Hip disability and osteoarthritis outcome score (HOOS) – validity and responsiveness in total hip replacement

BACKGROUND: The aim of the study was to evaluate if physical functions usually associated with a younger population were of importance for an older population, and to construct an outcome measure for hip osteoarthritis with improved responsiveness compared to the Western Ontario McMaster osteoarthritis score (WOMAC LK 3.0). METHODS: A 40 item questionnaire (hip disability and osteoarthritis outcome score, HOOS) was constructed to assess patient-relevant outcomes in five separate subscales (pain, symptoms, activity of daily living, sport and recreation function and hip related quality of life). The HOOS contains all WOMAC LK 3.0 questions in unchanged form. The HOOS was distributed to 90 patients with primary hip osteoarthritis (mean age 71.5, range 49–85, 41 females) assigned for total hip replacement for osteoarthritis preoperatively and at six months follow-up. RESULTS: The HOOS met set criteria of validity and responsiveness. It was more responsive than WOMAC regarding the subscales pain (SRM 2.11 vs. 1.83) and other symptoms (SRM 1.83 vs. 1.28). The responsiveness (SRM) for the two added subscales sport and recreation and quality of life were 1.29 and 1.65, respectively. Patients ≤ 66 years of age (range 49–66) reported higher responsiveness in all five subscales than patients >66 years of age (range 67–85) (Pain SRM 2.60 vs. 1.97, other symptoms SRM 3.0 vs. 1.60, activity of daily living SRM 2.51 vs. 1.52, sport and recreation function SRM 1.53 vs. 1.21 and hip related quality of life SRM 1.95 vs. 1.57). CONCLUSION: The HOOS 2.0 appears to be useful for the evaluation of patient-relevant outcome after THR and is more responsive than the WOMAC LK 3.0. The added subscales sport and recreation function and hip related quality of life were highly responsive for this group of patients, with the responsiveness being highest for those younger than 66

HIP disability : Patient education, classification and assessment

Hip disability is common and entails activity limitations, participation restrictions and increased risk of further disability and health problems, partially due to inactivity. Hip osteoarthritis (OA), the major diagnosis, is difficult to define, especially when no joint space narrowing is seen in radiography. However, radiological hip OA can be asymptomatic. The American College of Rheumatology (ACR) has developed clinical classification criteria for symptomatic hip OA, including two range-of-motion (ROM) variables: flexion and internal rotation. It has been clinically accepted that hip OA, with joint capsule involvement, occasions a "capsular pattern" of decreased ROM, but the exact ordering of the directions is controversial. Patient education in groups is an important supplement to individual treatment and is recommended by the ACR and the European League of Associations of Rheumatology for patients with OA. The overall objective of the present thesis was to develop early educational treatment in primary care for people with hip disability - a Hip School - and to assess its effects on self-rated hip problems and health-related quality of life. Further objectives were to analyse common diagnostic and classification criteria and to improve instruments for assessing self-rated hip problems. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), available in both knee and hip formats, was translated into Swedish and tested. A Hip School led by physiotherapists was developed covering, among other things, self-help hints (e.g. advice about daily physical activity to appropriate extents for at least a total of 30 minutes, hip ROM training at the end point of motion, and not sitting for longer than 20 minutes at a time). For assessment of the Hip School, persons with hip disability were recruited to a treatment group (n = 77) or to a control group (n = 68). Self-rated hip problems were assessed with the WOMAC and health-related quality of life with the Nottingham Health Profile (NHP) before and 6 months after the Hip School. The treatment group was also tested after an additional 6 months. For 168 persons with hip disability, passive range of motion (PROM) was tested in six directions with a goniometer. PROM limitations were calculated with three different norms and arranged by size in PROM patterns. The patterns and the number of hips with patterns corresponding to proposed capsular patterns were counted. Fifty-two persons with hip disability answered an extended version of the WOMAC twice with a one-week interval. Reproducibility, percentage of zero scores (best possible score) and mean scores of symptoms and perceived importance were analysed. The results showed that the Swedish version of WOMAC is a reliable, valid, and responsive instrument with measurement qualities in agreement with the original version. Assessment of the Hip School showed that the participants reduced their pain and activity limitations and improved their health-related quality of life after 6 months with maintained effects after one year. It was not possible to predict radiological evidence of hip OA from the multitude of PROM patterns. No support was found for the existence of a hip joint "capsular pattern". The failure of the clinical signs to coincide satisfactorily with radiographic hip OA was further emphasised when the ACR clinical classification criteria were used, as they achieved a sensitivity of 85% and a specificity of 25%. Gender and other factors such as age, ROM exercise and other ROM-demanding habits influence PROM. Being male contributed almost as much as having hip OA to the risk of having decreased hip ROM. The extended instrument Hip disability and osteoarthritis outcome score (HOOS), appears to be evaluative with increased ability, especially in early-stage hip disability, to detect clinically important change over time. It is concluded that the Hip School can be a useful early treatment strategy for persons with hip disability. It is not possible to diagnose hip OA with "capsular patterns" or to classify hip OA in early cases from reduction in PROM directions. HOOS can be used to assess treatment strategies

