 items accepted in original format), and 7 were reworded. Sixteen items were included in round 3, and all items reached greater than 70% consensus for inclusion. Limitations. The views of included Delphi panelists may differ from those of experts who declined participation and may not fully represent the views of all exercise experts. Conclusions. The CERT, a 16-item checklist developed by an international panel of exercise experts, is designed to improve the reporting of exercise programs in all evaluative study designs and contains 7 categories: materials, provider, delivery, location, dosage, tailoring, and compliance. The CERT will encourage transparency, improve trial interpretation and replication, and facilitate implementation of effective exercise interventions into practice

Should we be moving towards early controlled mobilization of extra-articular hand fractures in BC?

Hand fractures are the second most common fracture in both children and adults. They result in a considerable societal burden related to acute health care costs and lost socio-economic productivity due to a person's limited capacity to perform their normal functional activities throughout their recovery. Although early controlled mobilization (ECM) is commonly used following primary flexor tendon repairs and other equally fragile healing tissues in the hand, it is not commonly recommended for extra-articular hand fractures. There is scientific evidence to suggest that ECM of hand fractures has the potential to enhance early healing, improve regional hand soft tissue function and also lead to an improvement in a person's capacity to function throughout their recovery. However, ECM also may have a negative impact on healing and functional outcomes if introduced inappropriately. To date, the basic scientific and clinical literatures have not identified clear clinical parameters for the 'safe' introduction of ECM following an extraarticular hand fracture. Therefore, the overall objective of this research was to examine the potential clinical efficicacy of ECM following an extra-articular hand fractures as a possible alternative to acute post-fracture immobilization (IM) and to examine the implementation of ECM following an extra-articular hand fracture within the context of its application in the health care system in British Columbia (BC). A series of research inquires were completed, including a five year retrospective review of BC Linked Health Datasets (BCLHD) to define the incidence, demographics and acute health care utilization trends for hand fractures treated in BC; a systematic review of the literature to define the current level of scientifically validated clinical evidence related to early motion following an extra-articular hand fractures; and a pre-clinical efficacy trial examining the effect of early controlled passive motion (ECPM) on 4-point bending structural properties, dorsal fracture alignment and regional mineralized tissue distribution during early fracture healing (initial 28 days) in a closed, extraarticular metacarpal (simulated hand) fracture in a rabbit model. Between May 1,1996 and April 30, 2001 there were 72,481 hand fractures identified in the BCLHD with an estimated 14,500 hand fractures occurring each year in BC with no significant trend for a change over time in number or type of fractures. The annual incidence rate for hand fractures in BC was 36 / 10,000 people. Males were at a 2.1 greater relative risk for sustaining a hand fracture and they sustained most of this risk from the ages of 15 to 40. As well, markedly more hand fractures occurred in the spring and in the Northern Health Authority. In BC, most hand fractures (70%) were initially treated by primary care physicians, with the initial point of contact into the medical care system being either a physician's office or an emergency room setting. Finally, people in BC with more complex hand fracture injuries were referred to and treated quickly by surgeon specialists with only a small percentage (10%) admitted to hospital for management of their hand fracture. Consistent findings from a qualitative synthesis of six Quasi-Randomized Clinical Trials (Q-RCT) indicated that early motion following a simple, closed, extra-articular metacarpal fracture may lead to faster recovery of mobility, strength and return to work without affecting fracture alignment. In addition, in a closed metacarpal fracture in a rabbit model, when compared to fractures treated with IM, fractures treated with ECPM showed significantly (P < 0.05) better gains in 4-point bending initial stiffness (29% difference at twenty eight days), maximum stiffness (21% difference at twenty eight days), failure load (17% difference at twenty eight days) and energy absorbed per unit area (21% difference at twenty eight days), as well as, showing a significant reduction in dorsal fracture angulation (33% difference at twenty eight days). ECPM also had an apparent influence on the mineralized tissue distribution in the callus at the 28-day time period, possibly explaining the superior mechanical properties found in the rabbit healing model at this time point. Hand fractures are a common injury in BC, occurring most commonly in adolescent and young adult males during their most physically active and productive working years. Increased public awareness of hand fracture risk can lead to preventative measures that could reduce the incidence of hand fractures in BC. ECM following an extra-articular hand fracture warrants further randomized clinical investigation in humans as it has the potential to improve fracture healing and functional outcomes. Improved health outcomes following a hand fracture will reduce the socio-economic impact of this common injury in BC. Targeted education regarding the potential benefits of ECM following a hand fracture directed at clinicians treating hand fractures in BC will facilitate the recruitment of patients into future RCTs.Graduate and Postdoctoral StudiesGraduat

