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"Osteoarthritis (OA) is the leading cause of disability and a non-curable disease. In the city of New York, patients frequently come into a pain clinic with OA knee pain noting their poor quality of life to the point of depression and even with suicidal ideation. Treatments of osteoarthritis at the pain clinic were inconsistent and often created confusion to staff members, which led to poor outcomes for patients with osteoarthritis knee pain. Literature revealed having a high quality applicable evidence-based protocol is valuable to increase patient's health outcome and satisfaction. The design of this evidence-based practice (EBP) change project included 1) developing an educational program to increase patient's knowledge about osteoarthritis, 2) introduction of a self-manageable exercise program as recommended by Osteoarthritis Research Society International, and 3) pre and post evaluation of pain level, level of physical activity, and quality of life. The outcomes were measured by Numeric Pain Rating Scale (NPRS), Activities of Daily Living Scale (ADLS), and Patient Acceptable Symptom State (PASS). A total of 36 participants successfully completed both pre and post questionnaires. Findings revealed a 30.54%, 29.1%, and 21.91% improvement in pain level, physical activity level, and quality of life, respectively." -- Abstract.
An authoritative investigation of the sources andtreatment of osteoarthritic joint pain Millions of people throughout the world suffer from osteoarthritis (OA)—a medical condition causing its sufferers excruciating pain that is often disabling. This is the first book to offer clinicians an in-depth understanding of the biological sources of osteoarthritic pain and how they can be treated. Here, a team of leading international authorities has contributed state-of-the-art information on: The Neuroscience of Articular Pain—spinal and peripheral mechanisms of joint pain; experimental models for the study of osteoarthritic pain; inflammatory mediators and nociception in arthritis; phantoms in rheumatology; and more Osteoarthritis and Pain—joint mechanisms and neuromuscular aspects of OA; bone pain and pressure in OA joints; structural correlates of OA pain; and more Treatment of Osteoarthritic Pain—general approaches to treatment; treatments targeting pain receptors; treatments targeting biomechanical abnormalities; and treatments targeting inflammation Whether you're a medical professional, researcher, student, or a generalist or specialist focusing on pain or arthritis, this is your one-stop reference for understanding and treating joint pain in osteoarthritis.
A basic easy guide to creating your own walking fitness plan, including how to get started and stay motivated.
The Social Security Administration (SSA) administers two programs that provide disability benefits: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. SSDI provides disability benefits to people (under the full retirement age) who are no longer able to work because of a disabling medical condition. SSI provides income assistance for disabled, blind, and aged people who have limited income and resources regardless of their prior participation in the labor force. Both programs share a common disability determination process administered by SSA and state agencies as well as a common definition of disability for adults: "the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." Disabled workers might receive either SSDI benefits or SSI payments, or both, depending on their recent work history and current income and assets. Disabled workers might also receive benefits from other public programs such as workers' compensation, which insures against work-related illness or injuries occurring on the job, but those other programs have their own definitions and eligibility criteria. Selected Health Conditions and Likelihood of Improvement with Treatment identifies and defines the professionally accepted, standard measurements of outcomes improvement for medical conditions. This report also identifies specific, long-lasting medical conditions for adults in the categories of mental health disorders, cancers, and musculoskeletal disorders. Specifically, these conditions are disabling for a length of time, but typically don't result in permanently disabling limitations; are responsive to treatment; and after a specific length of time of treatment, improve to the point at which the conditions are no longer disabling.
