Musculoskeletal Pathology Annotated Bibliography
Introduction
There are numerous ways through which osteoarthritis can be management and even prevented. In this paper, I argue that osteoarthritis patients need to be empowered to be able to self-manage their conditions. In proposing home exercise as one of the interventions through which osteoarthritis patients can be empowered, this discourse is thus based on the following research question: how can home exercise be used in managing and preventing osteoarthritis? The paper reviews a broad spectrum of recent research to answer this question; thereby, providing evidence that osteoarthritis patients can and need to be empowered to manage their conditions so that they can take responsibility of alleviating their pain and improving the quality of their lives.
Carvalho, N.A., Bittar, S.T., Pinto, F.R., Ferreira, M., & Sitta, R.R. (2010). Manual for Guided Home Exercises for Osteoarthritis of the Knee. Clinics, 65(8): 775–780.
This prospective case series was aimed at assessing the efficiency of the guidance manuals for patience that are suffering from knee osteoarthritis regarding pain, muscle function and strength, range of movement, manual function and strength test and active goniometry. This observational study included 38 adults with knee osteoarthritis that had been referred to Santa Casa de Misericórdia de São Paulofor physiotherapy. They were guided on undertaking particular physical exercises and provided with an instructional manual on how to do the exercises at their homes. They were then evaluated for range of movement, muscle pain, function and strength. The evaluations were undertaken twice: before they were given the manual and 3 months after receiving it. They were monitored monthly in regards to improvements on their exercising abilities.
The study established that with proper guidance, physical therapy exercises is effective for maintaining muscle pain and strength, reducing functional incapacity, and enhancing the range of movement in the knee osteoarthritis patients. One of the strengths of the design used in this study is that it enhances the access to people in cases where the other methods of data collection such as interviews and questionnaires are not effective. In this case, the method led to the access of the patients at the de São Paulo hospital. The design is also reliable in terms of the validity of the study and understanding of the subjects. However, the findings that are generated by observational studies tend to be too subjective since they largely depend on the role that the researcher played in conducting the study. In sum, Carvalho et al. (2010) helped to add evidence to the thesis that home exercise are essential for maintaining osteoarthritis. Their study demonstrates that even without supervision, home exercises as guided by printed manuals are beneficial for maintaining knee osteoarthritis.
Focht, B.C., Garver, M.J., Devor, S.T., Dials, J., Rose, M., Lucas, A.R., Emery, C.F., Hackshaw, K., & Rejeski, W.J. (2012). Improving Maintenance of Physical Activity in Older, Knee Osteoarthritis Patients Trial-pilot (IMPACT-P): Design and Methods. Contemporary Clinical Trials 33 (2012): 976–986.
In this study, Focht (2012) acknowledge the need for identifying effective approaches for enhancing the maintenance of physical activities in managing knee osteoarthritis. They, therefore, employed a single-blind two pronged randomized controlled study to contrast the effects of cognitive behavioral group-mediated exercise intervention with that of the traditional center-based exercise therapy of 80 patients with knee osteoarthritis. The patients were aged above 55 years and demonstrated living sedentary lives. The study established that cognitive behavioral group-mediated exercise was effective in producing meaningful improvements in regards to mobility performance, physical activity adherence and the quality of life of the patients. This is because the approach emphasizes on the regulation of the patients’ behavior and their problem-solving inhibitors in their environments. It thus promotes the development of self-regulatory skills that is essential for transitioning from supervision to independence in undertaking home-based exercises. In using the single-blind two pronged randomized controlled design, the study was able to achieve high internal validity which provided quite meaningful implications for the use of physical activities in the maintenance of knee osteoarthritis.
However, the design method also exhibited limitations in the sense that its design is fraught with limited external validity and this makes the sample size included in this study not sufficient to yield significant generalization in all the tested outcomes. Besides, the single-blind two pronged randomized controlled design consumes much time and thus the differential sequencing of the intervention contacts within the three months of the traditional center-based exercise intervention and the nine months of the cognitive behavioral group-mediated intervention was potentially quite limiting. In providing the comparable effectiveness of the different approaches for promoting active lifestyle for knee osteoarthritis patients, the findings of the study were significant in answering the research question regarding the use of home exercise to manage osteoarthritis.
Peeler, J., Christian, M., Cooper, J., Leiter, J., & MacDonald, P. (2015). Managing Knee Osteoarthritis: The Effects of Body Weight Supported Physical Activity on Joint Pain, Function, and Thigh Muscle Strength. Clinical Journal of Sports Medicine, 1–6.
The main objective of this study was to determine the effect of lower body positive pressure that is supported by low-lead treadmill program on knee osteoarthritis overweight patients. The study aimed at establishing how the intervention would affect the patients’ knee joint functioning, pain and their thigh muscle strength. The prospective observational design used in the study included a sample of 31 overweight patients that suffered from knee osteoarthritis and were aged between 50–70 years of age. Each of the participants was given an identification number; they also filled in the informed consent forms and the knee demographic forms that provided the history of their knee osteoarthritis. The findings of the study demonstrated that the lower body positive pressure intervention is effective in providing safe maintenance of knee osteoarthritis through regular walking exercises without the risk of worsening the joint symptoms. The study also established that the intervention significantly decreased the knee joint pain, improved the knee joint functioning and significantly increased the strength in the thigh muscle of the affected knee.
