Revisión sistemática

No clasificado

Hip arthroscopy in osteoarthritis: a systematic review of the literature.

Año 2016
Revista Hip international : the journal of clinical and experimental research on hip pathology and therapy
Enlaces Pubmed , DOI
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BACKGROUND:

Hip arthroscopy treatment in patients with osteoarthritis is controversial.

HYPOTHESIS/PURPOSE:

To systematically review the clinical outcome of patients with hip osteoarthritis (OA) treated with arthroscopy and what proportion of these patients subsequently underwent total hip arthroplasty (THA).

STUDY DESIGN:

Systematic review.

METHODS:

PubMed, Cochrane library and LILACS were searched from January 1990 through December 2013 for eligible studies. The methodological quality of the collected data (applied to each study) was performed with a modified version of the Coleman methodology score (mCMS).

RESULTS:

11 studies were included in this review. Most of the studies included reported clinical improvements. The overall conversion rate to THA ranged from 9.5% to 50%. Mean time between arthroscopy and THA was 13.5 months.

CONCLUSIONS:

The quality of studies is low. We have found inconclusive evidence to make categorical indications for hip arthroscopy in the treatment of OA, although we have found that there is some postoperative clinical outcome improvement of pain and function in a short-term evaluation. Increasingly worse outcomes were seen as the severity of OA increased.

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Estudio primario

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Sulindac in osteoarthrosis of the hip.

Año 1976
Autores Dieppe PA , Burry HC , Grahame R , Perera T
Revista Rheumatology and rehabilitation
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Sulindac (400 mg/day) has been compared with ibuprofen (1200 mg/day) in 40 patients with osteoarthrosis of the hip, over an eight-week period, in a double-blind controlled clinical trial. The two drugs were comparable in terms of patient preference, effects on hip movements, and toxicity. Sulindac showed superior analgesic properties to ibuprofen, resulting in a significantly greater reduction in pain on weight-bearing and with passive movements (P less than 0.01).

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Revisión sistemática

No clasificado

Viscosupplementation for treating knee osteoarthrosis: review of the literature

Año 2015
Revista Revista brasileira de ortopedia
Enlaces Pubmed , DOI , Virtual Health Library , PMC
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The aim here was to evaluate the evidence that might support or refute the use of intra-articular viscosupplementation in treating patients with symptomatic knee osteoarthrosis. A review of the literature was conducted using the Medline, PubMed and Cochrane Controlled Trial Register databases and Cochrane database systematic reviews (Cochrane Library). Only studies presenting a high level of evidence were taken into consideration. This study included analysis on randomized clinical trials that included at least 100 patients in each intervention group, meta-analyses and systematic reviews. Two meta-analyses, five systematic reviews and six randomized clinical trials fulfilled the inclusion criteria for this review. In the light of the best evidence available so far, there is no consensus for indicating or even for contraindicating the use of intra-articular viscosupplementation among patients with symptomatic knee osteoarthrosis (level of evidence I and degree of recommendation A). Further studies with appropriate methodology are needed to elucidate this matter.

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Síntesis amplia / Guía

No clasificado

OARSI guidelines for the non-surgical management of knee osteoarthritis.

Año 2014
Revista Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society
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OBJECTIVE:

To develop concise, up-to-date, patient-focused, evidence-based,
expert consensus guidelines for the management of knee osteoarthritis (OA),
intended to inform patients, physicians, and allied healthcare professionals
worldwide.

METHOD:

Thirteen experts from relevant medical disciplines (primary
care, rheumatology, orthopedics, physical therapy, physical medicine and
rehabilitation, and evidence-based medicine), three continents and ten countries
(USA, UK, France, Netherlands, Belgium, Sweden, Denmark, Australia, Japan, and
Canada) and a patient representative comprised the Osteoarthritis Guidelines
Development Group (OAGDG). Based on previous OA guidelines and a systematic
review of the OA literature, 29 treatment modalities were considered for
recommendation. Evidence published subsequent to the 2010 OARSI guidelines was
based on a systematic review conducted by the OA Research Society International
(OARSI) evidence team at Tufts Medical Center, Boston, USA. Medline, EMBASE,
Google Scholar, Web of Science, and the Cochrane Central Register of Controlled
Trials were initially searched in first quarter 2012 and last searched in March
2013. Included evidence was assessed for quality using Assessment of Multiple
Systematic Reviews (AMSTAR) criteria, and published criticism of included
evidence was also considered. To provide recommendations for individuals with a
range of health profiles and OA burden, treatment recommendations were stratified
into four clinical sub-phenotypes. Consensus recommendations were produced using
the RAND/UCLA Appropriateness Method and Delphi voting process. Treatments were
recommended as Appropriate, Uncertain, or Not Appropriate, for each of four
clinical sub-phenotypes and accompanied by 1-10 risk and benefit scores.

