Multiple Psychological Factors Are Associated With Poorer Functioning in a Sample of Community-Dwelling Knee Osteoarthritis Patients Pain sensitisation and the risk of poor outcome following physiotherapy for patients with moderate to severe knee osteoarthritis: protocol for a prospective cohort study Feeling good rather than feeling better matters more to patients. A physiotherapist-delivered, combined exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a pilot study. Neuropathic pain symptoms on the modified painDETECT correlate with signs of central sensitization in knee osteoarthritis. Variability in conditioned pain modulation predicts response to NSAID treatment in patients with knee osteoarthritis A comparison of lower extremity muscle strength, obesity, and depression scores in elderly subjects with knee pain with and without radiographic evidence of knee osteoarthritis. Impact of chronic musculoskeletal pathology on older adults: a study of differences between knee OA and low back pain. Individuals’ experience of living with osteoarthritis of the knee and perceptions of total knee arthroplasty OARSI/OMERACT Initiative to Define States of Severity and Indication for Joint Replacement in Hip and Knee Osteoarthritis. An OMERACT 10 Special Interest Group Effects of self-care education on the health status of inner-city patients with osteoarthritis of the knee. A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis. Physical function and properties of quadriceps femoris muscle in men with knee osteoarthritis. Trabecular morphometry by fractal signature analysis is a novel marker of osteoarthritis progression. Treating disability in knee osteoarthritis with exercise therapy: a central role for self-efficacy and pain. Agility and Perturbation Training Techniques in Exercise Therapy for Reducing Pain and Improving Function in People With Knee Osteoarthritis: A Randomized Clinical Trial The effectiveness of self‐management educational interventions for osteoarthritis of the knee
Background Knee osteoarthritis ( OA ) is the most common type of arthritis and imposes a heavy burden on individual welfare among elderly people . There is preliminary evidence that psychological factors play a role in functional ability and pain in knee OA patients , particularly with respect to the surgery outcome . Less is known about psychological factors among community-dwelling patients with knee OA . Objectives We aim ed to determine which psychological factors are associated with pain and functional ability among community-dwelling knee OA patients using a comprehensive set of psychological question naires . Methods In the cross-sectional baseline setting of a prospect i ve , r and omized controlled intervention study , 111 patients aged from 35 to 75 years with clinical symptoms and radiographic grading of knee OA were included . They completed a comprehensive set of psychological question naires , including measures of re sources and coping , fear and catastrophizing , and distress . Results In cross-sectional comparisons , pain self-efficacy , fear of movement , pain catastrophizing , and elevated anxiety were associated with pain and a poorer functional ability . In logistic regression analysis , independent association was seen between pain self-efficacy and poorer functioning . Knee OA patients also reported elevated levels of anxiety . Conclusions The results reveal that both pain self-efficacy and negatively charged emotion and expectations toward pain are important factors when dealing with knee OA patients . Failure to consider these will probably contribute to prolonged disability and further pain . The results call for the routine assessment of multiple psychological factors in knee OA Introduction Pain is the dominant symptom of knee osteoarthritis ( OA ) , and recent evidence suggests factors outside of local joint pathology , such as pain sensitisation , can contribute significantly to the pain experience . It is unknown how pain sensitisation influences outcomes from commonly employed interventions such as physiotherapy . The aims of this study are , first , to provide a comprehensive description of the somatosensory characteristics of people with pain associated with knee OA . Second , we will investigate if indicators of pain sensitisation in patients with knee osteoarthritis are predictive of non-response to physiotherapy . Methods and analysis This is a multicentre prospect i ve cohort study with 140 participants . Eligible patients with moderate to severe symptomatic knee osteoarthritis will be identified at outpatient orthopaedic and rheumatology clinics . A baseline assessment will provide a comprehensive description of the somatosensory characteristics of each participant by means of clinical examination , quantitative sensory testing , and vali date d question naires measuring pain and functional capacity . Participants will then undergo physiotherapy treatment . The primary outcome will be non-response to physiotherapy on completion of the physiotherapy treatment programme as defined by the Osteoarthritis Research Society International treatment responder criteria . A