Correction to: Being active with a total hip or knee prosthesis: a systematic review into physical activity and sports recommendations and interventions to improve physical activity behavior

Objectives: Regular physical activity (PA) is considered important after total hip and knee arthroplasty (THA/TKA). Objective was to systematically assess literature on recommendations given by healthcare professionals to persons after THA and TKA and to provide an overview of existing interventions to stimulate PA and sports participation. Methods: A systematic review with a narrative synthesis including articles published between January 1995 and January 2021 reporting on recommendations and interventions. The PubMed, Embase, CINAHL and PsycInfo databases were systematically searched for original articles reporting on physical activity and sports recommendations given by healthcare professionals to persons after THA and TKA, and articles reporting on interventions/programs to stimulate a physically active lifestyle after rehabilitation or explicitly defined as part of the rehabilitation. Methodological quality was assessed with the Mixed Methods Appraisal Tool (MMAT). The review was registered in Prospero (PROSPERO:CRD42020178556). Results: Twenty-one articles reported on recommendations. Low-impact activities were allowed. Contact sports, most ball sports, and martial arts were not recommended. One study informed on whether health-enhancing PA recommendations were used to stimulate persons to become physically active. No studies included recommendations on sedentary behavior. Eleven studies reported on interventions. Interventions used guidance from a coach/physiotherapist; feedback on PA behavior from technology; and face-to-face, education, goal-setting, financial incentives and coaching/financial incentives combined, of which feedback and education seem to be most effective. For methodological quality, 18 out of 21 (86%) articles about recommendations and 7 out of 11 (64%) articles about interventions scored yes on more than half of the MMAT questions (0–5 score). Conclusion: There is general agreement on what kind of sports activities can be recommended by healthcare professionals like orthopedic surgeons and physiotherapists. No attention is given to amount of PA. The same is true for limiting sedentary behavior. The number of interventions is limited and diverse, so no conclusions can be drawn. Interventions including provision of feedback about PA, seem to be effective and feasible

Amount and type of physical activity and sports from one year forward after hip or knee arthroplasty—A systematic review

Introduction After rehabilitation following total hip or knee arthroplasty (THA/TKA), patients are advised to participate in physical activity (PA) and sports. However, profound insight into whether people adopt a physically active lifestyle is lacking. Aim is to gain insight into the performed amount and type of PA (including sports) and time spent sedentarily by persons after THA/ TKA. Methods A systematic review (PROSPERO: CRD42020178556). Pubmed, Cinahl, EMBASE and PsycInfo were systematically searched for articles reporting on amount of PA, and on the kind of activities performed between January 1995-January 2021. Quality of the articles was assessed with the adapted tool from Borghouts et al. Results The search retrieved 5029 articles, leading to inclusion of 125 articles reporting data of 123 groups; 53 articles reported on subjects post-THA, 16 on post-hip-resurfacing arthroplasty, 40 on post-TKA, 15 on post-unicompartimental knee arthroplasty and 12 on a mix of arthroplasty types. With respect to quality assessment, 14 articles (11%) met three or fewer criteria, 29 (24%) met four, 32 (26%) met five, 42 (34%) met six, and 6 (5%) met seven out of the eight criteria. PA levels were comparable for THA and TKA, showing a low to moderately active population. Time spent was mostly of low intensity. Roughly 50% of -subjects met health-enhancing PA guidelines. They spent the largest part of their day sedentarily. Sports participation was relatively high (rates above 70%). Most participation was in low-impact sports at a recreational level. Roughly speaking, participants were engaged in sports 3 hours/week, consisting of about three 1-hour sessions. Conclusion Activity levels seem to be low; less than half of them seemed to perform the advised amount of PA following health-enhancing guidelines Sports participation levels were high. However, many articles were unclear about the definition of sports participation, which could have led to overestimation

Being active with a total hip or knee prosthesis: a systematic review into physical activity and sports recommendations and interventions to improve physical activity behavior

