Use of Condition-Specific Patient-Reported Outcome Measures in Clinical Trials among Patients with Wrist Osteoarthritis: A Systematic Review Effect of an education programme for patients with osteoarthritis in primary care - a randomized controlled trial Rationale, design and conduct of a comprehensive evaluation of a primary care based intervention to improve the quality of life of osteoarthritis patients. The PraxArt-project: a cluster randomized controlled trial [ISRCTN87252339] Activity Increase Despite Arthritis (AÏDA): design of a Phase II randomised controlled trial evaluating an active management booklet for hip and knee osteoarthritis [ISRCTN24554946] Which outcome measures should be used in rheumatoid arthritis clinical trials? Clinical and quality-of-life measures' responsiveness to treatment in a randomized controlled trial. Development of an evidence-based exercise programme for people with hand osteoarthritis Feasibility and preliminary efficacy of a physical activity counseling intervention using Fitbit in people with knee osteoarthritis: the TRACK-OA study protocol A Community-Based Physical Activity Counselling Program for People With Knee Osteoarthritis: Feasibility and Preliminary Efficacy of the Track-OA Study Multidisciplinary and multifaceted outpatient management of patients with osteoarthritis: protocol for a randomised, controlled trial Exercise and hand osteoarthritis symptomatology: a controlled crossover trial. Exercise and manual physiotherapy arthritis research trial (EMPART) for osteoarthritis of the hip: a multicenter randomized controlled trial. Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials Case management of arthritis patients in primary care: a cluster-randomized controlled trial. Activity Increase Despite Arthritis (AÏDA): phase II randomised controlled trial of an active management booklet for hip and knee osteoarthritis in primary care. The impact of increased contact on psychosocial outcomes in patients with osteoarthritis: a randomized, controlled trial. Ottawa Panel evidence-based clinical practice guidelines for therapeutic exercise in the management of hip osteoarthritis* Comparison of commonly used orthopaedic outcome measures using palm-top computers and paper surveys.
Background . This paper aim ed to identify condition-specific patient-reported outcome measures used in clinical trials among people with wrist osteoarthritis and summarise empirical peer- review ed evidence supporting their reliability , validity , and responsiveness to change . Methods . A systematic review of r and omised controlled trials among people with wrist osteoarthritis was undertaken . Studies reporting reliability , validity , or responsiveness were identified using a systematic reverse citation trail audit procedure . Psychometric properties of the instruments were examined against predefined criteria and summarised . Results . Thirteen clinical trials met inclusion criteria . The most common patient-reported outcome was the disabilities of the arm , shoulder , and h and question naire ( DASH ) . The DASH , the  Michigan H and Outcomes Question naire ( MHQ ) , the  Patient Evaluation Measure ( PEM ) , and the  Patient-Reported Wrist Evaluation ( PRWE ) had evidence supporting their reliability , validity , and responsiveness . A post-hoc review of excluded studies revealed the AUSCAN Osteoarthritis H and Index as another suitable instrument that had favourable reliability , validity , and responsiveness . Conclusions . The DASH , MHQ , and AUSCAN Osteoarthritis H and Index instruments were supported by the most favourable empirical evidence for validity , reliability , and responsiveness . The PEM and PRWE also had favourable empirical evidence reported for these elements . Further psychometric testing of these instruments among people with wrist osteoarthritis is warranted Background Osteoarthritis ( OA ) is a degenerative disease , considered to be one of the major public health problems . Research suggests that patient education is feasible and valuable for achieving improvements in quality of life , in function , well-being and improved coping . Since 1994 , Primary Health Care in Malmö has used a patient education programme directed towards OA . The aim of this study was to evaluate the effects of this education programme for patients with OA in primary health care in terms of self-efficacy , function and self-perceived health . Method The study was a single-blind , r and omized controlled trial ( RCT ) in which the  EuroQol-5D and Arthritis self-efficacy scale were used to measure self-perceived health and self-efficacy and function was measured with Grip Ability Test for the upper extremity and five different functional tests for the lower extremity . Results We found differences between the intervention group and the control group , comparing the results at baseline and after 6 months in EuroQol-5D ( p < 0.001 ) and in st and ing one leg eyes closed ( p = 0.02 ) in