Effectiveness of a Web-Based Physical Activity Intervention in Patients With Knee and/or Hip Osteoarthritis: Randomized Controlled Trial Health-related quality of life after total knee or hip replacement for osteoarthritis: a 7-year prospective study Effects of activity strategy training on pain and physical activity in older adults with knee or hip osteoarthritis: a pilot study. Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. Health-related quality of life and appropriateness of knee or hip joint replacement. Exercise improves quality of life in bariatric surgery candidates: results from the Bari-Active trial. Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Feasibility and preliminary efficacy of a physical activity counseling intervention using Fitbit in people with knee osteoarthritis: the TRACK-OA study protocol Improving pain management after total joint replacement surgery. The usability and preliminary effectiveness of a web-based physical activity intervention in patients with knee and/or hip osteoarthritis Patient-reported outcome after total hip arthroplasty: comparison between lateral and posterior approach Small Increase of Actual Physical Activity 6 Months After Total Hip or Knee Arthroplasty Responsiveness and clinically important differences for the WOMAC and SF-36 after hip joint replacement. Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Impact of an exercise and walking protocol on quality of life for elderly people with OA of the knee. Land-based versus pool-based exercise for people awaiting joint replacement surgery of the hip or knee: results of a randomized controlled trial. The effects of total knee replacement and non-surgical treatment on pain sensitization and clinical pain.
Background Patients with knee and /or hip osteoarthritis ( OA ) are less physically active than the general population , while the benefits of physical activity ( PA ) have been well documented . Based on the behavioral grade d activity treatment , we developed a Web-based intervention to improve PA levels in patients with knee and /or hip OA , entitled “ Join2move ” . The Join2move intervention is a self-paced 9-week PA program in which the patient ’s favorite recreational activity is gradually increased in a time-contingent way . Objective The aim of the study was to investigate whether a fully automated Web-based PA intervention in patients with knee and /or hip OA would result in improved levels of PA , physical function , and self-perceived effect compared with a waiting list control group . Methods The study design was a two-armed r and omized controlled trial which was not blinded . Volunteers were recruited via articles in newspapers and health-related websites . Eligibility criteria for participants were : ( 1 ) aged 50 - 75 years , ( 2 ) self-reported knee and /or hip OA , ( 3 ) self-reported inactivity ( 30 minutes of moderate PA , 5 times or less per week ) , ( 4 ) no face-to-face consultation with a health care provider other than general practitioners , for OA in the last 6 months , ( 5 ) ability to access the Internet weekly , and ( 6 ) no contra-indications to exercise without supervision . Baseline , 3-month , and 12-month follow-up data were collected through online question naires . Primary outcomes were PA , physical function , and self-perceived effect . In a subgroup of participants , PA was measured objective ly using accelerometers . Secondary outcomes were pain , fatigue , anxiety , depression , symptoms , quality of life , self-efficacy , pain coping , and locus of control . Results Of the 581 interested respondents , 199 eligible participants were r and omly assigned to the intervention ( n=100 ) or waiting list control group ( n=99 ) . Response rates of question naires were 84.4 % ( 168/199 ) after 3 months and 75.4 % ( 150/199 ) after 12 months . In this study , 94.0 % ( 94/100 ) of participants actually started the program , and 46.0 % ( 46/100 ) reached the adherence threshold of 6 out of 9 modules completed . At 3 months , participants in the intervention group reported a significantly improved physical function status ( difference=6.5 points , 95 % CI 1.8 - 11.2 ) and a positive self-perceived effect ( OR 10.7 , 95 % CI 4.3 - 26.4 ) compared with the control group . No effect was found for self-reported PA . After 12 months , the intervention group showed higher levels of subjective ( difference=21.2 points , 95 % CI 3.6 - 38.9 ) and objective PA ( difference=24 minutes , 95 % CI 0.5 - 46.8 ) compared with the control group . After 12 months , no effect was found for physical function ( difference=5 points , 95 % CI −1.0 to 11.0 ) and self-perceived effect ( OR 1.2 , 95 % CI 0.6 - 2.4 ) . For several secondary endpoints , the intervention group demonstrated improvements in favor of the intervention group . Conclusions Join2move result ed in changes in the desired direction for several primary and secondary outcomes . Given the benefits and its self-help format , Join2move could be a component in the effort to enhance PA in sedentary patients with knee and /or hip OA . Trial Registration The Netherl and s National Trial Register : NTR2483 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=2483 ( Archived by WebCite at http://www.webcitation.org/67NqS6Beq ) Objective To assess health-related quality of life ( HRQOL ) in a prospect i ve study with 7 years of follow-up in 49 consecutive patients who underwent a total joint replacement because of osteoarthritis . Methods Generic HRQOL was assessed with the  short-form 36 ( SF-36 ) and specific HRQOL with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Results Out of the 39 subjects who have completed the 7 years of follow-up of this study , 22 ( 56.4 % ) underwent a hip replacement surgery and the other 17 ( 43.6 % ) a knee replacement . Six months after surgery , a significant improvement , compared to preoperative scores , was observed in two of the eight dimensions of the SF-36 ( i.e. physical function and pain ) . The same dimensions , pain and physical function , at the same time , 6 months after surgery , measured by the WOMAC , showed a significant improvement as well , but there was no significant change in the stiffness score . From 6 months to the end of follow-up , changes in SF-36 scores showed a significant improvement in physical function ( p = 0.008 ) , role-physical ( p = 0.004 ) and role-emotional ( p = 0.01 ) while all scores of the WOMAC improved ( p < 0.001 for pain , p < 0.001 for stiffness and p < 0.01 for physical function ) . Conclusion The improvements observed in HRQOL at short term after surgery , are at least maintained over a 7-year follow-up period OBJECTIVE To examine effects of activity strategy training ( AST ) , a structured rehabilitation program taught by occupational therapists and design ed to teach adaptive strategies for symptom control and engagement in physical activity ( PA ) . METHODS A r and omized controlled pilot trial was conducted at 4 sites ( 3 senior housing facilities and 1 senior center ) in southeastern , lower Michigan . Fifty-four older adults with hip or knee osteoarthritis ( mean + /- SD age 75.3+/-7.1 years ) participated . At each site , older adults were r and omly assigned to 1 of 2 programs : exercise plus AST ( Ex + AST ) or exercise plus health education ( Ex + Ed ) . The programs involved 8 sessions over 4 weeks with 2 followup sessions over a 6-month period , and were conducted concurrently within each site . Pain , total PA and PA intensity ( measured objective ly by actigraphy and subjectively by the Community Healthy Activities Model Program for Seniors question naire ) , arthritis self-efficacy , and physical function were assessed at baseline and posttest . RESULTS At posttest , participants who received Ex + AST had significantly higher levels of objective peak PA ( P=0.02 ) compared with participants who received Ex + Ed . Although not statistically significant , participants in Ex + AST tended to have larger pain decreases , increased total objective and subjective PA , and increased physical function . No effects were found for arthritis self-efficacy . CONCLUSION Although participants were involved in identical exercise programs , participants who received AST tended to have larger increases in PA at posttest compared with participants who received health education . Future studies will be needed to examine larger sample s and long-term effects of AST OBJECTIVE To quantify the magnitude of change seen with pain , function , and quality of life outcomes 6 months after  total hip and knee arthroplasties ( THA , TKA )  within a community based cohort of a regional health district . METHODS An inception cohort of 504 patients who received primary THA ( 228 ) or TKA ( 276 ) was prospect ively followed . All patients resided in the community and were assessed within one month prior to surgery and 6 months postoperatively . Health related quality of life measures were evaluated with the Western Ontario and McMaster Universities ( WOMAC ) Osteoarthritis Index and the Medical Outcome Survey Short Form SF-36 . Perioperative factors were extracted from medical charts . Health services utilization data were collected from regional health data bases . RESULTS Over 75 % of patients reported improvement in joint-specific pain and function , regardless of the type of