GFM-52 och symtom hos unga kvinnor med huvudvärk och friska

The aim of this study was to examine if a group of young women with long-lasting tension-type headache differed statistically significant concerning Global Physiotherapy Examination (GPE-52) and self-reported physical and psychological symptoms on a symptom list, compared to a corresponding group healthy young women. Twenty nine women with headache and 28 healthy women from upper secondary schools in Karlstad/Hammarö, Sweden, were examined once with GPE-52, and they reported occurrence of 30 symptoms on a symptom list. The results showed that the groups differed statistically significant concerning GPE-52 total sumscore, main domains respiration, movement and muscle, and 13 of 30 symptoms, except headache. Conclusion: A group of young women with long-lasting tension-type headache had significally more abbreviations in their bodies when they were examined with GPM-52, compared to healthy young women. The groups differed most in respiration. The women with headache also reported significally more symptoms than the healthy group

Live music therapy with lullaby singing as affective support during venepuncture. A case study with microanalysis of two premature born infants

Objective: During the most vulnerable period in a child’s life, preterm and sick newborns are exposed to a high number of painful procedures, sometimes without the comfort and affection of their parents. Since repeated pain and frequent use of opioids can have consequences for the neurological and behaviour-oriented development of the infant, it is vital to identify effective non-pharmacological interventions with regard to procedural pain. Methods: Preterm and ill term neonates (n=38) were subjected to venepuncture with and without live infant-directed lullaby singing, in a randomised order with a cross over design. Physiological data were collected and the procedures were videotaped. Parents (n=11) and staff (n=11) were interviewed about live singing as affective support. From this larger study two premature infants were selected for a case study. Their behavioural and physiological responses as well as the liveperformed lullaby, were analysed in-depth with microanalysis. Results: Transcriptions of the lullaby-performances identified signs of “amodal perception” and “time in movement” by which the infants transposed the vocalization of the live-singing into their behaviour synchronizing in dance-like body gestures with the variations in intensity, shape and temporal structures of the vocal performance. Live singing with premature infants is a social communicative interaction which may optimize homeostasis during painful procedures if the lullaby singing is predictable and regular from start. Conclusion: Since emotional regulation is a central feature of music therapy this case study brings important clinical implications for how the affective interaction between the music therapist or the parent and the infant should be composed during painful procedures. Pain involves the interaction of biopsychosocial and situational factors, therefore more research is needed to explore the potential benefits of music therapy including the role of the parents

Live music therapy with lullaby singing as affective support during venepuncture. A case study with microanalysis of two premature born infants