RESULTS:


Appropriate treatment modalities for all individuals with knee OA included
biomechanical interventions, intra-articular corticosteroids, exercise
(land-based and water-based), self-management and education, strength training,
and weight management. Treatments appropriate for specific clinical
sub-phenotypes included acetaminophen (paracetamol), balneotherapy, capsaicin,
cane (walking stick), duloxetine, oral non-steroidal anti-inflammatory drugs
(NSAIDs; COX-2 selective and non-selective), and topical NSAIDs. Treatments of
uncertain appropriateness for specific clinical sub-phenotypes included
acupuncture, avocado soybean unsaponfiables, chondroitin, crutches, diacerein,
glucosamine, intra-articular hyaluronic acid, opioids (oral and transdermal),
rosehip, transcutaneous electrical nerve stimulation, and ultrasound. Treatments
voted not appropriate included risedronate and electrotherapy (neuromuscular
electrical stimulation).

CONCLUSION:

These evidence-based consensus
recommendations provide guidance to patients and practitioners on treatments
applicable to all individuals with knee OA, as well as therapies that can be
considered according to individualized patient needs and preferences.

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Revisión sistemática

No clasificado

Efectividad de la acupuntura en el tratamiento del dolor en la artrosis de rodilla

Traducción oficial
Año 2002
Revista Atencion primaria / Sociedad Española de Medicina de Familia y Comunitaria
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OBJETIVO:

Determinar la efectividad de la acupuntura en el control del dolor de la artrosis de rodilla.

DISEÑO:

Revisión sistemática.

FUENTES DE DATOS:

MEDLINE, The Cochrane Library. Selección de estudios. De los 9 estudios encontrados, sólo 4 superaron los criterios de selección. Se trata de ensayos clínicos controlados aleatorios que estudian el efecto de la acupuntura únicamente en la articulación de la rodilla.

EXTRACCIÓN DE DATOS:

Los indicadores de resultado primarios valorados son: intensidad del dolor, medición global (mejoría general, proporción de pacientes recuperados, mejoría subjetiva de los síntomas) y estado funcional. Son considerados indicadores de resultado secundarios: mediciones fisiológicas objetivas (amplitud del movimiento de la rodilla, fuerza muscular, tiempo para caminar una determinada distancia, tiempo para escalar una altura determinada), estado general de salud y otros datos, como la necesidad de utilizar medicación o los efectos secundarios.

RESULTADOS:

Existe una evidencia moderada sobre la efectividad de la acupuntura en el tratamiento del dolor de la gonartrosis frente al no tratamiento, que puede ser explicada por su fuerte efecto placebo.

CONCLUSIONES:

En la actualidad no existe suficiente evidencia para recomendar la acupuntura como tratamiento del dolor de la gonartrosis. Son necesarios nuevos estudios, y mejor diseñados, para determinar el verdadero papel de la acupuntura en esta enfermedad.

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Revisión sistemática

No clasificado

Living with osteoarthritis: a systematic review and meta-ethnography.

Año 2014
Revista Scandinavian journal of rheumatology
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OBJECTIVES:

To review and synthesize the existing literature on the experience of living with a diagnosis of hip and/or knee osteoarthritis (OA).

METHOD:

A systematic review was undertaken using meta-ethnography. A search of both published (AMED, CINAHL, EMBASE, PsychINFO, SportsDisc, MEDLINE, Cochrane Clinical Trials Registry, PubMed) and unpublished/trial registry databases [World Health Organization (WHO) International Clinical Trials Registry Platform, Current Controlled Trials, the United States National Institute of Health Trials Registry, National Institute for Health Research (NIHR) Clinical Research Portfolio Database] was undertaken from their inception to 5 June 2013.

RESULTS:

Thirty-two studies formed the meta-ethnography of the lived experiences of people with OA. In total, 1643 people with OA were sampled, the majority diagnosed with knee OA. The evidence base was weak to moderate in quality. The majority of studies indicated that people viewed living with OA negatively. Four key factors influenced their attitudes to the condition: the severity of their symptoms; the impact of these symptoms on their functional capability; their attitude towards understanding their disease; and their perceptions of other people's beliefs towards their disease.

CONCLUSIONS:

The current literature suggests that greater knowledge of the pathology of OA, management of symptoms, promotion of functional activity for patients and their family/friends networks, and understanding to better inform OA patient's role in society are all important elements that affect a person's attitude to OA. By better understanding these factors during future consultations, clinicians may forge stronger relationships with their patients to more effectively manage this long-term disabling condition.