joint replaced . Other health dimensions such as social function , bodily pain , physical function , vitality , and general health showed significant improvement after surgery . Those psychosocial dimensions with modest changes had baseline values comparable to age and sex adjusted normal values ; whereas , bodily pain and physical function , which had large changes , had values lower than the normal values . Ninety-one percent of patients receiving THA were satisfied with their surgery , whereas 77 % were satisfied with their TKA . The average length of stay was 7 days and the in-hospital complication rate was 0.34 per patient . CONCLUSION Large improvements were reported for pain and function after joint arthroplasties , while small to moderate changes were seen in other areas related to quality of life .  Patients with hip arthroplasties showed greater improvement in pain and function and were more satisfied with their outcomes than patients with knee arthroplasties . Although pain and function show large improvements , bodily pain and physical function were less than the values reported in the general population BACKGROUND We studied the association between explicit appropriateness criteria for total hip joint replacement ( THR ) and total knee replacement ( TKR )  with changes in health-related quality of life of patients undergoing these procedures . METHODS Prospect i ve observational study of 1576 consecutive patients with diagnoses of osteoarthritis on waiting lists to undergo THR or TKR . Explicit appropriateness criteria using the R AND appropriateness method were applied . Patients completed 2 question naires that measured health-related quality of life , the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , before the procedure and 6 months afterward . RESULTS Patients who were considered appropriate c and i date s for these procedures had greater improvements than those who were considered inappropriate c and i date s in all 3 WOMAC domains ( pain , functional limitation , and stiffness ; THR : 43.0 , 40.6 , and 40.4 vs 14.7 , 19.1 , and 15.9 ; TKR : 34.9 , 32.5 , and 30.2 vs 23.2 , 18.9 , and 17.1 ; P<.001 for all comparisons ) . Patients who underwent THR and were judged to be appropriate c and i date s had greater improvements in the physical function , role-physical , bodily pain , and social function domains of the SF-36 than those judged to be inappropriate c and i date s ( 34.4 , 35.1 , 33.1 , and 26.6 vs 19.6 , 9.2 , 5.7 , and 7.0 ; P = .04 , P = .03 , P < .001 , and P < .001 , respectively ) . Appropriate c and i date s for TKR demonstrated greater improvement in the social function domain of the SF-36 after the procedure than those deemed inappropriate c and i date s ( 19.9 vs 7.9 ; P = .004 ) but not in the other domains of functional status . CONCLUSIONS These results suggest a direct relationship between explicit appropriateness criteria and better health-related quality -of-life outcomes after THR and TKR surgery . Our results support the use of these criteria for clinical guidelines or evaluation purpose OBJECTIVE To examine the impact of a pre-bariatric surgery physical activity intervention ( PAI ) , design ed to increase bout-related ( ≥10 min ) moderate to vigorous PA ( MVPA ) , on health-related quality of life ( HRQoL ) . METHODS Analyses included 75 adult participants ( 86.7 % female ; BMI = 45.0 ± 6.5 kg m(-2 ) ) who were r and omly assigned to 6 weeks of PAI ( n = 40 ) or st and ard pre-surgical care ( SC ; n = 35 ) .  PAI received 6 individual weekly counseling sessions to increase walking exercise . Participants wore an objective PA monitor for 7 days and completed the SF-36 Health Survey  at baseline and post-intervention to evaluate bout-related MVPA and HRQoL changes , respectively . RESULTS PAI increased bout-related MVPA from baseline to post-intervention ( 4.4 ± 5.5 to 21.0 ± 21.4 min day(-1 ) ) versus no change ( 7.9 ± 16.6 to 7.6 ± 11.5 min day(-1 ) ) for SC ( P = 0.001 ) . PAI reported greater improvements than SC on all SF-36 physical and mental scales ( P < 0.05 ) , except role-emotional . In PAI , better baseline scores on the physical function and general health scales predicted greater bout-related MVPA increases ( P < 0.05 ) , and greater bout-related MVPA increases were associated with greater post-intervention improvements on the physical function , bodily pain , and general health scales ( P < 0.05 ) . CONCLUSIONS Increasing PA preoperatively improves physical and mental HRQoL in bariatric surgery c and i date s. Future studies should examine whether this effect improves surgical safety , weight loss outcomes , and postoperative OBJECTIVE To determine the predictors of outcome in patients with osteoarthritis 2 years after receiving total hip or knee replacement .  