principal component analysis will identify measures related to pain sensitisation to include in the predictive model . Regression analyses will explore the relationship between responder status and pain sensitisation while accounting for confounders . Ethics and dissemination This study has been approved by St James ’ Hospital/AMNCH Research Ethics Committee and by the St Vincent 's Healthcare Group Ethics and Medical Research Committee . The results will be presented at international conferences and published in a peer review journal . Trial registration number NCT02310945 OBJECTIVE To determine the most appropriate means to assess the response to treatment in terms of  pain and functional impairment in a chronic rheumatic condition ( knee osteoarthritis [ OA ] ) and an acute rheumatic condition ( rotator cuff syndrome [ RCS ] ) . METHODS Two prospect i ve studies were conducted consisting of 1,019 out patients with knee OA and 271 patients with acute RCS . The minimal clinical ly important improvement and the patient acceptable symptom state were determined for knee OA pain using a visual analog scale , and for knee OA function using the Western Ontario and McMaster Universities Osteoarthritis Index function subscale ; for acute RCS pain , a numeral rating scale was used , and the Neer function subscale was used for RCS function . RESULTS The minimal clinical ly important improvement was shown to be the change required to achieve the patient acceptable symptom state , whatever the baseline level of symptom , the outcome ( pain or function ) , or type of condition ( chronic or acute ) . This acceptable state for pain was higher for chronic ( 27.0 - 36.4 across the baseline score ) than acute ( 16.7 - 24.1 ) conditions . The level of functional impairment considered satisfactory by patients with knee OA was higher for more disabled patients ( 43.1 ) than for less disabled patients ( 20.4 ) . CONCLUSION Patients consider that they experienced an important improvement only if this improvement allowed them to achieve a state they consider satisfactory . The most appropriate means to assess the response to therapy seems to be to assess whether patients feel good ( i.e. , achieve the patient acceptable symptom state ) BACKGROUND Osteoarthritis ( OA ) of the knee is associated with a number of physical and psychological impairments . Unfortunately , very few treatment strategies are capable of addressing both types of impairments concurrently . We performed a pilot , r and omized controlled , proof of principle trial investigating the feasibility and effects of an intervention combining physical exercise and pain coping skills training ( PCST ) . METHODS Twenty patients with a clinical and radiographical diagnosis of tibiofemoral OA were r and omized to receive either 10 weeks of physiotherapist supervised exercises ( lower limb strengthening and walking ) combined with non-directive counseling ( NDC ) or the same exercise program delivered concurrently with PCST . Primary outcomes included self-reported pain and pain coping , while secondary outcomes included self efficacy and self-reported physical function . RESULTS Ten participants were r and omized to each group and both groups exhibited significant improvements in isometric knee strength , self-reported knee pain and physical function , self efficacy for control of pain management and other arthritis symptoms . Only those in the exercise + PCST group reported statistically significant improvements in pain control coping and rational thinking . No between-group differences existed in any outcome ( 0.07 < p < 0.98 ) . Based on our findings , 63 participants per group would be needed for future large-scale studies using similar outcome measures and design . CONCLUSIONS Our study showed that an intervention that combines exercise and PCST within the same treatment session and delivered by specially-trained physiotherapists is feasible and can improve both physical and psychological outcomes in individuals with knee OA . LEVEL OF EVIDENCE Level II Clinical Trials Registry number : ACTRN12609000623291 OBJECTIVE Clinical tools are needed to identify and target a neuropathic-like phenotype , which may be associated with central sensitization ( CS ) , in osteoarthritis ( OA ) . The modified painDETECT question naire ( mPD-Q ) has face and content validity for identifying neuropathic-like symptoms in knee OA . To further vali date the mPD-Q , this study assessed the unknown relationship between mPD-Q scores and signs of CS on quantitative sensory testing ( QST ) in knee OA . DESIGN 36 Individuals were recruited with chronic , symptomatic , knee OA without other pain/neurological conditions . Reference QST data were obtained from 18 controls/32 eligible knees , enabling identification of sensory abnormalities/CS among case knees . A st and ardized question naire assessed psychological factors ( depressive symptoms and pain catastrophizing ) , and for individual knees , mPD-Q and pain intensity scores . A st and ardized/comprehensive QST protocol was conducted for each knee . QST signs of CS were defined as : mechanical hyperalgesia and /or enhanced