24-hour activity and sleep profiles in arthritis

Objectives: Identify 24-hour activity-sleep profiles in adults with arthritis and explore factors associated with profile membership. Methods: Cross-sectional cohort, using baseline data from two randomized trials studying activity counselling for people with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) or knee osteoarthritis (OA). Participants wore activity monitors for 1-week and completed surveys for demographics, mood (Patient Health Questionnaire-9) and sitting and walking habits (Self-Reported Habit Index). 1440 minutes / day stratified into minutes off-body, sleeping, resting, non-ambulatory, and intermittent or purposeful ambulation. Latent class analysis determined cluster numbers; baseline-category multinomial logit regression identified factors associated with cluster membership. Results: 172 people (RA: 51%, OA:30%, SLE: 19%). Clusters: High Sitters: 6.9 hours sleep, 1.6 hours rest, 13.2 hours non-ambulatory, 1.6 hours intermittent and 0.3 hours purposeful walking. Low Sleepers: 6.5 hours sleep, 1.2 hours rest, 12.2 hours non-ambulatory, 3.3 hours intermittent and 0.6 hours purposeful walking. High Sleepers: 8.4 hours sleep, 1.9 hours rest, 10.4 hours nonambulatory, 2.5 hours intermittent and 0.3 hours purposeful walking. Balanced Activity: 7.4 hours sleep, 1.5 hours sleep, 9.4 hours non-ambulatory, 4.4 hours intermittent and 0.8 hours purposeful walking. Younger age [OR: 0.95 (95% CI: 0.91-0.99)], weaker occupational sitting habit [OR: 0.55 (95% CI: 0.41-0.76)] and stronger walking outside habit [OR: 1.43 (95% CI: (1.06-1.91)] were each associated with Balanced Activity relative to High Sitters. Conclusions: Meaningful subgroups were identified based on 24-hour activity-sleep patterns. Suggesting tailoring interventions based on 24-hour activity-sleep profiles may be indicated, particularly in adults with stronger habitual sitting or weaker walking behaviors.Medicine, Faculty ofNon UBCPhysical Therapy, Department ofReviewedFacultyPostdoctora

Micro-structural bone changes in early rheumatoid arthritis persist over 1-year despite use of disease modifying anti-rheumatic drug therapy