METHODS A prospect i ve cohort study of 222 osteoarthritis patients undergoing total hip or knee replacement in Boston and Montreal was done . Their postoperative outcomes at 6 months were previously reported . This followup reports on the outcomes after 2 years among the 165 patients ( 74 % ) who remained . The subjects were divided into 2 groups according to the median value of their preoperative Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) function score . The Short Form 36-item physical function subscale and the WOMAC pain and function subscale scores were collected at baseline and at 3 , 6 , and 24 months postoperatively . Clinical outcomes were analyzed at 2 years , using descriptive and multiple regression analyses . RESULTS Improvements in pain and function at 2 years were similar to those observed at 6 months . Those subjects with the worst function and pain at the time of surgery ( baseline ) had comparatively worse function 2 years after surgery . CONCLUSION In this comparison , the poor outcomes observed at 6 months following total joint replacement in patients with worse baseline functional status persisted after 2 years . Although there are no vali date d indications for when a patient should optimally have total joint replacement , these data suggest that timing of surgery may be more important than previously realized and , specifically , that performing surgery earlier in the course of functional decline may be associated with better outcome 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 PURPOSE To test the effects of implementing evidence -based postoperative pain management content and strategies on patient , provider ( nurse and physician ) , and fiscal outcomes . SAMPLE 118 patients , 57 before and 61 after implementation , having total knee replacement ( TKR ) ( 54 % ) and total hip replacement ( THR ) ( 45 % ) , and 28 orthopaedic nurses . METHODS A research utilization approach with a pretest/posttest design was used . Independent variables ( interventions ) included evidence -based pain management content , education of care providers and patients , and system changes at the point of care . Dependent variables ( outcomes ) were patient perception of the postoperative pain experience , provider practice patterns , and length of stay ( LOS ) . FINDINGS The hypotheses of decreased provider use of meperidine and increased use of hydromorphone , i.v . route , pain plans of care , and nurse knowledge were supported . LOS was significantly reduced . The patient hypotheses decreased pain intensity and side effects and increased satisfaction and function were not supported . CONCLUSION Method ical implementation of evidence -based pain management information changed practice and fiscal outcomes . Improvement in the patient perception of pain management was more difficult to achieve Background A large proportion of patients with knee and /or hip osteoarthritis ( OA ) do not meet the recommended levels of physical activity ( PA ) . Therefore , we developed a web-based intervention that provides a tailored PA program for patients with knee and /or hip OA , entitled Join2move . The intervention incorporates core principles of the behaviour grade d activity theory ( BGA ) . The aim of this study was to investigate the preliminary effectiveness , feasibility and acceptability of Join2move in patients with knee and /or hip OA . Methods A non-r and omized pilot study was performed among patients with knee and /or hip OA . Primary outcomes were PA ( SQUASH Question naire ) , physical function ( HOOS and KOOS question naires ) and self-perceived effect ( 7-point Likert scale ) . Baseline , 6 and 12 week follow-up data were collected via online question naires . To assess feasibility and acceptability , program usage ( modules completed ) and user satisfaction ( SUS question naire ) were measured as secondary outcomes . Participants from the pilot study were invited to be interviewed . The interviews focused on users ’ experiences with Join2move . Besides the pilot study we performed two usability tests to determine the feasibility and acceptability of Join2move . In the first usability test , software experts evaluated the website from a list of usability concepts . In the second test , users were asked to verbalize thoughts during the execution of multiple tasks . Results Twenty OA patients with knee and /or hip OA between 50 and 80 years of age participated in the pilot study . After six weeks , pain scores increased from 5.3 to 6.6 ( p=0.04 ) . After 12 weeks this difference