temporal summation and /or allodynia . The relationship between the presence of CS ( yes/no ) and a pre-selected mPD-Q score ( ≤12 or > 12 ) , by knees , was assessed using generalized estimating equations . RESULTS Among 57 eligible case knees , 45.6 % had ≥1 sign of CS . Controlling for age , knees with higher mPD-Q scores ( > 12.0 ) had higher odds of having QST signs of CS ( adjusted odds ratio ( OR ) = 5.6 ; 95 % confidence interval ( CI ) , 1.3 - 22.9 ) . This relationship was unaffected by controlling for depression and pain intensity , but was attenuated by pain catastrophizing . CONCLUSIONS Among painful OA knees , higher mPD-Q scores were associated with greater odds of having signs of CS . Thus , the mPD-Q may aid the identification of CS in people with chronic knee OA Background Patients with painful knee osteoarthritis ( OA ) demonstrate hyperalgesia and altered pain-modulatory responses . While some prior work has demonstrated cross-sectional associations between laboratory and clinical pain measures , it is unknown whether individual variability in quantitative sensory testing ( QST ) responses at baseline can prospect ively predict analgesic treatment responses . Method Patients with knee OA ( n = 35 ) were compared on QST responses to a demographically-matched  pain-free control group ( n = 39 ) , after which patients completed a month-long treatment study of diclofenac sodium topical gel ( 1 % ) , applied up to 4 times daily . Results OA patients demonstrated reduced pain thresholds at multiple anatomic sites , as well as reduced conditioned pain modulation ( CPM ) and enhanced temporal summation of pain . The most pain-sensitive patients tended to report the most intense and neuropathic OA pain . Following diclofenac treatment , the knee OA cohort showed a roughly 30 % improvement in pain , regardless of the presence or absence of neuropathic symptoms . Baseline CPM scores , an index of endogenous pain-inhibitory capacity , were prospect ively associated with treatment-related changes in clinical pain . Specifically , participants with higher CPM at baseline ( i.e. , better functioning endogenous pain-inhibitory systems ) showed more reduction in pain at the end of treatment ( p < .05 ) . Conclusions These results support prior findings of amplified pain sensitivity and reduced pain-inhibition in OA patients . Moreover , the moderate to strong associations between laboratory-based measures of pain sensitivity and indices of clinical pain highlight the clinical relevance of QST in this sample . Finally , the prospect i ve association between CPM and diclofenac response suggests that QST-based phenotyping may have utility in explaining inter-patient variability in long-term analgesic treatment outcomes .Trial registration Clinical Trials . Gov Identifier : NCT01383954 . Registered June 22 , 2011 OBJECTIVE To determine , in subjects with knee pain but no radiographic changes of tibiofemoral or patellofemoral compartment osteoarthritis ( OA ) , whether mean body weight , quadriceps and hamstring strength , lower extremity muscle mass , depression scores , and perceptions of their general health status differed from those of subjects with symptomatic knee OA . METHODS Subjects were 25 women and 10 men with knee pain and radiographic evidence of OA at the baseline examination , and 21 women and 16 men who had knee pain at the baseline examination but no radiographic evidence of knee OA at either baseline examination or followup evaluation performed , on average , 31 months later . These individuals were a subset of a cohort of 462 independently living elderly individuals recruited by telephone interview after r and om selection through r and om digit dialing of households in central Indiana . Data from an additional 134 subjects who had neither knee pain nor radiographic changes of OA at either the baseline or followup examination were analyzed for comparison . Lower extremity muscle strength was measured by isokinetic dynamometry , lean tissue ( i.e. , muscle ) mass in the lower extremities by dual x-ray absorptiometry , depression by Center for Epidemiology Depression ( CES-D ) scale . knee pain by Western Ontario McMaster University OA instrument , and perceived general health status by the Medical Outcome Survey Short Form-36 . RESULTS In contrast to those with symptomatic knee OA , those who had knee pain but no radiographic evidence of OA were less obese , had hamstring as well as quadriceps weakness , and had CES-D scores high enough to qualify for a diagnosis of clinical depression . CONCLUSION Among subjects with knee pain but no OA-- and among women in this subset , in particular -- knee pain may be a manifestation of depression . rather than of joint disease OBJECTIVES The study aim ed to compare the psychological and physical characteristics of older adults with knee osteoarthritis ( OA ) vs those of adults with chronic low back pain ( CLBP ) and to identify psychological and physical predictors of function as measured by gait speed . DESIGN Secondary data analysis . METHOD AND PATIENTS Eighty-eight older adults with advanced knee OA and 200 with CLBP who had participated in separate r and omized controlled trials were selected for this study . MEASURES Inclusion criteria for both trials included age > or = 65 and pain of at least moderate intensity that occurred daily or almost every day for at least the previous 3 months .  