Background: We used High Resolution – peripheral Quantitative CT (HR-pQCT) imaging to examine peri-articular bone quality in early rheumatoid arthritis (RA) and explore whether bone quality improved over 12-months in individuals receiving care consistent with practice guidelines. Methods: A 1-year longitudinal cohort study (Baseline and 12-months) evaluating individuals with early RA compared to age/sex-matched peers. Personal demographic and health and lifestyle information were collected for all. Whereas, active joint count (AJC28), functional limitation, and RA medications were also collected for RA participants. HR-pQCT imaging analyses quantified bone density and microstructure in the Metacarpal Head (MH) and Ultra-Ultra-Distal (UUD) radius at baseline and 12-months. Analyses included a General Linear Modelling repeated measures analyses examined main effects for disease, time, and interaction on bone quality. Results: Participants (n = 60, 30 RA/30 NRA); 80% female, mean age 53 (varying from 21 to 74 years). At baseline, RA participants were on average 7.7 months since diagnosis, presenting with few active joints (AJC28: 30% none, remaining 70% Median 4 active joints) and minimal self-reported functional limitation (mHAQ-DI0–3: 0.56). At baseline, 29 of 30 RA participants had received one or more non-biologic disease-modifying anti-rheumatic drugs (DMARD);13 in combination with glucocorticoid and 1 in combination with a biologic medication. One participant only received glucocorticoid medication. Four RA participants withdrew leaving 26 pairs (n = 52) at 12-months; 23 pairs (n = 46) with UUD and 22 pairs (n = 44) with MH baseline and 12-month images to compare. Notable RA/NRA differences (p < 0.05) in bone quality at all three sites included lower trabecular bone density and volume, more rod-like trabeculae, and larger and more variable spaces between trabeculae; fewer trabeculae at the UUD and MH2 sites; and lower cortical bone density and volume in the MH sites. Rate of change over 12-months did not differ between RA/NRA participants which meant there was also no improvement over the year in RA bone quality. Conclusions: Early changes in peri-articular bone density and microstructure seen in RA are consistent with changes more commonly seen in aging bone and are slow or resistant to recover despite well controlled inflammatory joint symptoms with early DMARD therapy.Medicine, Faculty ofOther UBCNon UBCPhysical Therapy, Department ofReviewedFacult

Additional file 1: Table S4. of Micro-structural bone changes in early rheumatoid arthritis persist over 1-year despite use of disease modifying anti-rheumatic drug therapy

HR-pQCT Time (Baseline vs 12-months) Main Effects Summary. Summary of data and statistical results for the Time main (Baseline vs 12-months) effect analyses. Table S5. HR-pQCT Interaction [Disease (RA vs NRA) x Time (Baseline vs 12-months)] Main Effects Summary. Summary of data and statistical results for the Interaction (Disease x Time) main effect analyses. (XLSX 22 kb

A customized protocol to assess bone quality in the metacarpal head, metacarpal shaft and distal radius: a high resolution peripheral quantitative computed tomography precision study

Background: High Resolution-Peripheral Quantitative Computed Tomography (HR-pQCT) is an emerging technology for evaluation of bone quality in Rheumatoid Arthritis (RA). However, there are limitations with standard HR-pQCT imaging protocols for examination of regions of bone commonly affected in RA. We developed a customized protocol for evaluation of volumetric bone mineral density (vBMD) and microstructure at the metacarpal head (MH), metacarpal shaft (MS) and ultra-ultra-distal (UUD) radius; three sites commonly affected in RA. The purpose was to evaluate short-term measurement precision for bone density and microstructure at these sites. Methods: 12 non-RA participants, individuals likely to have no pre-existing bone damage, consented to participate [8 females, aged 23 to 71 y [median (IQR): 44 (28) y]. The custom protocol includes more comfortable/stable positioning and adapted cortical segmentation and direct transformation analysis methods. Dominant arm MH, MS and UUD radius scans were completed on day one; repeated twice (with repositioning) three to seven days later. Short-term precision for repeated measures was explored using intraclass correlational coefficient (ICC), mean coefficient of variation (CV%), root mean square coefficient of variation (RMSCV%) and least significant change (LSC%95). Results: Bone density and microstructure precision was excellent: ICCs varied from 0.88 (MH2 trabecular number) to .99 (MS3 polar moment of inertia); CV% varied from  3 on 5 point scale. Conclusion: In our facility, this custom protocol extends the potential for in vivo HR-pQCT imaging to assess, with high precision, regional differences in bone quality at three sites commonly affected in RA. Our methods are easy to adopt and we recommend other users of HR-pQCT consider this protocol for further evaluations of its precision and feasibility in their imaging facilities.Family Practice, Department ofMedicine, Faculty ofOrthopaedics, Department ofPhysical Therapy, Department ofOther UBCNon UBCReviewedFacult