disappeared ( p=0.5 ) . Overall , users were enthusiastic about Join2move . In particular , performing exercise at one 's own pace without time or travel restrictions was cited as convenient . However , some minor flaws were observed . Users perceived some difficulties in completing the entire introduction module and rated the inability to edit and undo actions as annoying . Conclusions This paper outlines the preliminary effectiveness , feasibility and acceptability of a web-based PA intervention . Preliminary results from the pilot study revealed that PA scores increased , although differences were not statistically significant . Interviews and usability tests suggest that the intervention is feasible and acceptable in promoting PA in patients with knee and /or hip OA . The intervention was easy to use and the satisfaction with the program was high . Trial registration The Netherl and s National Trial Register . Trial number : Background and purpose — Criticism of the lateral approach ( LA ) for hip arthroplasty is mainly based on the risk of poor patient-reported outcomes compared to the posterior approach ( PA ) . However , there have been no controlled studies comparing patient-reported outcomes between them . In this r and omized controlled trial , we tested the hypothesis that patient-reported outcomes are better in patients who have undergone total hip arthroplasty ( THA ) with PA  than in those who have undergone THA with LA , 12 months postoperatively . Patients and methods — 80 patients with hip osteoarthritis ( mean age 61 years ) were r and omized to THA  using  PA or the modified direct LA . We recorded outcome measures preoperatively and 3 , 6 , and 12 months postoperatively using the Hip Disability and Osteoarthritis Outcome Score – Physical Function Short Form ( HOOS-PS ) as the primary outcome . Secondary outcomes were HOOS-Pain , HOOS- Quality -Of-Life , EQ-5D , UCLA Activity Score , and limping . Results — We found no statistically significant difference in the improvements in HOOS-PS between the treatment groups at 12-month follow-up . All secondary outcomes showed similar results except for limping , where PA patients improved significantly more than LA patients . Interpretation — Contrary to our hypothesis , patients treated with PA did not improve more than patients treated with LA regarding physical function , pain , physical activity , and quality of life 12 months postoperatively . However , limping was more pronounced in the LA patients Abstract Limitation in daily physical activity is one of the reasons for total hip arthroplasty ( THA ) or total knee arthroplasty ( TKA ) . However , studies of the effects of THA or TKA generally do not determine actual daily activity as part of physical functioning . We determined the effect of THA or TKA on patients ’ actual physical activity and body function ( pain , stiffness ) , capacity to perform tasks , and self-reported physical functioning . We also assessed whether there are differences in the effect of the surgery between patients undergoing THA or TKA  and whether the improvements vary between these different outcome measures . We recruited patients with long-st and ing end-stage osteoarthritis of the hip or knee awaiting THA or TKA .  Measurements were performed before surgery and 3 and 6 months after surgery . Actual physical activity improved by 0.7 % . Patients ’ body function , capacity , and self-reported physical functioning also improved . The effects of the surgery on these aspects of physical functioning were similar for THA and TKA . The effect on actual physical activity ( 8 % ) was smaller than on body function ( 80%–167 % ) , capacity ( 19%–36 % ) , and self-reported physical functioning ( 87%–112 % ) . Therefore , in contrast to the large effect on pain and stiffness , patients ’ capacity , and their self-reported physical functioning , the improvement in actual physical activity of our patients was less than expected 6 months after surgery . Level of Evidence : Level I , prospect i ve study . See the Guidelines for Authors for a complete description of levels of evidence OBJECTIVES To study responsiveness and establish the minimal clinical ly important differences ( MCID ) and minimal detectable change ( MDC ) in patients undergoing total hip replacement ( THR )  using the Short Form 36 ( SF-36 ) and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . METHODS We conducted a prospect i ve observational study in three public hospitals of all consecutive patients with a diagnosis of hip osteoarthritis ( OA ) on waiting lists to undergo THR .  