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OBJECTIVE The Osteoarthritis Research Society International (OARSI) recommends assessment of physical function using a performance-based test of stair negotiation, but was unable to recommend any specific test. We assessed the reliability, validity, responsiveness, measurement error, and minimum important change (MIC) of the 6-step timed Stair Climb Test (SCT). METHODS We used pooled data from 397 participants with hip or knee osteoarthritis (54% women) from four clinical trials (86% retained at 12-week follow-up). Construct validity was assessed by testing six a priori hypotheses against other OARSI-recommended physical function measures. A self-reported Global Rating of Change scale was used to classify participants as worsened, improved and stable. Participants who worsened in physical function were excluded from all analyses. Responsiveness and MIC were assessed using multiple anchor-based and distribution-based approaches. Test-retest reliability, standard error of measurement (SEM) and smallest detectable change (SDC) were assessed on stable participants. RESULTS Five of six hypotheses (83%) for construct validity were met. Test-retest reliability was excellent (intraclass correlation coefficient2,1 : 0.83; 95% confidence interval: 0.71, 0.90). The SEM and SDC values were 0.44 and 1.21 seconds respectively. We did not find adequate support for responsiveness. The MIC values ranged from 0.78 to 1.95 seconds using different approaches (median=1.37 seconds). CONCLUSION The 6-step timed SCT adequately assesses the construct of physical function in individuals with hip or knee osteoarthritis with excellent 12-week test-retest reliability. However, support for its responsiveness was inadequate to recommend its use as an outcome measure in people with osteoarthritis for research and clinical practice.

Objectives To investigate whether the Health Assessment Questionnaire Disability Index (HAQ-DI) reflects objective measures of physical function in people with osteoarthritis (OA) and rheumatoid arthritis (RA). Methods In total, 139 people, 71 with RA fulfilling the American College of Rheumatology (ACR) criteria (1987) and 68 with OA fulfilling ACR criteria for OA of the hip or knee, completed the HAQ-DI. Physical function was assessed using Timed Up and Go (TUG), 30 seconds Sit to Stand (STS), grip strength dynamometry and pedometer steps over 7 days. Results The strongest association with HAQ-DI was with the TUG (R2 of 0.671 and 0.512 in RA and OA groups, respectively). HAQ-DI and STS showed a non-linear association in both groups with R2 of 0.380 in RA and 0.359 in OA. A strong association was found between HAQ-DI and grip strength in the OA group (R2 = 0.681), whereas the RA group showed a moderate association (R2 = 0.285). There was a strong association between the HAQ-DI and pedometer measures in RA (R2 = 0.562), although this association was weak in OA (R2 = 0.156). Conclusion The HAQ-DI has a strong association with the TUG in both RA and OA. There was variable association between the HAQ-DI and other physical performance measures, as well as differences between the RA and OA cohorts. In order to form a full and accurate clinical picture, health professionals should perform both subjective patient-reported outcome measures and objective physical performance measures of disability.

Objective To identify, by systematic review, patient characteristics that can be used by health care practitioners to predict the likelihood of knee osteoarthritis (OA) progression. Methods A search was conducted of the electronic databases Medline, EMBase, CINAHL, AMED, and Web of Science in November 2010. Two reviewers screened articles using inclusion/exclusion criteria. Study participants were adults with established knee OA. Outcome measures for disease progression were change in pain or function or deterioration in radiographic features. Included studies identified clinically relevant prognostic factors at baseline and reported a statistical association with outcome. Minimum followup was 1 year. Articles were assessed for bias, and strength of evidence was summarized for potential predictors of progression. Results Thirty studies were included, of which 26 were of high quality. Age, varus knee alignment, presence of OA in multiple joints, and radiographic features had strong evidence as predictors of knee OA progression. Body mass index was a strong predictor for long-term progression (>3 years). Moderate participation in physical activity was not associated with progression. Numerous variables had limited or conflicting evidence. Conclusion Relatively few predictive variables have strong supporting evidence; numerous variables have limited or conflicting evidence. All variables with strong evidence can be easily evaluated and utilized in clinical practice. Existing knowledge should be developed in future research, particularly in cases where study numbers are low or findings are limited or conflicting. Standardized measurement of potential predictors and outcome measures is recommended.

Background. Clinical guidelines recommend medications as first line treatment for many musculoskeletal injuries. As first line health professionals for musculoskeletal conditions, including sprains and strains, physiotherapists may be asked to recommend suitable medications. Currently recommending medications is outside of the physiotherapists scope of practice. However there is evidence that physiotherapists often do recommend medications, mostly simple analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). Purpose. The aim of this study was to investigate the current knowledge and behaviour of New Zealand musculoskeletal physiotherapists regarding recommendation of non-prescription medications for the treatment of musculoskeletal sprains and strains. Method. 2438 New Zealand physiotherapists were surveyed, of whom approximately 948 work in musculoskeletal physiotherapy. Results. Of 278 respondents (29.3% response rate), 213 (81.0%) sometimes or often recommend oral NSAIDs to patients, and 216 (82.1%) recommend oral paracetamol. Most respondents (225, 85.5%) report that they routinely provide information on potential side effects, 181 (68.8%) on potential risks. Many refer to a pharmacist, however 146 (55.5%) make recommendations on dose, and 119 (45.2%) recommend specific brand names. When asked what the risks associated with NSAIDs were, most respondents (>70%) were able to name at least gastrointestinal upset, ulcers or bleeding, while the proportion able to name respiratory, renal or allergic risks was lower (