Objective: During the most vulnerable period in a child’s life, preterm and sick newborns are exposed to a high number of painful procedures, sometimes without the comfort and affection of their parents. Since repeated pain and frequent use of opioids can have consequences for the neurological and behaviour-oriented development of the infant, it is vital to identify effective non-pharmacological interventions with regard to procedural pain. Methods: Preterm and ill term neonates (n=38) were subjected to venepuncture with and without live infant-directed lullaby singing, in a randomised order with a cross over design. Physiological data were collected and the procedures were videotaped. Parents (n=11) and staff (n=11) were interviewed about live singing as affective support. From this larger study two premature infants were selected for a case study. Their behavioural and physiological responses as well as the liveperformed lullaby, were analysed in-depth with microanalysis. Results: Transcriptions of the lullaby-performances identified signs of “amodal perception” and “time in movement” by which the infants transposed the vocalization of the live-singing into their behaviour synchronizing in dance-like body gestures with the variations in intensity, shape and temporal structures of the vocal performance. Live singing with premature infants is a social communicative interaction which may optimize homeostasis during painful procedures if the lullaby singing is predictable and regular from start. Conclusion: Since emotional regulation is a central feature of music therapy this case study brings important clinical implications for how the affective interaction between the music therapist or the parent and the infant should be composed during painful procedures. Pain involves the interaction of biopsychosocial and situational factors, therefore more research is needed to explore the potential benefits of music therapy including the role of the parents

Live Music Therapy With Lullaby Singing as Affective Support During Painful Procedures: A Case Study With Microanalysis

During the most vulnerable period in a child\u27s life, preterm and sick infants are exposed to a high number of painful procedures, sometimes without the comfort and affection of their parents. Since repeated pain and frequent use of analgesic drugs may have consequences for the neurological and behaviour-oriented development of the infant, it is vital to identify effective non-pharmacological interventions with regard to procedural pain. This paper reviews the use of live lullaby singing as an adjuvant to the control of premature infant pain. The objectives of this case study were to analyse the live lullaby singing for two premature infants during venipuncture in comparison to standard care only, and the infants\u27 physiological and affective responses emerging before, during and after this procedure. The empirical data stem from a quantitative clinical study. From this larger study, two premature infants were selected. Through microanalysis, with in-depth analysis of video footage, and pain assessment with Behavioral Indicators of Infant Pain (BIIP), painful standard care procedures with and without live lullaby singing, were analysed. The results show that live lullaby singing with premature infants is a communicative interaction which may optimize the homeostatic mechanisms of the infant during painful procedures. This case study shows the importance of predictability of the affective support, right from the start of the live singing intervention. It is important in a painful context that vocal interactions provide regular and comforting intensity, shape and temporal structures

Singing, sharing, soothing – biopsychosocial rationales for parental infant-directed singing in neonatal pain management

Infant-directed singing is a medium for parents and infants to communicate in a mutual relationship. Parental infant-directed singing is a multisensory, biopsychosocial communication that applies to ill and vulnerable hospitalised infants. The primary musical features of infant-directed singing are ideal for emotional coordination and sharing between parent and infant without the risk of over-stimulation. In this article, we suggest that parental infant-directed singing is regarded as a nonpharmacological emotion regulation intervention, which may modify the painful experience for both the infant and the parent before, during and after painful procedures in the neonatal intensive care context. Parents have the biopsychosocial resources to alleviate their infant’s pain through infant-directed singing, if they are empowered to do so and coached in this process. A music therapist specialised in neonatal music therapy methods can mentor parents in how to use entrained and attuned live lullaby singing in connection to painful procedures. Pain and the vast amount of painful procedures early in infancy, combined with early parent–infant separation and lack of parental participation in the care of the infant during neonatal intensive care, place arduous strain on the new family’s attachment process and on the infant’s and parents’ mental health, both from a short and long-term perspective. Therefore, we argue with biopsychosocial rationales, that live parental infant-directed singing should be promoted in neonatal pain care worldwide. Consequently, parents should be welcomed round the clock and invited as prescribed pain management for their infant