Patients completed the SF-36 and the  WOMAC  ( subscales transformed to 0 to 100 ) , which measured the health-related quality of life ( HRQoL ) , before intervention and 6 months and 2 years later , and additional transitional questions , which measured the changes in the joint 6 months postoperatively . RESULTS Improvements at 6 months after a THR were between 37 ( stiffness ) and 39 points ( pain ) , depending on the WOMAC domain . The SF-36 domains also showed improvements : physical function ( 31.91 ) , physical role ( 33.71 ) , and bodily pain ( 29.77 ) . From 6 months to 2 years , improvements ranged from 2 to 5 points , except for role physical ( 13.25 ) . A ceiling effect was detected on some WOMAC domains as well as a floor effect on the SF-36 . The MCID ranged from 25.91 ( stiffness ) to 29.26 ( pain ) on the WOMAC and from 10.78 ( physical role ) to 20.40 ( physical function ) on the SF-36 . The MDC ranged from 21.38 ( pain ) to 27.98 ( stiffness ) on the WOMAC and from 18.99 ( physical function ) to 42.05 ( social function ) on the SF-36 . CONCLUSIONS These values indicate expected gains after THR . However , the MCID and MDC values must be viewed cautiously due to the uncertainty of these estimators and should not be considered as absolute thresholds OBJECTIVES To study responsiveness and establish the minimal clinical ly important differences ( MCIDs ) and minimal detectable change ( MDC ) in patients undergoing total knee replacement ( TKR ) using the Short Form 36 ( SF-36 ) and Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . METHODS Prospect i ve observational study in three public hospitals of all consecutive patients on waiting lists to undergo TKR intervention with diagnosis of knee osteoarthritis ( OA ) . Patients were asked to complete before the intervention and at 6 months and 2 years afterward the  SF-36 and the WOMAC health-related quality of life question naires ( HRQoL ) , and additional transition questions which measured the changes in their joint at 6 months . In both question naires the possible range of values is from 0 to 100 points . RESULTS In WOMAC improvement at 6 months after a TKR was between 27 ( stiffness ) and 31 points ( pain ) . The SF-36 showed improvements between the 28.3 points of role physical and 2.79 of general health . From 6 months to 2 years , WOMAC improvements were between 2 and 6 points . The MCID ranged from 14.52 ( stiffness ) to 22.87 ( pain ) on the WOMAC and in the physical domains of SF-36 from 11.56 ( physical function ) to 16.86 ( bodily pain ) . On the WOMAC , the MDC ranged from 13.11 ( function ) to 29.12 ( stiffness ) , and on SF-36 from 19.50 ( physical function ) to 41.23 ( social functioning ) . CONCLUSIONS The MCID for TKR is around 15 on WOMAC , while with the SF-36 of at least 10 points . These values should not be considered as absolute thresholds BACKGROUND AND PURPOSE The knee is the weight-bearing joint most commonly affected by osteoarthritis ( OA ) . The symptoms of pain , morning stiffness of short duration and physical dysfunction in the activities of daily living ( ADL ) can have an effect on many aspects of health , affecting quality of life . Regular and moderate physical activity adapted to individuals ' life-styles and education , and joint protection strategies have been advocated as conservative management . The purpose of the present study was to assess the impact of an exercise and walking protocol on the quality of life of elderly people with knee OA . METHOD The study design was a r and omized controlled clinical trial . The subjects comprised 50 elderly people , aged 65 or more , with knee OA who had been referred to the geriatric outpatient unit for rehabilitation . Changes in severity of pain and quality of life were compared between a control group ( CG ) and an experimental group ( EG ) . Both groups participated in an educational session and the EG also received a 12-week exercise and walking protocol . Both groups were assessed at baseline and after three and six months by an independent observer . The Lequesne Index of Knee OA Severity ( LI ) , the Health Assessment Question naire ( HAQ ) and the Medical Outcomes Short-Form Health Survey ( SF-36 ) were used as measurement instruments . RESULTS In the CG , the measures of quality of life ( SF-36 ) , the HAQ and the LI between subjects did not yield statistically significant differences over the three measurement points . For the EG , there was a significant improvement in function , measured by HAQ , and decreasing OA symptom severity , measured by LI . For the SF-36 there were significant improvements in physical function , functional role limitation and pain . Comparisons between the groups showed statistically significant differences after