favour of the intervention group . No other differences between the groups were found . Conclusion This study has shown that patient education for patients with osteoarthritis is feasible in a primary health care setting and can improve self-perceived health as well as function in some degree , but not self-efficacy . Further research to investigate the effect of exercise performance on function , as well as self-efficacy is warranted . Trial registration The trial is registered with Clinical Trials.gov . Registration number : Background Osteoarthritis ( OA ) has a high prevalence in primary care . Conservative , guideline orientated approaches aim ing at improving pain treatment and increasing physical activity , have been proven to be effective in several context s outside the primary care setting , as for instance the Arthritis Self management Programs ( ASMPs ) . But it remains unclear if these comprehensive evidence based approaches can improve patients ' quality of life if they are provided in a primary care setting . Methods / Design PraxArt is a cluster r and omised controlled trial with GPs as the unit of r and omisation . The aim of the study is to evaluate the impact of a comprehensive evidence based medical education of GPs on individual care and patients ' quality of life . 75 GPs were r and omised either to intervention group I or II or to a control group . Each GP will include 15 patients suffering from osteoarthritis according to the criteria of ACR.In intervention group I GPs will receive medical education and patient education leaflets including a physical exercise program . In intervention group II the same is provided , but in addition a practice nurse will be trained to monitor via monthly telephone calls adherence to GPs prescriptions and advices and ask about increasing pain and possible side effects of medication . In the control group no intervention will be applied at all . Main outcome measurement for patients ' QoL is the GERMAN- AIMS 2-SF question naire . In addition data about patients ' satisfaction ( using a modified EUROPEP-tool ) , medication , health care utilization , comorbidity , physical activity and depression ( using PHQ-9 ) will be retrieved . Measurements ( pre data collection ) will take place in months I-III , starting in June 2005 . Post data collection will be performed after 6 months . Discussion Despite the high prevalence and increasing incidence , comprehensive and evidence based treatment approaches for OA in a primary care setting are neither established nor evaluated in Germany . If the evaluation of the presented approach reveals a clear benefit it is planned to provide this GP-centred interventions on a much larger scale Background Hip and knee osteoarthritis is a common cause of pain and disability , which can be improved by exercise interventions . However , regular exercise is uncommon in this group because the low physical activity level in the general population is probably reduced even further by pain related fear of movement . The best method of encouraging increased activity in this patient group is not known . A booklet has been developed for patients with hip or knee osteoarthritis . It focuses on changing disadvantageous beliefs and encouraging increased physical activity . Methods / Design This paper describes the design of a Phase II r and omised controlled trial ( RCT ) to test the effectiveness of this new booklet for patients with hip and knee osteoarthritis in influencing illness and treatment beliefs , and to assess the feasibility of conducting a larger definitive RCT in terms of health status and exercise behaviour . A computerised search of four general medical practice patients ' record data bases will identify patients older than 50 years of age who have consulted with hip or knee pain in the previous twelve months . A r and om sample of 120 will be invited to participate in the RCT comparing the new booklet  with a control booklet , and we expect 100 to return final question naires . This trial will assess the feasibility of recruitment and r and omisation , the suitability of the control intervention and outcome measurement tools , and will provide an estimate of effect size . Outcomes will include beliefs about hip and knee pain , beliefs about exercise , fear avoidance , level of physical activity , health status and health service costs . They will be measured at baseline , one month and three months . Discussion We discuss the merits of testing effectiveness in a phase II trial , in terms of intermediate outcome measures , whilst testing the processes for a larger definitive trial . We also discuss the advantages and disadvantages of testing the psychometric properties of the primary outcome measures concurrently with the trial . Trial registration Current Controlled Trials IS RCT OBJECTIVE To determine the discriminant validity of the core set of outcome measures proposed by the American College of Rheumatology ( ACR ) and the