Objectives Regular physical activity (PA) is considered important after total hip and knee arthroplasty (THA/TKA). Objective was to systematically assess literature on recommendations given by healthcare professionals to persons after THA and TKA and to provide an overview of existing interventions to stimulate PA and sports participation. Methods A systematic review with a narrative synthesis including articles published between January 1995 and January 2021 reporting on recommendations and interventions. The PubMed, Embase, CINAHL and PsycInfo databases were systematically searched for original articles reporting on physical activity and sports recommendations given by healthcare professionals to persons after THA and TKA, and articles reporting on interventions/programs to stimulate a physically active lifestyle after rehabilitation or explicitly defined as part of the rehabilitation. Methodological quality was assessed with the Mixed Methods Appraisal Tool (MMAT). The review was registered in Prospero (PROSPERO:CRD42020178556). Results Twenty-one articles reported on recommendations. Low-impact activities were allowed. Contact sports, most ball sports, and martial arts were not recommended. One study informed on whether health-enhancing PA recommendations were used to stimulate persons to become physically active. No studies included recommendations on sedentary behavior. Eleven studies reported on interventions. Interventions used guidance from a coach/physiotherapist; feedback on PA behavior from technology; and face-to-face, education, goal-setting, financial incentives and coaching/financial incentives combined, of which feedback and education seem to be most effective. For methodological quality, 18 out of 21 (86%) articles about recommendations and 7 out of 11 (64%) articles about interventions scored yes on more than half of the MMAT questions (0-5 score). Conclusion There is general agreement on what kind of sports activities can be recommended by healthcare professionals like orthopedic surgeons and physiotherapists. No attention is given to amount of PA. The same is true for limiting sedentary behavior. The number of interventions is limited and diverse, so no conclusions can be drawn. Interventions including provision of feedback about PA, seem to be effective and feasible

Are Work Demand, Support and Control Associated with Work Ability and Disability during Back Pain Treatment? A Prospective Explorative Study

Background: Low back pain is a multifactorial disease with consequences for work ability and social participation. Improved integration of the work domain in health care management is needed. The aim of this study was to explore the relation between working conditions with outcome of low back pain treatment. Methods: Observational study of 41 patients attending physiotherapy for low back pain. Work demands, support and control were registered at baseline and work ability and disability also at baseline, with follow up after three and nine months. We used mixed-effects models to estimate the longitudinal associations between working conditions and outcome. Results: Higher work demands were related to reduced work ability (−1.1 points, 95% CI: −2.1 to −0.1) and slightly increased disability (5.6 points, 95% CI: 0.5 to 10.7). Lack of social support from colleagues was associated with reduced work ability (−2.7 points, 95% CI: −0.2 to 1.5) and disability (14.0 points, 95% CI: 4.9 to 23.1). Conclusions: This explorative study found associations between work demands and support, and work ability and disability outcome. Screening for psychosocial working conditions may influence the work ability and disability treatment outcome. The results need replication in larger samples and may indicate that patients seeking primary care management for low back pain should be screened for work demands, support and control

Risk classification of patients referred to secondary care for low back pain

Background Nonspecific low back pain is characterized by a wide range of possible triggering and conserving factors, and initial screening needs to scope widely with multilevel addressment of possible factors contributing to the pain experience. Screening tools for classification of patients have been developed to support clinicians. The primary aim of this study was to assess the criterion validity of STarT Back Screening Tool (STarT Back) against the more comprehensive Örebro Musculoskeletal Pain Questionnaire (ÖMPSQ), in a Norwegian sample of patients referred to secondary care for low back pain. Secondary aims were to assess risk classification of the patients, as indicated by both instruments, and to compare pain and work characteristics between patients in the different STarT Back risk categories. Methods An observational, cross-sectional survey among patients with low back pain referred to outpatient secondary care assessment at Trondheim University Hospital, Norway. Cohen’s Kappa coefficient, Pearson’s r and a Bland-Altman plot were used to assess criterion validity of STarT Back against ÖMPSQ. Furthermore, linear regression was used to estimate mean differences with 95% CI in pain and work related variables between the risk groups defined by the STarT Back tool. Results A total of 182 persons participated in the study. The Pearsons correlation coefficient for correspondence between scores on ÖMPSQ and STarT Back was 0.76. The Kappa value for classification agreement between the instruments was 0.35. Risk group classification according to STarT Back allocated 34.1% of the patients in the low risk group, 42.3% in the medium risk, and 23.6% in the high risk group. According to ÖMPSQ, 24.7% of the participants were allocated in the low risk group, 28.6% in the medium risk, and 46.7% in the high risk group. Patients classified with high risk according to Start Back showed a higher score on pain and work related characteristics as measured by ÖMPSQ. Conclusion The correlation between score on the screening tools was good, while the classification agreement between the screening instruments was low. Screening for work factors may be important in patients referred to multidisciplinary management in secondary care