I exercise to postpone death - Interviews with persons with hip and/or knee osteoarthritis who are attending an osteoarthritis school

Background: Physical activity (PA) and exercise constitute the first line of treatment for osteoarthritis (OA) of the hip and/or knee. Even though the symptoms may vary, OA should be considered a chronic disease and therefore PA and exercise should be performed lifelong. That needs knowledge and motivation. Purpose: The purpose of this study was to explore and create a deeper understanding of the motivational processes for PA and exercise for persons with hip and/or knee OA who have participated in a self-management program OA school that included long-term exercise supervised by physical therapists. Methods: Twenty-two in-depth interviews were conducted with 18 participants recruited from the OA school at a Physical Therapy Rehabilitation Clinic in Sweden. The interviews were analyzed with qualitative content analysis. Results: The analysis resulted in one main theme, Developing health literacy to encourage motivational processes for PA and exercise in OA and four themes: 1) meeting an established self-management program; 2) carrying my life history; 3) understanding the intelligence of the body; and 4) growing in existential motivation Conclusion: Motivation for being physically active and to exercise, the life history in relation to PA and what creates existential motivation are important areas to ask questions about when people come to OA schools. Knowledge about the signals of the body connected to OA should be implemented in OA schools in order to motivate people to live an active life despite OA. Health literacy and the awareness of how PA can postpone death are likely to be important for existential motivation

Lower-extremity constraint-induced movement therapy improved motor function, mobility, and walking after stroke

BACKGROUND: To regain the ability to walk is one of the most commonly stated goals for people who have had a stroke due to its importance in everyday life. Walking ability affects patients’ mobility, self-care, and social lives. Constraint-induced movement therapy (CIMT) is known to be effective in improving upper extremity outcomes post-stroke. However, there is insufficient evidence regarding its efficacy in improving lower extremity outcomes.AIM: To investigate whether a highly intensive CIMT for lower extremity (LE-CIMT) function post-stroke can improve motor function, functional mobility, and walking ability. Furthermore, it also aimed to investigate whether age, gender, stroke type, more-affected side, or time after stroke onset affect the efficacy of LE-CIMT on walking ability outcomes. DESIGN: Longitudinal cohort study. SETTING: Outpatient clinic in Stockholm, Sweden. POPULATION: A total of 147 patients mean age 51 years (68% males; 57% right-sided hemiparesis), at the sub-acute or chronic phases post-stroke who had not previously undergone LE-CIMT. METHODS: All patients received LE-CIMT for 6 hours per day over 2 weeks. The Fugl-Meyer Assessment (FMA) of the lower extremity, Timed Up and Go (TUG) test, Ten-Meter Walk Test (10MWT), and six-Minute Walk Test (6MWT) were used to assess functional outcomes before and directly after the 2-week treatment was complete as well at 3-month post-intervention. RESULTS: Compared to baseline values, FMA (P<0.001), TUG (P<0.001), 10MWT (P<0.001) and 6MWT (P<0.001) scores were statistically significantly improved directly after the LE-CIMT intervention. These improvements persisted at the 3-month post-intervention follow-up. Those who completed the intervention 1-6 months after stroke onset had statistically significant larger improvements in 10MWT compared to those who received the intervention later than 6 months after stroke onset. Age, gender, stroke type, and more-affected side did not impact 10MWT results. CONCLUSIONS: In an outpatient clinic setting, high-intensity LE-CIMT statistically significant improved motor function, functional mobility, and walking ability in middle-aged patients in the sub-acute and chronic post-stroke phases. However, studies with more robust designs need to be conducted to deepen the understanding of the efficacy of LE-CIMT. CLINICAL REHABILITATION IMPACT: High-intensity LE-CIMT may be a feasible and useful treatment option in outpatient clinics to improve post-stroke walking ability