Outcome Measures in Clinical Trials ( OMERACT ) conference committee to be used in clinical trials of rheumatoid arthritis ( RA ) . METHODS Utilizing data from a multicenter r and omized double-blind clinical trial of low-dose cyclosporine and placebo in RA , we estimated the relative efficiency ( RE ) of measures to detect a treatment effect ( relative to tender joint count , which was assigned a value of 1 ) . Four pain measures ( 10-cm visual analog scale [ VAS ] , 5-point categorical scale , Health Assessment Question naire [ HAQ ] pain index , Arthritis Impact Measurement Scales [ AIMS ] pain score ) and 3 quality -of-life measures ( Problem Elicitation Technique [ PET ] , HAQ , AIMS )  were compared . RESULTS Physician and patient global measures were the most responsive instruments , although neither was statistically superior to tender joint count . Swollen joint count , grip strength , pain measured on a 10-cm VAS , and functional status as measured by the PET and HAQ were all of intermediate responsiveness . Morning stiffness , 5-point pain scale , and erythrocyte sedimentation rate were the least responsive instruments . CONCLUSION This study provides further evidence to support the core set of outcome measures proposed by the ACR and OMERACT Abstract Background : Exercising is recommended for people with h and osteoarthritis ( HOA ) , but there is no consensus regarding the design of exercise programmes . Objective : To describe the development and content of an evidence -based exercise programme for people with HOA . Methods : The development was based on research evidence , professional expertise , and client evidence and adhered to the new Medical Research Council framework for design and evaluation of complex interventions . The process included literature search and appraisal , discussion s with clinicians and patient research partners , and piloting , followed by a revision of the programme based on feedback from pilot participants . Results : The programme contains three exercises to increase the strength and stability of the shoulder , arm and wrist muscles , and four exercises to maintain or increase range of motion , grip strength , and joint stability in the finger joints . It starts with a warm-up period , ends with a finger stretch exercise , and follows the American College of Sports Medicine ’s recommendations regarding exercise intensity , session frequency , and length of exercise period . An exercise diary is included as part of the programme . Conclusions : An evidence -based exercise programme for people with HOA has been developed . The effect of the programme has recently been evaluated in a r and omized controlled trial Background Physical activity ( PA ) reduces pain and improves functioning in people with knee osteoarthritis ( OA ) , but few people with the condition meet recommended PA guidelines . Successful intervention strategies to increase PA include goal setting , action planning , self-monitoring , and follow-up feedback from a healthcare professional . Recently developed consumer wearable activity trackers allow users to set activity goals , self-monitor daily goal -progress , and provide feedback on goal attainment . It is hypothesized that a multi-component physiotherapist-led intervention that includes a short ( 40-min ) education module , guided goal - setting and action planning , the use of a wristb and activity tracker , and weekly follow-up phone calls will lead to increased PA outcomes . Methods / design Thirty-six participants will be recruited from the community for a two-group pilot r and omized controlled trial with a stepped-wedge design using an intention-to-treat analysis . Computer-generated block r and omization will be performed using varying block sizes and a 1:1 allocation ratio . The 4-week intervention will be delivered immediately ( immediate-intervention group ) or after a 5-week delay ( delayed-intervention group ) . Outcome measures of pain and disability ( Knee Injury and OA Outcome Score ) , disease self-management ability ( Partners in Health Scale ) , and objective bouted moderate-to-vigorous PA and sedentary time ( BodyMedia SenseWear Mini Armb and ) will be collected at baseline ( week 0 ) and two follow-ups ( weeks 5 and 10 ) , for a total study duration of 11 weeks . Feasibility data relating to process , re source , management , and scientific elements of the trial will be collected . Outcome measure and feasibility data will be summarized , and an estimate of intervention efficacy will be obtained by regression model with planned comparisons . The trial began recruiting in February 2015 . To date , 34 subjects have been recruited . Discussion This study will evaluate the feasibility and preliminary efficacy of a novel intervention to promote  PA in people living with knee OA . The results will provide valuable information to inform a larger r and omized trial to assess intervention effectiveness . Trial registration Clinical