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Changes in physical activity and the association between pain and physical activity – a longitudinal analysis of 17,454 patients with knee or hip osteoarthritis from the GLA:D® registry

  • L. Baumbach
    Correspondence
    Address correspondence and reprint requests to: L. Baumbach, Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Tel.: 49-40-7410-59047.
    Affiliations
    Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Germany

    Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
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  • D.T. Grønne
    Affiliations
    Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
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  • N.C. Møller
    Affiliations
    Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
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  • S.T. Skou
    Affiliations
    Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark

    The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark
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  • E.M. Roos
    Affiliations
    Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
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Published:October 19, 2022DOI:https://doi.org/10.1016/j.joca.2022.09.012

      Summary

      Objective

      Investigate change in physical activity following an 8-week education and exercise therapy program for patients with knee/hip osteoarthritis, focusing on those with low physical activity level. Furthermore, to evaluate associations between changes in pain intensity and physical activity.

      Method

      Data from the Good Life with osteoArthritis in Denmark (GLA:D®) registry, at baseline, immediately after completion, and 12 months after entering the program was used. Measures of interest were UCLA activity scale (1–10) and Visual Analog Scale for pain intensity (0–100 mm). Changes in physical activity levels (low 1–4, moderate 5–6, and high 7–10) over three time points were investigated. Asymmetric fixed effects regression models were used to evaluate the association between clinically relevant change in pain (≥15 mm) and change in physical activity level from baseline to 12 months.

      Results

      37% with low activity level at baseline (n = 4,836) and 69% of all patients (n = 17,454) reached or maintained at least a moderate physical activity level at follow-ups.
      Surprisingly, both an improvement (β = 1.44, P < 0.001) and a worsening (β = 1.18, P < 0.001) in pain intensity was associated with increased physical activity in low activity patients. For all patients a similar trend was observed (β = 0.51, P < 0.001 and β = 0.11, P = 0.215, respectively).

      Conclusion

      In low active knee or hip OA patients, a third of patients participating in an education and exercise therapy program reached and maintained at least a moderate physical activity level for 1 year. The improvement in physical activity was not dependent on pain reduction.

      Keywords

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      References

      1. Physical activity: World Health Organization. Available from: https://www.who.int/news-room/fact-sheets/detail/physical-activity.