Background: As the incidence of knee osteoarthritis (OA) increases, physiotherapists can help people manage OA by utilizing clinical practice guidelines (CPGs) to recommend treatment options. Purposes: 1) assess the quality of newly developed or recently updated CPGs for knee OA, 2) summarize the non-pharmacological recommendations in the CPGs, 3) establish self-reported clinical practice of physiotherapists in Canada, 4) investigate beliefs, barriers and facilitators pertaining to CPGs and 5) compare the clinical practice of physiotherapists with recommendations in the CPGs. Methods: Two pairs of evaluators used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to appraise CPGs with non-pharmacological recommendations for people with knee OA. The included CPGs were published between January 2014 and January 2019. We conducted an online survey to investigate the clinical practice of physiotherapists and gather information on CPGs. Physiotherapists who were licensed to practice in Canada and treated people with knee OA were eligible to participate. Results: A total of 10 clinical practice guidelines were included in the critical appraisal and six of those were deemed to be high quality. Nearly all guidelines recommended education, exercise and weight management for individuals with knee OA. Data from physiotherapists who responded to the survey (n = 388) indicated that almost all respondents provided education and strengthening exercises. Less than 60% offered aerobic exercise and weight-management advice. Of the respondents, 271 individuals were aware of CPGs and 253 reported they followed CPGs. As well, 204 respondents reported barriers and 117 reported facilitators to utilizing CPGs. Conclusion: Most CPGs we appraised were high quality and agreed that education, exercise and weight-management advice should be standard recommendations offered to people with knee OA. Physiotherapists provided aspects of care that aligned with the core recommendations found in the CPGs, such as offering education and leg strengthening exercises. We recommend that physiotherapists who treat people with knee OA in Canada assess their clinical practice to ensure the care they provide is aligned with evidence-based research for people with knee OA thus helping people maximize their quality of life, mobility and function. Key words: care-maps, knee osteoarthritis, knee osteo-arthritis, non-pharmacological/ non- surgical clinical practice guidelines, pathways, physiotherapy, recommendations.
This comprehensive reference on total knee arthroplasty describes all surgical techniques and prosthetic designs for primary and revision arthroplasty, discusses every aspect of patient selection, preoperative planning, and intraoperative and postoperative care.
PURPOSE: The Coverage and Analysis Group at the Centers for Medicare and Medicaid Services (CMS) requested from The Technology Assessment Program (TAP) at the Agency for Healthcare Research and Quality (AHRQ), a review of the evidence that intraarticular injections of hyaluronic acid (HA) in individuals with degenerative joint disease (osteoarthritis [HA]) of the knee improve function and quality of life (QoL) and that they delay or prevent the need for total knee replacement (TKR), specifically for individuals age 65 and over.. AHRQ assigned this report to the following Evidence-based Practice Center: RAND Southern California Evidence -based Practice Center (Contract Number: HHSA290201200006I). DATA SOURCES: Searches of Medline, Cochrane Library, Web of Science, Clinicaltrials.gov, the FDA Premarket Approval database, and unpublished documents identified in grey literature searches or provided by manufacturers. REVIEW METHODS: Randomized controlled trials (RCTs) or observational studies that reported on HA administration and delay or avoidance of TKR; double-blind placebo-controlled RCTs that reported on functional outcomes or QoL; RCTs, case reports, and large cohort studies and case series that assessed the safety of HA; and unpublished data identified through grey literature searches or provided by manufacturers for efficacy or safety outcomes, in human subjects of mean age 65 or older, were considered for inclusion, as were recent comprehensive systematic reviews that reported on the effects of HA injections on knee pain as an outcome. A standardized protocol with predefined criteria was used to extract details on study design, interventions, outcomes, and study quality and to analyze the data. RESULTS: Only one RCT reported on delay or avoidance of TKR as a pre-specified outcome of interest and found a non-statistically significantly longer delay of TKR compared with placebo; two RCTs reported TKR only as a secondary outcome; and 13 published observational studies reported on TKR as an outcome in HA-treated participants. Eighteen RCTs that enrolled participants of average age 65 or older reported on functional outcomes of intra-articular HA injection: pooled analysis of ten sham-injection placebo-controlled, assessor-blinded trials showed a standardized mean difference of -0.23 (95% CI -0.34, -0.02) significantly favoring HA at 6 months' follow-up. Durability of effect could not be assessed because of the short duration of most studies. Too few head-to-head trials were available to assess superiority of one product over another. Three RCTs that compared changes in QoL/HRQoL between HA- and placebo-treated participants reported no differences between active treatment and placebo. Two recent large, good quality systematic reviews that conducted meta-analysis of the effects of HA on pain and function (pooling 71 and 52 RCTs for the outcome of pain, respectively) showed a significant and clinically important effect of HA on both outcomes among adults of all ages, but a subgroup analysis that included only the largest double-blind placebo-controlled studies reduced the average effect of HA to less than the prespecified minimum clinically important difference. Studies of intra-articular HA reported few serious adverse events, with no statistically significant difference in the rates of serious or non-serious adverse events between HA- and placebo-treated groups. CONCLUSIONS: Trials enrolling older participants show a small, statistically significant effect of HA on function and relatively few serious adverse events; however no studies limited participation to those 65 years or older. No conclusions can be drawn from the available literature on delay or avoidance of TKR through the use of HA. Studies that can compare large numbers of treated and untreated individuals, preferably with a randomized design, are needed to answer this question.