Psychological constructs ( catastrophizing , fear avoidance , self-efficacy , depression , affective distress ) and physical measures ( comorbid medical conditions , pain duration , pain severity , pain related interference , self-rated health ) were obtained . RESULTS Subjects with CLBP had slower gait ( 0.88 m/s vs 0.96 m/s , P = 0.002 ) and more comorbid conditions than subjects with knee pain ( mean 3.36 vs 1.97 , P < 0.001 ) . All the psychological measures were significantly worse in the CLBP group except the Multidimensional Pain Inventory-Affective Distress score . Self-efficacy , pain severity , and medical comorbidity burden were associated with slower gait regardless of the location of the pain . CONCLUSIONS Older adults with chronic pain may have distinct psychological and physical profiles that differentially impact gait speed . These findings suggest that not all pain conditions are the same in their psychological and physical characteristics and may need to be taken into consideration when developing treatment plans This study investigated the physical and psychosocial consequences of living with osteoarthritis ( OA ) in daily life and peoples ’ views of total knee arthroplasty ( TKA ) and the role of physiotherapy . In-depth interview data were used from a prospect i ve qualitative study conducted by the senior author ( KY ) . Participants were 15 volunteers with knee OA who were awaiting TKA at a specialized orthopaedic tertiary care facility in Toronto . A modified grounded theory method approach was used to analyze the interview data . The findings showed that experiences for the participants with OA were conceptualized as a “ breakpoint . ” The breakpoint was centred on the experiences/processes of living with unremitting pain , the limitations of mobility , leisure and social activities , and the result ing consequences to the participant 's physical and psychological well-being . In addition to the above experiences , participants also discussed their perceptions of  TKA surgery .  The findings showed that expectations of TKA were linked to participants ’ knowledge of the procedure and its outcomes . The participants listed acquaintances , friends , family members , and doctors as the main sources of knowledge for TKA . On the basis of the above analysis , recommendations are made for developing a preoperative physiotherapy program that would focus on minimizing preoperative disability and maximizing postoperative recovery Objective . To define pain and physical function cutpoints that would , coupled with structural severity , define a surrogate measure of “ need for joint replacement surgery , ” for use as an outcome measure for potential structure-modifying interventions for osteoarthritis ( OA ) . Methods . New scores were developed for pain and physical function in knee and hip OA . A cross-sectional international study in 1909 patients was conducted to define data -driven cutpoints corresponding to the orthopedic surgeons ’ indication for joint replacement . A post hoc analysis of 8 r and omized clinical trials ( 1379 patients ) evaluated the prevalence and validity of cutpoints , among patients with symptomatic hip/knee OA . Results . In the international cross-sectional study , there was substantial overlap in symptom levels between patients with and patients without indication for joint replacement ; indeed , it was not possible to determine cutpoints for pain and function defining this indication . The post hoc analysis of trial data showed that the prevalence of cases that combined radiological progression , high level of pain , and high degree of function impairment was low ( 2%–12 % ) . The most discriminatory cutpoint to define an indication for joint replacement was found to be [ pain ( 0–100 ) + physical function ( 0–100 ) > 80 ] . Conclusion . These results do not support a specific level of pain or function that defines an indication for joint replacement . However , a tentative cutpoint for pain and physical function levels is proposed for further evaluation . Potentially , this symptom level , coupled with radiographic progression , could be used to define “ nonresponders ” to disease-modifying drugs in OA clinical trials OBJECTIVE To evaluate a concise program of self-care education delivered by an arthritis nurse specialist as an adjunct to primary care for inner-city patients with knee osteoarthritis ( OA ) . METHODS An attention-controlled clinical trial ; 211 inner-city patients with knee OA were assigned arbitrarily to education ( E ) or attention-control ( AC ) conditions . Group E received an individualized 30 - 60-minute educational intervention that emphasized nonpharmacologic management of joint pain , preservation of function by problem-solving , and practice of principles of joint protection . Brief telephone contacts 1 week and 4 weeks later monitored and