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Osteoarthritis (OA) is a rheumatic disease that affects the well-being of the patient, compromises physical and mental function, and affects other quality of life aspects. In the literature, several evidence-based guidelines and recommendations for the management of knee osteoarthritis (KOA) are available. These recommendations list the different therapeutic options rather than addressing a hierarchy between the treatments and defining the real target. Therefore, a question arises: are patients and physicians satisfied with the current management of KOA? Actually, the answer may be negative, thus suggesting a change in our therapeutic strategies. In this article, we address this challenge by suggesting that it is time to develop a "treat to target strategy" for KOA. [ABSTRACT FROM AUTHOR]

Objective: Exercise is a cornerstone of diabetes management and the prevention of incident diabetes. However, the impact of the mode of exercise on cardiovascular (CV) risk factors in type 2 diabetes is unclear.Research Design and Methods: We conducted a systematic review of the literature between 1970 and October 2009 in representative databases for the effect of aerobic or resistance exercise training on clinical markers of CV risk, including glycemic control, dyslipidemia, blood pressure, and body composition in patients with type 2 diabetes.Results: Of 645 articles retrieved, 34 met our inclusion criteria; most investigated aerobic exercise alone, and 10 reported combined exercise training. Aerobic alone or combined with resistance training (RT) significantly improved HbA(1c) -0.6 and -0.67%, respectively (95% CI -0.98 to -0.27 and -0.93 to -0.40, respectively), systolic blood pressure (SBP) -6.08 and -3.59 mmHg, respectively (95% CI -10.79 to -1.36 and -6.93 to -0.24, respectively), and triglycerides -0.3 mmol/L (95% CI -0.48 to -0.11 and -0.57 to -0.02, respectively). Waist circumference was significantly improved -3.1 cm (95% CI -10.3 to -1.2) with combined aerobic and resistance exercise, although fewer studies and more heterogeneity of the responses were observed in the latter two markers. Resistance exercise alone or combined with any other form of exercise was not found to have any significant effect on CV markers.Conclusions: Aerobic exercise alone or combined with RT improves glycemic control, SBP, triglycerides, and waist circumference. The impact of resistance exercise alone on CV risk markers in type 2 diabetes remains unclear. [ABSTRACT FROM AUTHOR]

BACKGROUND: Osteoarthritis of the great toe can lead to a progressive decrease in range of motion (ROM) and pain at the first metatarsophalangeal (MTP) joint. This condition, observed in older golfers, results in reduced participation and enjoyment of this popular activity.OBJECTIVE: To assess the efficacy, safety, and patient satisfaction with a series of intra-articular injections of hyaluronic acid (HA) into the first MTP joint in older patients who reported osteoarthritis-associated pain, loss of MTP joint ROM, and disability that interfered with golf participation.METHODS: Forty-seven consecutive male golfers met the inclusion criteria and were given a weekly intra-articular HA injection for 8 weeks. Baseline measures of MTP joint ROM, pain at rest and immediately after tiptoe walking for 10 m, and global patient satisfaction (GPS) were compared with measures at 9 and 16 weeks and at presentation for a second injection series.RESULTS: Adverse events (only local injection site pain was noted) were <0.01%. At 9 weeks, significant improvement in pain at rest, pain after tiptoe walking, ROM, and GPS were observed. These changes were maintained for all measures at 16 weeks. At presentation for the second series, GPS was significantly higher than at baseline and at 16 weeks. Pain at rest, tiptoe walking pain, and ROM were significantly improved from baseline, but tiptoe-walking pain was significantly reduced at 16 weeks.CONCLUSION: Intra-articular HA injection significantly improved pain tolerance at rest and with activity. Patient acceptance of the treatment was high, with very few adverse events in golfers who had osteoarthritis of the first MTP joint. [ABSTRACT FROM AUTHOR]