Trials.gov Identifier : NCT02313506 ( registration date 8 December 2014 ) . First participant r and omized 20 February 2015 Background Physical activity can improve health outcomes in people with knee osteoarthritis ( OA ) ; however , participation in physical activity is very low in this population . Objective The objective of our study was to assess the feasibility and preliminary efficacy of the use of wearables ( Fitbit Flex ) and telephone counselling by a physical therapist ( PT ) for improving physical activity in people with a physician-confirmed diagnosis of knee OA , or who have passed 2 vali date d criteria for early OA . Methods We conducted a community-based feasibility r and omized controlled trial . The immediate group ( n=17 ) received a brief education session by a physical therapist , a Fitbit Flex activity tracker , and a weekly telephone call for activity counselling with the physical therapist . The delayed group ( n=17 ) received the same intervention 1 month later . All participants were assessed at baseline ( T0 ) , and the end of 1 month ( T1 ) and 2 months ( T2 ) . Outcomes were ( 1 ) mean moderate to vigorous physical activity time , ( 2 ) mean time spent on sedentary behavior , ( 3 ) Knee Injury and Osteoarthritis Outcome Score ( KOOS ) , and ( 4 ) Partners in Health Scale . Feasibility data were summarized with descriptive statistics . We used analysis of covariance to evaluate the effect of the group type on the outcome measures at T1 and T2 , after adjusting for blocking and T0 . We assessed planned contrasts of changes in outcome measures over measurement periods . Results We identified 46 eligible individuals ; of those , 34 ( 74 % ) enrolled and no one dropped out . All but 1 participant adhered to the intervention protocol . We found a significant effect , with the immediate intervention group having improved in the moderate to vigorous physical activity time and in the Partners in Health Scale at T0 to T1 compared with the delayed intervention group . The planned contrast of the immediate intervention group at T0 to T1 versus the delayed group at T1 to T2 showed a significant effect in the sedentary time and the KOOS symptoms subscale , favoring the delayed group . Conclusions This study demonstrated the feasibility of a behavioral intervention , supported by the use of a wearable device , to promote physical activity among people with knee OA . Trial Registration Clinical Trials.gov NCT02313506 ; https:// clinical trials.gov/ct2/show/NCT02313506 ( Archived by WebCite at http://www.webcitation.org/6r4P3Bub0 Background Osteoarthritis ( OA ) is a prevalent joint disorder with a need for efficient and evidence -based management strategies . Objectives The primary purpose of this study is to compare the effects of a multidisciplinary outpatient clinic , including a brief group-based educational programme , with a traditional individual outpatient clinic for patients with hip , knee , h and or generalized OA . A secondary purpose is to investigate the effects of a telephone follow-up call . Methods This is a pragmatic r and omised single-blind controlled study with a total of 400 patients with hip , knee , h and or generalized OA between 40 and 80 years referred to an outpatient rheumatology hospital clinic . The r and omisation is stratified according to the diagnostic subgroups . The experimental group is exposed to a multidisciplinary and multifaceted intervention , including a 3.5 hour group-based patient education programme about OA in addition to individual consultations with members of a multidisciplinary team . The control intervention is based on regular care with an individual outpatient consultation with a rheumatologist ( treatment as usual ) . Primary outcomes are patient satisfaction measured at 4 months and cost-effectiveness measured at 12 months . Secondary outcomes are pain and global disease activity measured on a numeric rating scales ( NRS ) , generic and disease specific functioning and disability using Short Form-36 ( SF-36 ) health survey , the Western Ontario and McMaster Universities Osteoarthritis Index 3 ( WOMAC ) , the Australian/Canadian Osteoarthritis H and Index ( AUSCAN ) , and a patient-generated measure of disability ( Patient-Specific Functional scale , PSFS ) . Global perceived effect of change in health status during the study period is also reported . At 4-month follow-up , patients in both groups will be r and omly allocated to a 10-minute telephone call or no follow-up ( " treatment as usual " ) . After additional 8 months ( 12-month follow-up ) the four groups will be compared in a secondary analysis with regard to health outcomes and health care costs . Discussion This trial will provide results on how multidisciplinary and multifaceted management of patients with OA affects health outcomes and health care costs . Trial registration Current Controlled Trials IS RCT STUDY DESIGN R and omized Clinical Trial . INTRODUCTION H and exercises