reinforced new self-care activities . Group AC viewed a 20-minute st and ardized public education presentation on arthritis and received followup telephone calls ( only to encourage continued participation in the study ) . Outcomes included the Health Assessment Question naire ( HAQ ) Disability and Discomfort Scales , 10-cm visual analog scales measuring knee pain at rest and while walking , and the Quality of Well-Being ( QWB ) scale . Assessment s were made at baseline and at 4-month intervals for 1 year . RESULTS A total of 165 subjects ( 78 % ) completed all assessment s. After control for baseline status , group E had significantly lower scores for disability and resting knee pain throughout the year of postintervention followup ( P < 0.05 for both ) . Effects were somewhat discordant . By 12 months , functional benefits had begun to wane , while the effect on resting knee pain had grown . The overall effects of education on walking knee pain , overall joint pain ( by HAQ ) , and general health status ( by QWB ) were not significant . CONCLUSION Self-care education for inner-city patients with knee OA , delivered as an adjunct to primary care , was found to result in notable preservation of function and control of resting knee pain . The magnitude of the observed effects compares well with those of more labor-intensive and time-consuming intervention models . However , more sustained preservation of function and consistent effects on pain may require prolonged , more proactive followup , either by the patient educator or by a trained clinical assistant dedicated to the task of supporting self-care by patients with knee OA OBJECTIVE To investigate the therapeutic effects of different muscle-strengthening exercises on the functional status of patients with knee osteoarthritis ( OA ) . METHODS One hundred thirty-two patients with bilateral knee OA ( Altman Grade II ) were sequentially divided into 4 r and om groups ( GI to GIV ) . The patients in group I received isokinetic muscle-strengthening exercise , group II received isotonic muscle-strengthening exercise , group III received isometric muscle-strengthening exercise , and group IV acted as controls . The changes of muscle power of leg flexion and extension were measured with a Kinetic Communicator dynamometer , and patients ' functional status was evaluated by visual analogue scale , ambulation speed , and Lequesne index before and after treatment , and at the follow-up 1 year later . RESULTS The results showed that the patients with OA in each treated group had significant improvement in pain reduction , disability reduction , and in walking speed after treatment and at follow-up when compared with their initial status . Isotonic exercise had the greatest effect on pain reduction after treatment , and fewer participants discontinued the treatment because of exercise knee pain . Isokinetic exercise caused the greatest increase of walking speed and decrease of disability after treatment and at follow-up . The greatest muscle-strength gain in 60 degrees /second angular velocity peak torques was found in the isokinetic and isotonic exercise groups . A significant muscle-strength gain in 180 degrees /second angular velocity peak torques was found only in the isokinetic group after treatment . CONCLUSION AND RELEVANCE Isotonic exercise is suggested for initial strengthening in patients with OA with exercise knee pain , and isokinetic exercise is suggested for improving joint stability or walking endurance at a later time OBJECTIVES To examine the objective physical function of the lower extremities , to measure the properties of quadriceps femoris muscle ( QFM ) , and to assess subjective disabilities in men with knee osteoarthritis ( OA ) and to compare the results with those obtained from age- and sex-matched control subjects . DESIGN Cross-sectional study . SETTING Rehabilitation clinic in a university hospital . PARTICIPANTS Male volunteers ( n=54 ) ( age range , 50 - 69y ) with knee OA and r and omly selected healthy , age- and sex-matched control subjects ( n=53 ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Physical function evaluated with a test battery including the QFM composition measurement , the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , and the R AND 36-Item Short-Form Health Survey , version 1.0 .  RESULTS Knee OA patients had 13 % to 26 % poorer ( P range , .050-.001 ) physical function and muscle strength compared with the controls . There were also significant differences in QFM composition . WOMAC ( P range , .050-.001 ) and muscle strength ( P<.001 ) associated with physical function tests , but subjective pain correlated with neither physical function nor muscle strength in knee OA patients . The radiographic knee OA grade did not have any significant effect on physical function , but passive knee motion , knee extension strength , and WOMAC were related to the severity of the disease ( P<.05 ) . CONCLUSIONS The patients with knee OA exhibited impaired physical function and muscle strength and QFM composition compared with healthy controls . The severity of radiographic knee OA clearly had adverse