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Revisión sistemática

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Physical Therapy Interventions for Knee Pain Secondary to Osteoarthritis

Año 2012
Libro AHRQ Comparative Effectiveness Reviews
Enlaces Pubmed
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OBJECTIVES:

To assess the association between intermediate and patient-centered outcomes and harms with physical therapy interventions in community-dwelling adults with chronic knee pain secondary to osteoarthritis and to examine validity and minimum clinically important differences of the tools for outcome measurement.

DATA SOURCES:

We searched major electronic bibliographic databases including MEDLINE, the Cochrane Library, the Physiotherapy Evidence Database, and Allied and Complementary Medicine and trial registries up to February 29, 2012.

REVIEW METHODS:

We performed a systematic review of randomized and nonrandomized studies published in English to synthesize rates or means of measured pain, function, and quality of life with physical therapy interventions. Observational studies provided evidence of the association between changes in knee joint functional tests and patient-centered outcomes and minimum clinically important differences in validated tools for outcome measures. We performed meta-analyses of standardized mean differences using random effects models to synthesize the evidence.

RESULTS:

Of 4,266 retrieved references, 154 eligible references examined the association between patient-centered and intermediate outcomes and 422 eligible references examined physical therapy interventions. Of these, 193 randomized controlled trials (RCTs) reported on knee pain, disability, quality of life, and functional outcomes after physical therapy interventions. Pooling criteria were met by 84 RCTs that provided evidence for 12 physical therapy interventions on pain (n = 58), physical function (n = 36), and disability (n = 29). Most studies reported physical therapy effects at followups of 3 months or less. Evidence on longer-term physical therapy effects was available for seven intervention-outcome pairs. Meta-analyses at the longest time of followup provided low-strength evidence that aerobic (n = 11) and aquatic exercise (n = 3) improved disability; aerobic exercise (n = 19), strengthening exercise (n = 17), and ultrasound (n = 6) reduced pain and improved function. Six of 11 individual RCTs demonstrated clinically important improvements in pain and disability with aerobic exercise. Pain relief was consistent in RCTs that reported physical therapist supervision of aerobic exercise. Diathermy, orthotics, and magnetic stimulation demonstrated no benefit. Limited direct comparative effectiveness evidence demonstrated similar benefits in disability measures with aerobic, aquatic, and strengthening exercise. Evidence from individual RCTs did not permit robust conclusions about which physical therapy interventions are most effective or whether differences in effect could be attributed to patient characteristics. Patients with high compliance to exercise tended to have better treatment responses. We found no association between the duration of examined interventions and better intermediate or patient-centered outcomes. Adverse events were uncommon and not severe enough to deter participants from continuing treatment. Gait, mobility restrictions, muscle strength, and range-of-motion measures were associated with disability measures in individual studies. Minimum clinically important differences in scales were determined for 26 tools but have not been used in RCTs to examine the clinical importance of improvements. The definition of the Patient Acceptable Symptom State that accounts for patient satisfaction was available for the Western Ontario McMaster Universities Osteoarthritis Index, the Visual Analog Scale for Pain, and the Patient Global Assessment Scale.

CONCLUSIONS:

Low-strength evidence suggested that core physical therapy interventions, including aerobic, aquatic, strengthening, and proprioception exercise, improved patient outcomes. Risk of bias in studies and heterogeneity in populations and physical therapy interventions downgraded the strength of evidence to low or moderate in most cases. Studies focused on a single modality of physical therapy rather than the combinations typically used in practice. Benefits with physical therapy interventions were not consistently evaluated according to the clinical importance of improvement in scales and tests. Adverse events were uncommon and not severe enough to deter participants from continuing treatment. Evidence about long-term adherence to and benefits of available physical therapy interventions is lacking.

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Revisión sistemática

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Variables associated with the progression of hip osteoarthritis: a systematic review.

Año 2009
Autores Wright AA , Cook C , Abbott JH
Revista Arthritis and rheumatism
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OBJECTIVE:

As populations age and the prevalence of hip osteoarthritis (OA) increases, health care providers must manage increasing demands for services. Evidence regarding the progression of hip OA can assist health care practitioners in determining expected patient prognosis and planning care. This systematic review of prospective cohort studies examines prognostic variables in patients with hip OA.

METHODS:

Articles were selected following a comprehensive search of Medline, EMBase, CINAHL, and Allied and Complementary Medicine from database inception to October 2008 and hand searches of the reference lists of retrieved articles. Inclusion criteria involved 1) estimates of the association between prognostic variables and progression of OA, 2) prospective cohort design, 3) patients diagnosed with hip OA based on established criteria, 4) at least 1 year of followup, and 5) access to the full published text. Two independent reviewers assessed the methodologic quality of each study and the association between prognostic variables and OA progression.