have been recommended as treatment for h and osteoarthritis ( OA ) but research evidence is sparse . PURPOSE OF THE STUDY To investigate effects of daily 16-week home-based h and exercise among persons with h and OA . METHODS Forty-six older adults completed a crossover trial  with washout between exercise and sham treatments . The AUSCAN physical function sub-scale served as the primary outcome measure . Other outcomes included pain and stiffness sub-scales , dexterity , and grip & pinch strengths . RESULTS Changes in AUSCAN sub-scales did not differ between exercise and sham treatments . No changes in dexterity were seen . Grip and pinch measures modestly improved after exercise but not sham . CONCLUSIONS It is possible that our exercise protocol may have been too ambitious for this age group . Future research will further the underst and ing of the role of h and exercise in h and OA symptomatology . LEVEL OF EVIDENCE 2b OBJECTIVES To determine the effectiveness of exercise therapy ( ET ) compared with ET with adjunctive manual therapy ( MT ) for people with hip osteoarthritis ( OA ) ; and to identify if immediate commencement of treatment ( ET or ET+MT ) was more beneficial than a 9-week waiting period for either intervention . DESIGN Assessor-blind r and omized controlled trial with a 9-week and 18-week follow-up . SETTING Four academic teaching hospitals in Dublin , Irel and . PARTICIPANTS Patients ( N=131 ) with hip OA recruited from general practitioners , rheumatologists , orthopedic surgeons , and other hospital consultants were r and omized to 1 of 3 groups : ET ( n=45 ) , ET+MT ( n=43 ) , and waitlist controls ( n=43 ) . INTERVENTIONS Participants in both the ET and ET+MT groups received up to 8 treatments over 8 weeks . Control group participants were rer and omized into either ET or ET+MT groups after 9 week follow-up . Their data were pooled with original treatment group data : ET ( n=66 ) and ET+MT ( n=65 ) . MAIN OUTCOME MEASURES The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) physical function ( PF ) subscale . Secondary outcomes included physical performance , pain severity , hip range of motion ( ROM ) , anxiety/depression , quality of life , medication usage , patient-perceived change , and patient satisfaction . RESULTS There was no significant difference in WOMAC PF between the ET ( n=66 ) and ET+MT ( n=65 ) groups at 9 weeks ( mean difference , .09 ; 95 % confidence interval [ CI ] -2.93 to 3.11 ) or 18 weeks ( mean difference , .42 ; 95 % CI , -4.41 to 5.25 ) , or between other outcomes , except patient satisfaction with outcomes , which was higher in the ET+MT group ( P=.02 ) . Improvements in WOMAC , hip ROM , and patient-perceived change occurred in both treatment groups compared with the control group . CONCLUSIONS Self-reported function , hip ROM , and patient-perceived improvement occurred after an 8-week program of ET for patients with OA of the hip . MT as an adjunct to exercise provided no further benefit , except for higher patient satisfaction with outcome Background Osteoarthritis ( OA ) of the hip and knee are among the most common chronic conditions , result ing in substantial pain and functional limitations . Adequate management of OA requires a combination of medical and behavioral strategies . However , some recommended therapies are under-utilized in clinical setting s , and the majority of patients with hip and knee OA are overweight and physically inactive . Consequently , interventions at the provider-level and patient-level both have potential for improving outcomes . This manuscript describes two ongoing r and omized clinical trials being conducted in two different health care systems , examining patient-based and provider-based interventions for managing hip and knee OA in primary care . Methods / Design One study is being conducted within the Department of Veterans Affairs ( VA ) health care system and will compare a Combined Patient and Provider intervention relative to usual care  among n = 300 patients ( 10 from each of 30 primary care providers ) . Another study is being conducted within the Duke Primary Care Research Consortium and will compare Patient Only , Provider Only , and Combined ( Patient + Provider ) interventions relative to usual care  among n = 560 patients across 10 clinics . Participants in these studies have clinical and / or radiographic evidence of hip or knee osteoarthritis , are overweight , and do not meet current physical activity guidelines . The 12-month , telephone-based patient intervention focuses on physical activity , weight management , and cognitive behavioral pain management . The provider intervention involves provision of patient-specific recommendations for care ( e.g. , referral to physical therapy , knee brace , joint injection ) , based on evidence -based guidelines . Outcomes are collected at baseline , 6-months , and 12-months . The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index ( self-reported