effects on functional ability at the later stages of the disease . The results highlight the effect of QFM strength on physical function as well as the importance of patient 's subjective and objective physical function when deciding on knee OA treatment policy OBJECTIVE To evaluate the effectiveness of using subchondral bone texture observed on a radiograph taken at baseline to predict progression of knee osteoarthritis ( OA ) over a 3-year period . METHODS A total of 138 participants in the Prediction of Osteoarthritis Progression study were evaluated at baseline and after 3 years . Fractal signature analysis ( FSA ) of the medial subchondral tibial plateau was performed on fixed flexion radiographs of 248 nonreplaced knees  , using a commercially available software tool . OA progression was defined as a change in joint space narrowing ( JSN ) or osteophyte formation of 1 grade according to a st and ardized knee atlas . Statistical analysis of fractal signatures was performed using a new model based on correlating the overall shape of a fractal dimension curve with radius . RESULTS Fractal signature of the medial tibial plateau at baseline was predictive of medial knee JSN progression ( area under the curve [ AUC ] 0.75 , of a receiver operating characteristic curve ) but was not predictive of osteophyte formation or progression of JSN in the lateral compartment . Traditional covariates ( age , sex , body mass index , knee pain ) , general bone mineral content , and joint space width at baseline were no more effective than r and om variables for predicting OA progression ( AUC 0.52 - 0.58 ) . The predictive model with maximum effectiveness combined fractal signature at baseline , knee alignment , traditional covariates , and bone mineral content ( AUC 0.79 ) . CONCLUSION We identified a prognostic marker of OA that is readily extracted from a plain radiograph using FSA . Although the method needs to be vali date d in a second cohort , our results indicate that the global shape approach to analyzing these data is a potentially efficient means of identifying individuals at risk of knee OA progression OBJECTIVE To examine the effects of aerobic and resistance exercise on self-efficacy beliefs in older adults with knee osteoarthritis ( OA ) and to determine whether self-efficacy and knee pain mediated the effects of the treatments on stair time performance and health perceptions . METHODS Measures of self-efficacy , knee pain , stair climbing performance , and health perceptions were collected prior to r and omization and again at an 18-month followup in older adults with knee OA who were assigned to 1 of 3 treatment conditions : aerobic exercise , resistance training , or health education control .  All analyses were conducted on the intention-to-treat principle . RESULTS Both exercise treatments increased self-efficacy for stair climbing in comparison to the health education control group . Both knee pain and self-efficacy mediated the effect of the treatments on stair climb time , whereas only knee pain mediated health perceptions . CONCLUSIONS The findings suggest that control beliefs and changes in physical symptoms such as knee pain are important outcomes in physical activity programs with patients who have OA of the knee . Moreover , these variables mediate the effects that such programs have on disability and health perceptions Background Impairment-based exercise programs have yielded only small to moderate benefits in reducing pain and improving function in people with knee osteoarthritis ( OA ) . It has previously been proposed that adding agility and perturbation training to exercise programs for people with knee OA may improve treatment effects for pain and function . Objective The purpose of this study was to examine the effectiveness of adding agility and perturbation techniques to st and ard exercise therapy compared with the st and ard exercise program alone for people with knee OA . Design This was a single-blinded r and omized controlled trial . Setting The study was conducted in the outpatient physical therapy clinic of a large , university-based health center . Participants One hundred eighty-three people with knee OA ( 122 women , 61 men ) participated . Interventions Participants were r and omly assigned to either a group that received agility and perturbation training with st and ard exercise therapy or a group that received only the st and ard exercise program . Measurements The outcome measures were self-reported knee pain and function , self-reported knee instability , a performance-based measure of function , and global rating of change . Results Although both groups exhibited improvement in self-reported function and in the global rating of change at the 2- , 6- , and 12-month follow-up periods , there were no differences between groups on these outcomes . There was no reduction in knee pain or improvement in performance-based function in either group . Limitations It is possible that more-intense application of the interventions or application of the interventions to participants with knee OA who were at greater risk for falling may have yielded additive