BACKGROUND: The incidence of in-line skating injuries has increased with the rapid growth in the sport's popularity, but few studies have examined patterns of injuries.OBJECTIVE: This study sought to determine the demographics of at-risk in-line skaters, document protective equipment use, identify contributing or precipitating factors associated with injuries, and obtain a profile of the injuries sustained.DESIGN: This prospective, descriptive study examined injuries among in-line skaters seen in emergency departments from three hospitals in Canada from August 23, 1995, to November 19, 1996. Patients completed questionnaires about their injuries, and the data were used for the analysis.RESULTS: A total of 121 skaters completed the study. The mean age of injured skaters was 24 years. The largest age-group of injured skaters (50%) were those between 18 and 35 years old. Although the ratio of male to female skaters was about equal (45% female, 55% male), twice as many males as females were younger than 18. The most common cause of injury was a loss of control with no obstacles (50% of patients), and the most common injury was forearm fracture. Most injured skaters were either experienced recreational (33.2%) or novice (37.5%), and, when injured, most skaters were wearing less protective equipment than usual.CONCLUSION: Loss of control and inexperience were factors contributing to about half the injuries. Protective equipment among skaters was underused. Future research must identify the overall incidence of injuries, optimal design and efficacy of protective equipment, and effectiveness of preventive strategies such as safety education. [ABSTRACT FROM AUTHOR]

Objective: To review and determine the effectiveness of exercise treatment in osteoarthritis of the knee.Methods: A computerised literature search of Medline was carried out searching between June 1966 and January 2000.Results: Twenty three randomised controlled trials were identified from the literature. Only three trials were sufficiently powered. Small to moderate beneficial effects of exercise treatment were found for pain, small beneficial effects on disability outcome measures, and moderate to great beneficial effects were observed according to patient global assessment of effect. It was not possible to obtain evidence on the content of exercise interventions, as studies were hampered by lack of attention to proper concealment, reporting of adverse effects, and long term effects of exercise treatment. The lack of standard outcomes measures is also noted.Conclusions: The available evidence indicates beneficial short term effects of exercise treatment in patients with osteoarthritis of the knee. However, the number of available studies is limited, and more research is needed to expand this recommendation. Specifically, additional trials should provide information on adherence, home based interventions, interaction with pharmacological treatments, functional outcomes measures relevant to exercise treatment in these patients, and long term effects. At present, doctors should recommend exercise to all patients with mild/moderate disease. Further study should be encouraged and exercise should be continued to be recommended as a mainstay of non-pharmacological treatment of osteoarthritis of the knee. [ABSTRACT FROM AUTHOR]

Background: Prefracture physical function must be accurately determined to set appropriate and attainable goals for rehabilitation following hip fracture. This is especially important for people who were living independently prior to their fracture. This study determines reliability and internal consistency of a prefracture physical function questionnaire (PFPFQ) completed by both patients and knowledgeable informants (KIs).Methods: A 20-item PFPFQ, including ambulation, transfers, balance, and self-care domains, was developed using focus groups. Community-dwelling patients with a hip fracture (N = 40, 77.9 +/- 8 years) completed the PFPFQ on two occasions during postoperative acute care. Forty KIs were identified by the patients and also completed the PFPFQ on two occasions via telephone interview. Day-to-day reliability of the patients and KIs [intraclass correlation coefficients (ICC)], and internal consistency [Kuder-Richardson coefficient (KR)] of the PFPFQ were determined.Results: Intrarater reliability was high with ICCs (95% confidence interval) of 0.94 (0.89, 0.96) for patients and 0.96 (0.93, 0.98) for KIs. Interrater reliability on occasion 1 had an ICC of 0.81 (0.69, 0.88). Internal consistency of the patient responses on the first occasion was high (KR coefficient = 0.896).Conclusions: The PFPFQ is a reliable and internally consistent instrument for determining prefracture physical function in community-dwelling people who fracture their hip. In situations where patients with a hip fracture are unable to provide this necessary information, KIs can provide reliable estimates of prefracture function to assist in setting appropriate rehabilitation goals. [ABSTRACT FROM AUTHOR]