pain , stiffness , and function ) , and secondary outcomes are the Short Physical Performance Test Protocol ( objective physical function ) and the Patient Health Question naire-8 ( depressive symptoms ) . Cost effectiveness of the interventions will also be assessed . Discussion Results of these two studies will further our underst and ing of the most effective strategies for improving hip and knee OA outcomes in primary care setting s . Trial registration NCT01130740 ( VA ) ; NCT 01435109 ( NIH OBJECTIVE To assess whether providing information on arthritis self-management through general practitioners ( GPs ) increases the quality of life in patients with osteoarthritis and whether additional case management provided by practice nurses shows better results . METHODS We conducted a pragmatic , cluster-r and omized , controlled , 3-arm trial that included 1,021 patients from 75 primary care practice s in Germany . GPs were r and omized to intervention group I , group II , or a control group . GPs of both intervention groups participated in 2 peer group meetings . In intervention group II , additional case management was conducted via telephone by a practice nurse . The primary outcome was change in quality of life , assessed by the German version of the Arthritis Impact Measurement Scales Short Form ( AIMS 2-SF ) . Secondary outcomes were health service utilization , prescriptions , and physical activity . Data were controlled for depression using the Patient Health Question naire 9 as a potential confounder . RESULTS Of 1,125 administered question naires , 1,021 were analyzed . Compared with the control group , no significant changes occurred in intervention group I with respect to the primary outcome . Performed radiographs decreased significantly ( P = 0.050 ) , whereas prescriptions of  acetaminophen  increased significantly ( P < 0.001 ) . In intervention group II , significant changes in the AIMS 2-SF dimensions social ( P < 0.001 ) , symptom ( P = 0.048 ) , and lower body ( P = 0.049 ) were identified . Radiographs ( P = 0.031 ) and orthopedic referrals ( P = 0.044 ) decreased whereas prescriptions of pain relievers increased significantly . CONCLUSION Improving the quality of life in patients with arthritis using arthritis self-management seems challenging . Simply providing this information through GPs is not sufficient but combining it with case management seems to be a promising approach BACKGROUND The Hip & Knee Book : Helping you cope with osteoarthritis was developed to change disadvantageous beliefs and encourage physical activity in people with hip or knee osteoarthritis . AIM To assess the feasibility of conducting a definitive r and omised controlled trial ( RCT ) of this evidence -based booklet in people with hip or knee osteoarthritis . DESIGN Phase II feasibility r and omised controlled trial ( RCT ) . METHOD Computerised search es of patients ' record data bases identified people with osteoarthritis of the hip or knee , who were invited to participate in the RCT comparing the new booklet with a control booklet . Outcomes were measured at baseline , 1 month , and 3 months , and included : beliefs about hip and knee pain , exercise , and fear avoidance ; level of physical activity ; and health service use . RESULTS The trial methods were feasible in terms of recruitment , r and omisation , and follow-up , but most participants recruited had longst and ing established symptoms . After one and 3 months , there was a small relative improvement in illness , exercise , and fear-avoidance beliefs and physical activity level in The Hip & Knee Book group ( n = 59 ) compared with the control group ( n = 60 ) , which provides some proof of principle for using these outcomes in future trials . CONCLUSION This feasibility study provided proof of principle for testing The Hip & Knee Book in a larger definitive RCT After baseline in home interviews , 439 patients with osteoarthritis ( OA ) were r and omly assigned to the control or one of 3 intervention groups which differed only in method of delivery ( i.e. , phone , clinic , both ) . Trained non clinical interviewers review ed medications , problems with joint pain , gastrointestinal symptoms , early warning signs for common chronic diseases , scheduled outpatient visits , an evening/weekend clinic telephone number ,  barriers to care  , and suggestions to encourage participation during clinic visits . We hypothesized that the intervention would enhance social support , satisfaction with care , morale , and medication compliance . We found that none of the interventions had any effect upon these outcomes Objectives : The primary objective is to identify effective l and -based therapeutic exercise interventions and provide evidence -based recommendations for managing hip osteoarthritis . A secondary objective is to develop an Ottawa Panel evidence -based clinical practice guideline for hip osteoarthritis . Methods : The search strategy and modified selection criteria from a Cochrane review were used . Studies included hip osteoarthritis patients in comparative controlled trials with therapeutic exercise interventions .  