There were various merits that came with the use of prospective observational design for this study. For one, the design is effective in making evaluations of the effects of an unusual or rare exposure given that the researchers have the liberty for identifying an adequate number of participants that have such unusual exposure, which in this case was the overweight knee osteoarthritis patients who were aged between 50–70 years. In the same vein, the design allows for the selection of participants who are highly likely to have outcomes of interest given that the outcome is not recognized at the baseline with the establishment of the exposure status. The method was, however, limited in the sense that its methodological approach did not include the examination of the knee-joint articular cartilage; therefore, any conclusion in regards to the low-load walking exercises cannot be made. Generally, the findings of the study are significant given that they arguably represent those of the first study to ever been conducted on the use of the lower body positive pressure intervention to support the use of the exercises regimen on patients with knee osteoarthritis.
Oiestad, B.E., Osterås, N., Frobell, R., Grotle, M., Brogger, H., & Risberg, M.A. (2013). The efficacy of strength and aerobic exercise on patient-reported outcomes and structural changes in patients with knee osteoarthritis: study protocol for randomized controlled trial. BMC Musculoskeletal Disorders, 14 (266).
In this study, Oiestad et al. (2013) aimed at comparing the efficacy of two types of exercise programs as compared to the control groups of individuals that have established symptomatic and radiographic knee osteoarthritis that affects their quality of life characterized by pain in the knee and limited physical functioning. The data for this study was collected through the use of a three-pronged randomized controlled trial that involved two exercise interventions applied on the control group of patients. The patients posted mild to moderate radiographic osteoarthritis and were aged between 45–65 years and had no grave mental or physical illness. A sample size of 207 individuals were included in the study and the intervention program was carried out within the duration of 14 weeks.
The study established that exercise therapy is quite effective in managing knee osteoarthritis though the knowledge of its working mechanism is not yet established. One of the strengths of the design employed in this study is that they have a high level of internal validity and enhance the control of the exposure to factors such as the timing, duration and the frequency. Besides, the randomization ensures that the study achieves a true measure of the efficacy of the therapy interventions. However, with the design, there is a limited opportunity for measuring the external validity and it is also a complex method, which is not just expensive but also takes a lot of time to implement. Besides, the design can only be implemented in an artificial environment where strict eligibility criteria are applied and the ethical considerations are significantly limited. In sum, Oiestad et al. (2013) concludes that exercise therapy is effective for the management of knee osteoarthritis, which answers the research question of this study that home exercise can actually be used to manage osteoarthritis; it however, does not provide evidence of whether exercise therapy could help to prevent osteoarthritis.
Conclusion
The review of these studies have helped to answer the research question in this discourse in numerous ways. For one, in Oiestad et al. (2013), it was noted that home exercises were not just cost effective but they also demonstrated positive clinical outcomes for knee osteoarthritis patients with mild to moderate cases. The element of cost-effectiveness is a significant component of home exercising and it is accompanied by convenience which is characterized by the responsibility accorded to the patient to take charge of the maintenance and prevention of the osteoarthritis condition. Carvalho (2010) established that with proper guidance, physical therapy exercises is effective for maintaining muscle pain and strength, reducing functional incapacity and enhancing the range of movement in the knee osteoarthritis patients. This indicates that what is required for home exercise to be effective is proper guidance to osteoarthritis patients as this enables them to maintain their conditions without posing further risks to themselves, such that could stem from poor performance of the exercises. Furthermore, Focht et al. (2012) helped point that osteoarthritis patients are better empowered through inculcating exercising as a habit. Their study found out that that cognitive behavioral group-mediated exercise was effective in producing meaningful improvements in regards to mobility performance, physical activity adherence and the quality of life of the patients.
These findings recognized the difficulties of undertaking home exercises, which need strict discipline in undertaking them. The findings, therefore, propose that for effective management of the conditions, patients need to be empowered to carry out the exercise as a habit so that they can successfully undertake it without any supervision. Finally, Peeler et al. (2015) also support the use of home exercise in the management of osteoarthritis. Their study demonstrated that the lower body positive pressure intervention is effective in providing safe maintenance of knee osteoarthritis through regular walking exercises without the risk of worsening the joint symptoms. This also applies to home exercising to those patients that have got gyms at their homes and would find it convenient and cost effective to manage their condition at home rather than be enrolled in a program at health centers. However, even though these studies concur on the feasibility of home exercise in managing and preventing osteoarthritis, they propose various exercising methods that patients could employ. There is, therefore, need for further research to be conducted in regards to the home exercise method that is most convenient, cost effective and actually effective for maintaining and preventing the osteoarthritis condition in patients. This will go a long way in narrowing down the options for patients who may be juggling between what options they should choose.
References
Carvalho, N.A., Bittar, S.T., Pinto, F.R., Ferreira, M., & Sitta, R.R. (2010). Manual for Guided Home Exercises for Osteoarthritis of the Knee. Clinics, 65(8): 775–780.
Focht, B.C., Garver, M.J., Devor, S.T., Dials, J., Rose, M., Lucas, A.R., Emery, C.F., Hackshaw, K., &Rejeski, W.J. (2012). Improving Maintenance of Physical Activity in Older, Knee Osteoarthritis Patients Trial-pilot (IMPACT-P): Design and Methods. Contemporary Clinical Trials 33 (2012): 976–986.
Peeler, J., Christian, M., Cooper, J., Leiter, J., & MacDonald, P. (2015). Managing Knee Osteoarthritis: The Effects of Body Weight Supported Physical Activity on Joint Pain, Function, and Thigh Muscle Strength. Clinical Journal of Sports Medicine, 1–6.
Oiestad, B.E., Osterås, N., Frobell, R., Grotle, M., Brogger, H., & Risberg, M.A. (2013). The efficacy of strength and aerobic exercise on patient-reported outcomes and structural changes in patients with knee osteoarthritis: study protocol for randomized controlled trial. BMC Musculoskeletal Disorders, 14 (266).