RESULTS:

Eighteen articles met the inclusion criteria; 17 were considered to be of high quality. Strong evidence of progression was associated with age, joint space width at entry, femoral head migration, femoral osteophytes, bony sclerosis, Kellgren/Lawrence hip grade 3, baseline hip pain, and Lequesne index score > or =10. Strong evidence of no association with progression was associated with acetabular osteophytes. Evidence was weak or inconclusive regarding associations between various other radiographic or clinical variables, molecular biomarkers, or use of nonsteroidal inflammatory drugs.

CONCLUSION:

Overall, few variables were found to be strongly associated with the progression of hip OA, and a variety of other variables were weakly predictive of outcome.

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Estudio primario

No clasificado

Fatigue in osteoarthritis: a qualitative study.

Año 2008
Revista BMC musculoskeletal disorders
Enlaces Pubmed , DOI , PMC
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BACKGROUND:

Fatigue is recognized as a disabling symptom in many chronic conditions including rheumatic disorders such as rheumatoid arthritis (RA) and lupus. Fatigue in osteoarthritis (OA) is not routinely evaluated and has only been considered in a very limited number of studies. To date, these studies have focused primarily on patients with OA under rheumatological care, which represent the minority of people living with OA. The purpose of this study was to increase our understanding of the fatigue experience in community dwelling people with OA.

METHODS:

In 2004, 8 focus groups were conducted with 28 men and 18 women (mean age 72.3) with symptomatic hip or knee OA recruited from a population-based cohort. Participants completed a self-administered questionnaire, which included demographics, measures of OA severity (WOMAC), depression (CES-D) and fatigue (FACIT). Sessions were audio taped and transcribed verbatim. Two researchers independently reviewed the transcripts to identify themes. Findings were compared and consensus reached.

RESULTS:

Mean pain, disability, depression and fatigue scores were 8.7/20, 27.8/68, 15.4/60, and 30.9/52, respectively. Participants described their fatigue as exhaustion, being tired and "coming up against a brick wall". Participants generally perceived fatigue as different from sleepiness and distinguished physical from mental fatigue. Factors believed to increase fatigue included OA pain and pain medications, aging, various types of weather and poor sleep. Mental health was identified as both affecting fatigue and being affected by fatigue. Participants described fatigue as impacting physical function, and their ability to participate in social activities and to do household chores. Rest, exercise, and avoiding or getting assistance with activities were cited as ways of coping. Participants generally did not discuss their fatigue with anyone except their spouses.

CONCLUSION:

Participants with OA described experiencing notable amounts of fatigue and indicated that it had a substantial impact on their lives. Further research is required to better understand the role of fatigue in OA in order to identify strategies to reduce its impact.

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Estudio primario

No clasificado

Does isolated patellofemoral osteoarthritis matter?

Año 2009
Autores Duncan R , Peat G , Thomas E , Wood L , Hay E , Croft P
Revista Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society
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OBJECTIVES:

To describe the structure-pain and structure-function associations in isolated patellofemoral osteoarthritis (PF OA).

DESIGN:

Population-based study of 819 adults aged > or =50 years with knee pain. The severity of knee pain, stiffness and disability were measured using the Western Ontario and McMaster Osteoarthritis Index (WOMAC). Three radiographic views of the knee were obtained.

RESULTS:

Isolated PF OA was mild in 142 participants and moderate/severe in 44. Mean WOMAC scores for pain, stiffness and function were associated with radiographic severity of PF OA (F(2,389)=4.7, P=0.01; F(2,392)=4.5, P=0.012 and F(2,392)=6.1, P=0.002, respectively, adjusted for age, gender, and body mass index (BMI)). Post-hoc tests demonstrated statistically significant differences for mean pain, stiffness and function score between those with mild PF OA and those with normal X-rays. In task-specific items there was evidence of a stepped response, the proportion of participants with moderate/severe/extreme pain or difficulty in performing everyday tasks increasing with the severity of PF OA. The strongest association was observed for pain going up and down stairs (age-gender-BMI adjusted odds ratio (OR) 3.0; 95% confidence interval (CI) 1.4,6.6. Functional tasks most strongly related to radiographic severity were: descending stairs (OR 3.2; (CI 1.5,6.5)), getting in/out of the bath (3.2; 1.5,6.6), getting in/out of a car (3.0; 1.4,6.1).

CONCLUSIONS:

Mild isolated PF OA is significantly associated with symptoms of pain, stiffness and functional limitation. Further research on its recognition in clinical practice and the development of targeted treatments to prevent or slow progression are warranted.

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