155?Sex-related differences in muscle co-activation in individuals with knee osteoarthritis

Background: Sex-related differences in muscle function have been well established in healthy individuals. In individuals with knee osteoarthritis (KOA), impairments in muscle function such as muscle weakness and high muscle co-activation have also been demonstrated. Muscle dysfunction has been shown to be a strong contributor to poor physical function and low health-related quality of life in patients with KOA. The purpose of this study was, therefore, to analyse sex and osteoarthritis-related differences in muscle function, to establish to what extent both sex and disease status contribute to muscle dysfunction.Methods: Muscle co-activation was assessed in 77 symptomatic KOA participants (62.5±8.1yrs; 48/29 women/men) and 18 age-matched asymptomatic controls (62.5±10.4yrs; 9/9 women/men), using electromyography (EMG) during a series of walking, stair ascent and descent and sit-to-walk activities. EMG was recorded from 7 sites medial/lateral gastrocnemius, biceps femoris, semitendinosus, vastus lateralis/medialis and normalised to maximal voluntary contraction. Normalised EMG was used to calculate hamstrings-quadriceps and medial-lateral muscle co-activation as (antagonist/agonist) *(antagonist+agonist). The stance phase of walking was split into pre-stance (150ms prior to initial contact), loading (0-15% of stance), early-stance (15-40%), mid-stance (40-60%), late-stance (60-100%) and overall-stance (0-100%). Stairs negotiation was also split into transition (stance phase on the floor) and continuous (stance phase on the second step of the staircase). All participants provided written informed consent and the study was approved by Research Ethics committees (HLS12/86, 13/ws/0146). Independent samples T-tests were performed to assess the differences between KOA and controls. Linear regressions were performed to investigate the relationship between muscle function, sex and disease status, and Bonferroni corrected for multiple comparisons.Results: Individuals with KOA were weaker than controls (P < 0.007). Overall there were very few differences in muscle co-activation between KOA and controls. Women were weaker than men (P ⩽ 0.002) and had higher hamstrings-quadriceps and medial-lateral muscle co-activation across all activities of daily living. In multiple regression analyses sex and muscle weakness, but not age or disease status, predicted high muscle co-activation.Conclusion: High muscle co-activation was associated with female sex and muscle weakness regardless of disease status and age. It has previously been suggested that muscle co-activation acts as a compensatory mechanism for muscle weakness, accommodating for the diminished force generating capabilities to maintain a certain level of function and movement activation patterns. This suggests that muscle weakness may be the main contributing factor for high muscle co-activation which is thought to increase joint loads with detrimental effects on cartilage and joint integrity. This may explain high muscle co-activation in women with muscle weakness and increased risk of incidence and progression of KOA in women

Looking through the 'window of opportunity': is there a new paradigm of podiatry care on the horizon in early rheumatoid arthritis?

Over the past decade there have been significant advances in the clinical understanding and care of rheumatoid arthritis (RA). Major paradigm changes include earlier disease detection and introduction of therapy, and 'tight control' of follow-up driven by regular measurement of disease activity parameters. The advent of tumour necrosis factor (TNF) inhibitors and other biologic therapies have further revolutionised care. Low disease state and remission with prevention of joint damage and irreversible disability are achievable therapeutic goals. Consequently new opportunities exist for all health professionals to contribute towards these advances. For podiatrists relevant issues range from greater awareness of current concepts including early referral guidelines through to the application of specialist skills to manage localised, residual disease activity and associated functional impairments. Here we describe a new paradigm of podiatry care in early RA. This is driven by current evidence that indicates that even in low disease activity states destruction of foot joints may be progressive and associated with accumulating disability. The paradigm parallels the medical model comprising early detection, targeted therapy, a new concept of tight control of foot arthritis, and disease monitoring

Overlap of cognitive concepts in chronic widespread pain: An exploratory study

<p>Abstract</p> <p>Background</p> <p>A wide variety of cognitive concepts have been shown to play an important role in chronic widespread pain (CWP). Although these concepts are generally considered to be distinct entities, some might in fact be highly overlapping. The objectives of this study were to (i) to establish inter-relationships between self-efficacy, cognitive coping styles, fear-avoidance cognitions and illness beliefs in patients with CWP and (ii) to explore the possibility of a reduction of these cognitions into a more limited number of domains.</p> <p>Methods</p> <p>Baseline measurement data of a prospective cohort study of 138 patients with CWP were used. Factor analysis was used to study the associations between 16 different cognitive concepts.</p> <p>Results</p> <p>Factor analysis resulted in three factors: 1) negative emotional cognitions, 2) active cognitive coping, and 3) control beliefs and expectations of chronicity.</p> <p>Conclusion</p> <p>Negative emotional cognitions, active cognitive coping, control beliefs and expectations of chronicity seem to constitute principal domains of cognitive processes in CWP. These findings contribute to the understanding of overlap and uniqueness of cognitive concepts in chronic widespread pain.</p

A protocol for a randomised controlled trial of prefabricated versus customised foot orthoses for people with rheumatoid arthritis: the FOCOS RA trial [Foot Orthoses – Customised v Off-the-Shelf in Rheumatoid Arthritis]

Background Foot pain is common in rheumatoid arthritis and appears to persist despite modern day medical management. Several clinical practice guidelines currently recommend the use of foot orthoses for the treatment of foot pain in people with rheumatoid arthritis. However, an evidence gap currently exists concerning the comparative clinical- and cost-effectiveness of prefabricated and customised foot orthoses in people with early rheumatoid arthritis. Early intervention with orthotics may offer the best opportunity for positive therapeutic outcomes. The primary aim of this study is to evaluate the comparative clinical- and cost-effectiveness of prefabricated versus customised orthoses for reducing foot pain over 12 months. Methods/design This is a multi-centre two-arm parallel randomised controlled trial comparing prefabricated versus customised orthoses in participants with early rheumatoid arthritis (< 2 years disease duration). A total of 160 (a minimum of 80 randomised to each arm) eligible participants will be recruited from United Kingdom National Health Service Rheumatology Outpatient Clinics. The primary outcome will be foot pain measured via the Foot Function Index pain subscale at 12 months. Secondary outcomes will include foot related impairments and disability via the Foot Impact Scale for rheumatoid arthritis, global functional status via the Stanford Health Assessment Questionnaire, foot disease activity via the Rheumatoid Arthritis Foot Disease Activity Index, and health-related quality of life at baseline, 6 and 12 months. Process outcomes will include recruitment/retention rates, data completion rates, intervention adherence rates, and participant intervention and trial participation satisfaction. Cost-utility and cost-effectiveness analyses will be undertaken. Discussion Outcome measures collected at baseline, 6 and 12 months will be used to evaluate the comparative clinical- and cost- effectiveness of customised versus prefabricated orthoses for this treatment of early rheumatoid arthritis foot conditions. This trial will help to guide orthotic prescription recommendations for the management of foot pain for people with early rheumatoid arthritis in future. Trial registration ISRCTN13654421. Registered 09 February 2016