effects of the agility and perturbation training approach . Conclusions Both intervention groups exhibited improvement in self-reported function and the global rating of change . Our results , however , did not support an additive effect of agility and perturbation training with st and ard exercise therapy in our sample of individuals with knee OA . Further study is needed to determine whether there are subgroups of individuals who might achieve an added benefit with this approach Background Osteoarthritis ( OA ) is a common cause of pain and disability , and is the most common form of arthritis in the Western world . The most common joint to be affected is the knee . Pain and functional disability are common symptoms , which can lead to reduced quality of life and increase the risk of further morbidity . Current treatment aims to educate patients about the management of OA , reduce pain , improve function , decrease disability and reduce the progression of the disease . Education with clients has been described as a set of planned educational activities design ed to improve patients ' health behaviours and /or health status . The purpose of self‐education is to maintain or improve health , or , in some cases , to slow deterioration by increasing participant 's perception of self efficacy defined as an ability to control or manage various aspects of OA . To date , there is no systematic review of the literature undertaken to identify the effectiveness of self‐management educational activities for osteoarthritis of the knee . Objective The objective of this systematic review is to evaluate the effectiveness of  self‐management educational interventions on function and quality of life for adult subjects with OA of the knee . Search strategy A comprehensive search strategy was undertaken on data bases available from University of South Australia from their inception to January 2007 . Selection criteria R and omised controlled trials or clinical controlled trials were sought which evaluated any self management interventions for osteoarthritis knee . Critical appraisal of study quality was undertaken using Joanna Briggs Institute critical appraisal instruments . Data extraction was via the Joanna Briggs Institute st and ard data extraction form for evidence of effectiveness , and Review Manager Software was used to calculate comparative statistics . Results Thirteen trials were included in the review . Trials were clinical ly and method ologically heterogeneous . Pooled results indicate evidence of a beneficial effect from  self management strategies with reducing pain ( SMD ‐0.25 , 95%CI ‐0.36 to ‐0.13 , 11 trials 1379 participants ) . There was no effect on physical function ( SMD 0.13 , 95%CI ‐0.33 to ‐0.08 , eight trials , 1156 subjects ) . No beneficial effects were found from self management interventions with improving quality of life . We also found the exercise component of self management ( four trials ) demonstrated a benefit with reducing pain , improving function and quality of life . Exercise also offered a benefit over no exercise  . Overall method ological quality was moderate . Discussion Pooled results indicate evidence of a beneficial effect from self management strategies with reducing pain and improving function . Significant heterogeneity was found between trials . This was controlled for in the analysis but may be explained by heterogeneity in both the intervention and control group . The exercise component of self management programmes appears to contribute a significant benefit . Conclusion There is encouraging evidence of a small benefit from exercise in self management programs . Clear guidelines can not be provided for practice regarding the exercise content due to heterogeneity but overall benefit suggests this component should be emphasized and implemented in primary care self management programmes
Results The FreKAQ-J had acceptable internal consistency , unidimensionality , good test-retest reliability , and was functional on the category rating scale .
The FreKAQ-J was significantly correlated with pain in motion , disability , pain-related catastrophizing , fear of movement , and anxiety symptomatology .
Conclusions We developed FreKAQ-J by modifying the FreBAQ-J. The FreKAQ-J fits the Rasch measurement model well and is suitable for use in people with knee OA .
Background Recent systematic review s have demonstrated that pain associated with knee osteoarthritis ( OA ) is a complex phenomenon that involves various contributors .
People with knee OA exhibit symptoms of impaired body-perception , including reduced tactile acuity , impairments in limb laterality recognition , and de grade d proprioceptive acuity .
The Fremantle Back Awareness Question naire ( FreBAQ ) was developed to assess body-perception specific to the back in people with chronic low back pain .
The aim of this study was to develop and assess the psychometric properties of a knee-specific version of the FreBAQ-J ( FreKAQ-J ) , determine whether people with knee pain experience perceptual impairments and investigate the relationship between disturbed self-perception and clinical status .