Risk classification of patients referred to secondary care for low back pain

Abstract Background Nonspecific low back pain is characterized by a wide range of possible triggering and conserving factors, and initial screening needs to scope widely with multilevel addressment of possible factors contributing to the pain experience. Screening tools for classification of patients have been developed to support clinicians. The primary aim of this study was to assess the criterion validity of STarT Back Screening Tool (STarT Back) against the more comprehensive Örebro Musculoskeletal Pain Questionnaire (ÖMPSQ), in a Norwegian sample of patients referred to secondary care for low back pain. Secondary aims were to assess risk classification of the patients, as indicated by both instruments, and to compare pain and work characteristics between patients in the different STarT Back risk categories. Methods An observational, cross-sectional survey among patients with low back pain referred to outpatient secondary care assessment at Trondheim University Hospital, Norway. Cohen’s Kappa coefficient, Pearson’s r and a Bland-Altman plot were used to assess criterion validity of STarT Back against ÖMPSQ. Furthermore, linear regression was used to estimate mean differences with 95% CI in pain and work related variables between the risk groups defined by the STarT Back tool. Results A total of 182 persons participated in the study. The Pearsons correlation coefficient for correspondence between scores on ÖMPSQ and STarT Back was 0.76. The Kappa value for classification agreement between the instruments was 0.35. Risk group classification according to STarT Back allocated 34.1% of the patients in the low risk group, 42.3% in the medium risk, and 23.6% in the high risk group. According to ÖMPSQ, 24.7% of the participants were allocated in the low risk group, 28.6% in the medium risk, and 46.7% in the high risk group. Patients classified with high risk according to Start Back showed a higher score on pain and work related characteristics as measured by ÖMPSQ. Conclusion The correlation between score on the screening tools was good, while the classification agreement between the screening instruments was low. Screening for work factors may be important in patients referred to multidisciplinary management in secondary care

The influence of multisite pain and psychological comorbidity on prognosis of chronic low back pain: longitudinal data from the Norwegian HUNT Study

Objectives: This study aimed to investigate the prospective influence of multisite pain, depression, anxiety, self-rated health and pain-related disability on recovery from chronic low back pain (LBP). Setting: The data is derived from the second (1995–1997) and third (2006–2008) wave of the Nord-Trøndelag Health Study (HUNT) in Norway. Participants: The study population comprises 4484 women and 3039 men in the Norwegian HUNT Study who reported chronic LBP at baseline in 1995–1997. Primary outcome measures: The primary outcome was recovery from chronic LBP at the 11-year follow-up. Persons not reporting pain and/or stiffness for at least three consecutive months during the last year were defined as recovered. A Poisson regression model was used to estimate adjusted risk ratios (RRs) with 95% CIs. Results: At follow-up, 1822 (40.6%) women and 1578 (51.9%) men reported recovery from chronic LBP. The probability of recovery was inversely associated with number of pain sites (P-trend<0.001). Compared with reporting 2–3 pain sites, persons with only LBP had a slightly higher probability of recovery (RR 1.10, 95% CI 0.98 to 1.22 in women and RR 1.10, 95% CI 1.01 to 1.21 in men), whereas people reporting 6–9 pain sites had substantially lower probability of recovery (RR 0.58, 95% CI 0.52 to 0.63 in women and RR 0.70, 95% CI 0.63 to 0.79 in men). Poor/not so good self-rated general health, symptoms of anxiety and depression, and pain-related disability in work and leisure were all associated with reduced probability of recovery, but there was no statistical interaction between multisite pain and these comorbidities. Conclusions: Increasing number of pain sites was inversely associated with recovery from chronic LBP. In addition, factors such as poor self-rated health, psychological symptoms and pain-related disability may further reduce the probability of recovery from chronic LBP

Prognostic ability of STarT Back Screening Tool combined with work-related factors in patients with low back pain in primary care: a prospective study

Objective Primary care screening tools for patients with low back pain may improve outcome by identifying modifiable obstacles for recovery. The STarT Back Screening Tool (SBST) consists of nine biological and psychological items, with less focus on work-related factors. We aimed at testing the prognostic ability of SBST and the effect of adding items for future and present work ability. Methods Prospective observational study in patients (n=158) attending primary care physical therapy for low back pain. The prognostic ability of SBST and the added prognostic value of two work items; expectation for future work ability and current work ability, were calculated for disability, pain and quality of life outcome at 3 months follow-up. The medium and high-risk group in the SBST were collapsed in the analyses due to few patients in the high-risk group. The prognostic ability was assessed using the explained variance (R2) of the outcomes from univariable and multivariable linear regression and beta values with 95% CIs were used to assess the prognostic value of individual items. Results The SBST classified 107 (67.7%) patients as low risk and 51 (32.3%) patients as medium/high risk. SBST provided prognostic ability for disability (R2=0.35), pain (R2=0.25) and quality of life (R2=0.28). Expectation for return to work predicted outcome in univariable analyses but provided limited additional prognostic ability when added to the SBST. Present work ability provided additional prognostic ability for disability (β=−2.5; 95% CI=−3.6 to −1.4), pain (β=−0.2; 95% CI=−0.5 to −0.002) and quality of life (β=0.02; 95% CI=0.001 to 0.04) in the multivariable analyses. The explained variance (R2) when work ability was added to the SBST was 0.60, 0.49 and 0.47 for disability, pain and quality of life, respectively. Conclusions Adding one work ability item to the SBST gives additional prognostic information across core outcomes