three and six months for all measures , except for the SF-36 emotional domains . CONCLUSION The exercise protocol and walking programme had a positive effect on the quality of life of elderly individuals with knee OA OBJECTIVE To compare the preoperative effects of multidimensional l and -based and pool-based exercise programs for people awaiting joint replacement surgery of the hip or knee . DESIGN R and omized , single-blind , before-after trial . SETTING Physiotherapy gymnasium and hydrotherapy pool . PARTICIPANTS Patients awaiting elective hip or knee joint replacement surgery . INTERVENTIONS  L and -based ( n=40 ) or pool-based exercise program ( n=42 ) . Each 6-week program included an education session , twice-weekly exercise classes , and an occupational therapy home assessment . MAIN OUTCOME MEASURES Participants were assessed immediately before and after the 6-week intervention , then 8 weeks later . Primary outcomes were pain and self-reported function ( Western Ontario and McMaster Universities Osteoarthritis Index ) and patient global assessment . Secondary outcomes were performance-based measures ( timed walk and chair st and ) and psychosocial status ( Medical Outcomes Study 36-Item Short-Form Health Survey mental component score ) . Pain was also measured before and after each exercise class on a 7-point verbal rating scale . RESULTS Although both interventions were effective in reducing pain and improving function , there were no postintervention differences between the groups for the primary and secondary outcomes . However , the pool-based group had less pain immediately after the exercise classes . CONCLUSIONS While our multidimensional exercise-based interventions appeared to be effective in reducing disability in those awaiting joint replacement surgery of the hip or knee , there were no large differences in the postintervention effects of the interventions . However , pool-based exercise appeared to have a more favorable effect on pain immediately after the exercise classes BACKGROUND The objective was to compare the effect of total knee replacement ( TKR ) followed by a 3-month non-surgical treatment with the non-surgical treatment alone in reducing pain sensitization and other pain-related measures in patients with knee osteoarthritis . METHODS One hundred patients were r and omized to ( 1 ) TKR followed by a non-surgical treatment of neuromuscular exercise , education , diet , insoles and pain medication or ( 2 ) the non-surgical treatment alone . Outcomes assessed at baseline and after 3 months were as follows : ( 1 ) pain sensitization assessed as pressure-pain thresholds ( PPTs ) at the knee ( localized sensitization ) and the lower leg ( spreading sensitization ) , ( 2 ) peak pain intensity during the previous 24 h , ( 3 ) pain intensity after 30 min of walking , ( 4 ) pain location and pattern , ( 5 ) spreading of pain on a region-divided body chart and ( 6 ) the usage of pain medication . RESULTS There was a statistical significant mean difference ( 95 % CI ) in change in PPTs from baseline to 3 months between groups in the crude analysis of 71 kPa ( 21 - 121 ) and of 75 kPa ( 33 - 117 ) when adjusting for baseline PPT , age , gender and body mass index , favouring the group having TKR . There were no significant between-group differences in change in the pain-related measures from baseline to 3 months ( p = 0.15 - 0.27 ) . Both groups improved in most of the pain-related measures ( p < 0.05 ) . CONCLUSIONS At 3 months , TKR followed by non-surgical treatment is more effective in reducing localized and spreading pain sensitization than non-surgical treatment alone . Both treatments are equally efficacious in reducing the pain-related measures of this study . WHAT DOES THIS STUDY ADD ? : Knee replacement followed by non-surgical treatment is more effective in reducing pain sensitization , but not other pain-related measures , as compared to non-surgical treatment alone at 3 months
Physical activity did not change at 6 months , and a small to moderate improvement was found at 12 months postsurgery , despite large improvements in quality of life , pain , and physical function .
Reasons for the lack of increased PA are unknown but may be behavioral in nature , as a sedentary lifestyle is difficult to change .
OBJECTIVE Little is known about the extent to which  physical activity ( PA )  levels change following total knee or hip joint replacement relative to pain , physical function , and quality of life .
Our objective was to conduct a systematic review and meta- analysis on changes in PA relative to pain , quality of life , and physical function  after total knee or hip joint replacement .