Osteoarthritis (OA), the most common form of arthritis, is a progressive disorder characterized by gradual loss of cartilage and the development of bony spurs and cysts at the surface and margins of the joints. Inflammation, pain, stiffness, limited movement, and possible deformity of the joint may result. Treatments for OA aim to reduce or control pain, improve physical function, prevent disability, and enhance quality of life—all of which constitute clinical outcomes of importance to patients. Treatment options include pain relievers, anti-inflammatory drugs, weight loss, general physical exercise, PT, and, when conservative treatments fail, surgery. This Future Research Needs (FRN) project is a follow up to the draft Comparative Effectiveness Review “Physical Therapy Interventions for Knee Pain Secondary to Osteoarthritis (OA).” The review was motivated by uncertainty around the effectiveness and comparative effectiveness of physical therapy (PT) treatments for adult patients with knee pain secondary to osteoarthritis (OA). FRN projects identify gaps in the current research that limit the conclusions in CERs and inform those who conduct and fund research of these gaps. FRN projects aim to encourage research likely to fill gaps and make the body of evidence more useful to decisionmakers. The report addressed the following Key Questions (KQs): KQ 1: What are the effectiveness and comparative effectiveness of available PT interventions (without drug treatment) for adult patients with chronic knee pain due to OA on intermediate and patient-centered outcomes when compared with no active treatment or another active PT modality? a. Which patient characteristics are associated with the benefits of examined interventions of PT on intermediate and patient-centered outcomes? b. Do changes in intermediate and patient-centered outcomes differ by the dose, duration, intensity, and frequency of examined interventions of PT? c. Do changes in intermediate and patient-centered outcomes differ by the time of follow up? KQ 2: What is the association between changes in intermediate outcomes with changes in patient-centered outcomes after PT interventions? a. What is the validity of the tests and measures used to determine intermediate outcomes of PT on OA in association with patient-centered outcomes? b. Which intermediate outcomes meet the criteria of surrogates for patient-centered outcomes? c. What are minimal clinically important differences (MCIDs) of the tests and measures used to determine intermediate outcomes? KQ 3: What are the harms from PT interventions available for adult patients with chronic knee pain due to OA when compared with no active treatment or active controls? a. Which patient characteristics are associated with the harms of examined PT interventions? b. Do harms differ by the duration of the treatment and time of follow up? The review was motivated by uncertainty around the effectiveness and comparative effectiveness of physical therapy (PT) treatments for adult patients with knee pain secondary to osteoarthritis (OA). The purpose of this FRN project is to identify and prioritize specific gaps in the current literature on PT for knee pain due to OA that would aid decisionmakers. We used a deliberative process to identify evidence gaps, translate gaps into researchable questions, and solicit stakeholder opinion on the importance of research questions. This report proposes specific research needs along with research design considerations that may be useful in advancing the field.
This book will enable readers to understand the principles underpinning the management of pain which a particular emphasis upon the care of the older adult. The chapters will explore concepts that are recognised to be involved in the pain experience but each author will then add their own unique perspective by applying the principles to their specialist area of practice and the care of the older adult. It is structured to include the aims and outcomes of the chapter at the beginning so that readers can track their progress, and provides chapter outlines and further reading suggestions foir this unique topic area.