Holdninger til fysisk aktivitet hos personer i Norge med primær totalprotese i kne eller hofte: En nasjonal spørreundersøkelse

Bakgrunn: I Europa øker andelen proteseoperasjoner. Samtidig går det fysiske aktivitetsnivået i befolkningen ned. Andelen med overvekt og fedme øker. Et transeuropeisk prosjekt for å promotere fysisk aktivitet hos pasienter etter proteseoperasjon ble derfor gjennomført. Denne artikkelen baseres på en delstudie som har kartlagt faktorer som bidrar å forklare holdninger til fysisk aktivitet hos pasienter i Norge som fått innsatt hofte- eller kneprotese. Metode: En spørreundersøkelse med bakgrunnsinformasjon om demografi, livsstil, helse og helsevesen, og spørsmål om holdninger til fysisk aktivitet innen domenene: Livskvalitet, Fysisk aktivitetsnivå, Funksjon og Kinesiofobi, ble sendt til 947 personer >18 år som hadde fått primær hofte- eller kneprotese 6-12 måneder tidligere. MANOVA sammenlignet svarene mellom menn og kvinner og mellom hofte- og kneopererte. En regresjonsanalyse undersøkte hvilke bakgrunnsvariabler som kunne forklare holdninger til fysisk aktivitet. Resultat: Svarene (n=714) var stort sett uavhengig av kjønn eller typer protese, og de fleste hadde en positiv holdning til fysisk aktivitet. Høy grad av tidligere fysisk aktivitet bidro mest til en positiv holdning, mens høy alder og kroppsvekt og ganghjelpemidler bidro til en mindre positiv holdning for alle domener. Deltakelse i prehabilitering og rehabilitering bidro positivt for Fysisk aktivitetsnivå. Informasjon fra helsevesenet bidro positivt til Livskvalitet og Fysisk aktivitetsnivå, men ikke til Funksjon eller Kinesiofobi. Implikasjoner og konklusjon: En historikk med fysisk aktivitet hadde mest å si for holdningen til fysisk aktivitet post-operativt. Informasjon og opptreningstilbud fra helsetjenesten bør skje på en måte som trygger pasienten på hva vedkommende kan utføre av aktivitet, spesielt for eldre og brukere av ganghjelpemidler.Background: In Europe, arthroplasty surgeries are increasing while the level of physical activity is decreasing and overweight is rising. A transeuropean project promoting physical activity after total knee- or hip replacement was conducted. As a part of that project, this study has surveyed factors contributing to explain attitudes toward physical activity in patients in Norway after total knee- or hip replacement. Method: A survey consisting of background information on demographics, lifestyle, health, and health-service with questions on attitudes toward physical activity within the domains of Quality of life, Physical activity level, Function and Kinesiophobia was sent to 947 persons aged >18 years who had received total hip- or knee replacement 6-12 months earlier. MANOVA compared data between men and women and between hip - and knee operated. A regression analysis investigated which background variables that explained the attitudes toward physical activity. Results: The responses (n=714) were similar independent on men, women, or type of prosthesis. Most respondents had a positive attitude. For all domains, high former level of physical activity was the strongest positive factor, while old age, high body weight, and walking aids contributed to a less positive attitude. Participation in pre- and rehabilitation contributed positively to Physical activity level. Information from the health-service contributed positively to Quality of life and Physical activity level, but not to Function or Kinesiophobia. Implications and conclusion: For a positive attitude toward physical activity, focus should be directed to the importance of former physical activity engagement. Information from the health-service need to be individually adapted to make the patient feel safe with regard to being physically active, particularly for elderly and users of walking aids.publishedVersio

Evaluation of the Efficacy and Safety of an Exercise Program for Persons with Total Hip or Total Knee Replacement: Study Protocol for a Randomized Controlled Trial

Total hip replacement (THR) and total knee replacement (TKR) are among the most common elective surgical procedures. There is a large consensus on the importance of physical activity promotion for an active lifestyle in persons who underwent THR or TKR to prevent or mitigate disability and improve the quality of life (QoL) in the long term. However, there is no best practice in exercise and physical activity specifically designed for these persons. The present protocol aims to evaluate the efficacy and safety of an exercise program (6 month duration) designed for improving quality of life in people who had undergone THR or TKR. This paper describes a randomized controlled trial protocol that involves persons with THR or TKR. The participant will be randomly assigned to an intervention group or a control group. The intervention group will perform post-rehabilitation supervised training; the control group will be requested to follow the usual care. The primary outcome is QoL, measured with the Short-Form Health Survey (SF-36); Secondary outcomes are clinical, functional and lifestyle measures that may influence QoL. The results of this study could provide evidence for clinicians, exercise trainers, and policymakers toward a strategy that ensures safe and effective exercise physical activity after surgery