        • Booth F.W.
        • Roberts C.K.
        • Laye M.J.
        Lack of exercise is a major cause of chronic diseases.
        Compr Physiol. 2012; 2: 1143
        • Pedersen B.K.
        • Saltin B.
        Exercise as medicine–evidence for prescribing exercise as therapy in 26 different chronic diseases.
        Scand J Med Sci Sport. 2015; 25: 1-72
        • McAlindon T.E.
        • Bannuru R.R.
        • Sullivan M.
        • Arden N.
        • Berenbaum F.
        • Bierma-Zeinstra S.
        • et al.
        OARSI guidelines for the non-surgical management of knee osteoarthritis.
        Osteoarthr Cartil. 2014; 22: 363-388
        • Bannuru R.R.
        • Osani M.
        • Vaysbrot E.
        • Arden N.
        • Bennell K.
        • Bierma-Zeinstra S.
        • et al.
        OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.
        Osteoar Cartil. 2019; 27: 1578-1589
        • Kolasinski S.L.
        • Neogi T.
        • Hochberg M.C.
        • Oatis C.
        • Guyatt G.
        • Block J.
        • et al.
        2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee.
        Arthritis Rheumatol. 2020; 72: 220-233
        • Wallis J.A.
        • Webster K.E.
        • Levinger P.
        • Taylor N.F.
        What proportion of people with hip and knee osteoarthritis meet physical activity guidelines? A systematic review and meta-analysis.
        Osteoarthr Cartil. 2013; 21: 1648-1659
        • Lazaridou A.
        • Martel M.O.
        • Cornelius M.
        • Franceschelli O.
        • Campbell C.
        • Smith M.
        • et al.
        The association between daily physical activity and pain among patients with knee osteoarthritis: the moderating role of pain catastrophizing.
        Pain Med. 2019; 20: 916-924
        • Kanavaki A.M.
        • Rushton A.
        • Efstathiou N.
        • Alrushud A.
        • Klocke R.
        • Abhishek A.
        • et al.
        Barriers and facilitators of physical activity in knee and hip osteoarthritis: a systematic review of qualitative evidence.
        BMJ Open. 2017; 7
        • French D.P.
        • Olander E.K.
        • Chisholm A.
        • Mc Sharry J.
        Which behaviour change techniques are most effective at increasing older adults' self-efficacy and physical activity behaviour? A systematic review.
        Ann Behav Med. 2014; 48: 225-234
        • Williamson W.
        • Kluzek S.
        • Roberts N.
        • Richards J.
        • Arden N.
        • Leeson P.
        • et al.
        Behavioural physical activity interventions in participants with lower-limb osteoarthritis: a systematic review with meta-analysis.
        BMJ Open. 2015; 5e007642
        • Ding D.
        • Lawson K.D.
        • Kolbe-Alexander T.L.
        • Finkelstein E.A.
        • Katzmarzyk P.T.
        • Van Mechelen W.
        • et al.
        The economic burden of physical inactivity: a global analysis of major non-communicable diseases.
        Lancet. 2016; 388: 1311-1324
        • Stubbs B.
        • Hurley M.
        • Smith T.
        What are the factors that influence physical activity participation in adults with knee and hip osteoarthritis? A systematic review of physical activity correlates.
        Clin Rehabil. 2015; 29: 80-94
        • Veenhof C.
        • Huisman P.
        • Barten J.
        • Takken T.
        • Pisters M.
        Factors associated with physical activity in patients with osteoarthritis of the hip or knee: a systematic review.
        Osteoarthr Cartil. 2012; 20: 6-12
        • Skou S.T.
        • Roos E.M.
        Good Life with osteoArthritis in Denmark (GLA: D™): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide.
        BMC Muscoskel Disord. 2017; 18: 1-13
        • Zhang W.
        • Doherty M.
        • Peat G.
        • Bierma-Zeinstra M.
        • Arden N.
        • Bresnihan B.
        • et al.
        EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis.
        Ann Rheum Dis. 2010; 69: 483-489
        • Mørup-Petersen A.
        • Skou S.T.
        • Holm C.E.
        • Holm P.M.
        • Varnum C.
        • Krogsgaard M.R.
        • et al.
        Measurement properties of UCLA Activity Scale for hip and knee arthroplasty patients and translation and cultural adaptation into Danish.
        Acta Orthop. 2021; : 1-8
        • Zahiri C.A.
        • Schmalzried T.P.
        • Szuszczewicz E.S.
        • Amstutz H.C.
        Assessing activity in joint replacement patients.
        J Arthroplast. 1998; 13: 890-895
        • Naal F.D.
        • Impellizzeri F.M.
        • Leunig M.
        Which is the best activity rating scale for patients undergoing total joint arthroplasty?.
        Clin Orthop Relat Res. 2009; 467: 958-965
        • Lübbeke A.
        • Zimmermann-Sloutskis D.
        • Stern R.
        • Roussos C.
        • Bonvin A.
        • Perneger T.
        • et al.
        Physical activity before and after primary total hip arthroplasty: a registry-based study.
        Arthritis Care Res. 2014; 66: 277-284
        • Allison P.D.
        Asymmetric fixed-effects models for panel data.
        Socius. 2019; 52378023119826441
        • Cameron A.C.
        • Trivedi P.K.
        Microeconometrics: Methods and Applications.
        Cambridge University Press, 2005
        • Farrar J.T.
        • Young Jr., J.P.
        • LaMoreaux L.
        • Werth J.L.
        • Poole R.M.
        Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale.
        Pain. 2001; 94: 149-158
        • Salaffi F.
        • Stancati A.
        • Silvestri C.A.
        • Ciapetti A.
        • Grassi W.
        Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale.
        Eur J Pain. 2004; 8: 283-291
        • Von Elm E.
        • Altman D.G.
        • Egger M.
        • Pocock S.J.
        • Gøtzsche P.C.
        • Vandenbroucke J.P.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        Bull World Health Organ. 2007; 85: 867-872
        • Ernstgård A.
        • PirouziFard M.
        • Thorstensson C.A.
        Health enhancing physical activity in patients with hip or knee osteoarthritis-an observational intervention study.
        BMC Muscoskel Disord. 2017; 18: 1-9
        • Taul-Madsen L.
        • Kjeldsen T.
        • Skou S.T.
        • Mechlenburg I.
        • Dalgas U.
        Exercise booster sessions as a mean to maintain the effect of an exercise-intervention – a systematic review.
        Phys Ther Rev. 2022; 27: 103-113
        • Brüderl J.
        • Ludwig V.
        Fixed-effects Panel Regression.
        The Sage Handbook of Regression Analysis and Causal Inference. 2015: 327-357
        • Brüderl J.
        • Ludwig V.
        Applied panel data analysis using Stata.
        (Online verfügbar unter) (zuletzt geprüft am. 2015;16)
        • Mouw T.
        Estimating the causal effect of social capital: a review of recent research.
        Annu Rev Sociol. 2006; : 79-102