An Expert Panel arrived at a Delphi survey consensus to endorse the recommendations . The Ottawa Panel hierarchical alphabetical grading system ( A , B , C+ , C , D , D+ , or D- ) considered the study design ( level I : r and omized controlled trial and level II : controlled clinical trial ) , statistical significance ( p < 0.5 ) , and clinical importance ( ⩾15 % improvement ) . Results : Four high- quality studies were included , which demonstrated that variations of strength training , stretching , and flexibility exercises are generally effective for improving the management of hip osteoarthritis . Strength training exercises displayed the greatest improvements for pain ( Grade A ) , disability ( Grade s A and C+ ) , physical function ( Grade A ) , stiffness ( Grade A ) , and range of motion ( Grade A ) within a short time period ( 8–24 weeks ) . Stretching also greatly improved physical function ( Grade A ) , and  flexibility exercises improved pain ( Grade A ) , range of motion ( Grade A ) , physical function ( Grade A ) , and stiffness ( Grade C+ ) . Conclusion : The Ottawa Panel recommends l and -based therapeutic exercise , notably strength training , for management of hip osteoarthritis in reducing pain , stiffness and self-reported disability , and improving physical function and range of motion INTRODUCTION Measuring  patient-perceived outcomes  following orthopaedic procedures have become an important component of clinical research and patient care . General and disease-specific outcomes measures have been developed and applied in orthopaedics to assess the patients ' perceived health status . Unfortunately , paper-based , self-administered instruments remain inefficient for collecting data because of : ( a ) missing data ( b ) respondent error , and ( c ) the costs to administer and enter data . OBJECTIVE To study the comparability of palm-top computer devices and paper-pencil self-administered question naires in the collection of health-related quality of life ( HRQL ) information from patients . METHODS The comparability of administering HRQL question naires using palm-top computer and traditional paper-based forms was tested in a sample of 96 patients with complaints of hip and /or knee pain . Each patient completed mailed versions of the Medical Outcomes Study ( MOS ) , 36-item Health Survey ( SF-36 ) , and Western Ontario and McMasters University Arthritis Index ( WOMAC ) three weeks prior to presenting to clinic . At the clinic they were asked to complete the same outcomes measures using the palm-top computer or a paper- and -pencil version . ANALYSIS In the analysis , scale distributions , floor and ceiling effects , internal consistency and retest reliability of scales were compared across the two data collection methods . Because the baseline characteristics of the groups were not strictly comparable according to age , the data were analyzed for the entire sample and stratified according to age . RESULTS Few statistically significant differences were found for the means , variances and intra-class correlation coefficients between the methods of administration . While the scale distribution between the two methods was comparable , the internal consistency of the scales was dissimilar . CONCLUSIONS Administration of HRQL question naires using portable palm-top computer devices has the potential advantage of decreased cost and convenience . These data lend some support for the comparability of palm-top computers and paper surveys for outcomes measures widely used in the field of orthopaedic surgery . The present study identified the lack of reliability across modes of administration that requires further study in a r and omized comparability trial . These mode effects are important for orthopaedic surgeons to appreciate before implementing innovative data -capture technologies in their practice
The DASH , the  Michigan H and Outcomes Question naire ( MHQ ) , the  Patient Evaluation Measure ( PEM ) , and the  Patient-Reported Wrist Evaluation ( PRWE ) had evidence supporting their reliability , validity , and responsiveness .
A post-hoc review of excluded studies revealed the AUSCAN Osteoarthritis H and Index as another suitable instrument that had favourable reliability , validity , and responsiveness .
The DASH , MHQ , and AUSCAN Osteoarthritis H and Index instruments were supported by the most favourable empirical evidence for validity , reliability , and responsiveness .
The PEM and PRWE also had favourable empirical evidence reported for these elements .
This paper aim ed to identify condition-specific patient-reported outcome measures used in clinical trials among people with wrist osteoarthritis and summarise empirical peer- review ed evidence supporting their reliability , validity , and responsiveness to change .