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To evaluate the effectiveness and health costs of a new primary care service delivery model (the Optimising Primary Care Management of Knee Osteoarthritis [PARTNER] model) to improve health outcomes for patients with knee osteoarthritis (OA) compared to usual care.This study was a 2-arm, cluster, superiority, randomized controlled trial with randomization at the general practice level, undertaken in Victoria and New South Wales, Australia. We aimed to recruit 44 practices and 572 patients age ≥45 years with knee pain for3 months. Professional development opportunities on best practice OA care were provided to intervention group general practitioners (GPs). All recruited patients had an initial GP visit to confirm knee OA diagnosis. Control patients continued usual GP care, and intervention patients were referred to a centralized care support team (CST) for 12-months. Via telehealth, the CST provided OA education and an agreed OA action plan focused on muscle strengthening, physical activity, and weight management. Primary outcomes were patient self-reported change in knee pain (Numerical Rating Scale [range 0-10; higher score = worse]) and physical function (Knee Injury and Osteoarthritis Outcome Score activities of daily living subscale [range 0-100; higher score = better] at 12 months. Health care cost outcomes included costs of medical visits and prescription medications over the 12-month period.Recruitment targets were not reached. A total of 38 practices and 217 patients were recruited. The intervention improved pain by 0.8 of 10 points (95% confidence interval [95% CI] 0.2, 1.4) and function by 6.5 of 100 points (95% CI 2.3, 10.7), more than usual care at 12 months. Total costs of medical visits and prescriptions were $3,940 (Australian) for the intervention group versus $4,161 for usual care. This difference was not statistically significant.The PARTNER model improved knee pain and function more than usual GP care. The magnitude of improvement is unlikely to be clinically meaningful for pain but is uncertain for function.

BACKGROUND Scalable knee osteoarthritis programs are needed to deliver recommended education, exercise, and weight loss interventions. OBJECTIVE To evaluate two 6-month, telehealth-delivered exercise programs, 1 with and 1 without dietary intervention. DESIGN 3-group, parallel randomized (5:5:2) trial. (Australian New Zealand Clinical Trials Registry: ACTRN12618000930280). SETTING Australian private health insurance members. PARTICIPANTS 415 persons with symptomatic knee osteoarthritis and a body mass index between 28 and 40 kg/m2 who were aged 45 to 80 years. INTERVENTION All groups received access to electronic osteoarthritis information (control). The exercise program comprised 6 physiotherapist consultations via videoconference for exercise, self-management advice, and behavioral counseling, plus exercise equipment and resources. The diet and exercise program included an additional 6 dietitian consultations for a ketogenic very-low-calorie diet (2 formulated meal replacements and a low-carbohydrate meal daily) followed by a transition to healthy eating, as well as nutrition and behavioral resources. MEASUREMENTS Primary outcomes were changes in knee pain (numerical rating scale [NRS] of 0 to 10, higher indicating worse) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]; scale, 0 to 68, higher indicating worse) at 6 months (primary time point) and 12 months. Secondary outcomes were weight, physical activity, quality of life, mental health, global change, satisfaction, willingness to have surgery, orthopedic appointments, and knee surgery. RESULTS A total of 379 participants (91%) provided 6-month primary outcomes, and 372 (90%) provided 12-month primary outcomes. At 6 months, both programs were superior to control for pain (between-group mean difference in change on NRS: diet and exercise, -1.5 [95% CI, -2.1 to -0.8]; exercise, -0.8 [CI, -1.5 to -0.2]) and function (between-group mean difference in change on WOMAC: diet and exercise, -9.8 [CI, -12.5 to -7.0]; exercise, -7.0 [CI, -9.7 to -4.2]). The diet and exercise program was superior to exercise (pain, -0.6 [CI, -1.1 to -0.2]; function, -2.8 [CI, -4.7 to -0.8]). Findings were similar at 12 months. LIMITATION Participants and clinicians were unblinded. CONCLUSION Telehealth-delivered exercise and diet programs improved pain and function in people with knee osteoarthritis and overweight or obesity. A dietary intervention conferred modest additional pain and function benefits over exercise. PRIMARY FUNDING SOURCE Medibank, the Medibank Better Health Foundation Research Fund, and a National Health and Medical Research Council Centre of Research Excellence.

Objective To systematically review the literature to determine whether external ankle supports influence ankle biomechanics in chronic ankle instability (CAI) participants during sports-related tasks. Data Sources A literature search of MEDLINE, SPORTDiscus, and CINAHL databases was conducted in November 2021. Study Selection Included studies were randomised cross-over or parallel-group controlled trials with CAI participants using external ankle supports, compared to no support, assessing ankle biomechanics during landing, running, or change of direction. Data Extraction Two authors independently conducted study identification, data extraction, risk of bias (RoB2), and quality of evidence (GRADE) assessments. Meta-analysis using random-effects was used to compare between-group mean differences (MD) with 95% confidence intervals (CI). GRADE recommendations were used to determine the certainty of findings. Data Synthesis Thirteen studies of low to moderate risk of bias were included. During landing, very low-grade evidence indicate external ankle supports reduce frontal plane excursion (MD [95% CI] −1.83° [−2.97, −0.69], p=0.002), plantarflexion ground contact angle (−3.86° (−6.18, −1.54), p=0.001), sagittal plane excursion (−3.45° [−5.00, −1.90], p Conclusion There is low to very low-grade evidence that external ankle supports reduce frontal plane excursion but not inversion ground contact angle in CAI participants during landing. Limiting frontal plane excursion may reduce ankle sprain risk. Frontal plane ankle kinematics were not influenced by external ankle supports during running. Sagittal plane reductions were observed with external ankle supports during landing and running, but its influence on ankle sprain risk is undetermined.

Objective To explore the relationships between participant characteristics, perceptions of a short educational video about osteoarthritis and its management, and immediate changes in behavioural determinants for effective self-management behaviours. Methods Seventy-eight participants with knee OA (77% female, mean age 63.0 ± 8.7) watched the 9-min video that included evidence-based content and was designed to foster empowerment to self-manage effectively. Data were collected by online questionnaire at baseline and immediately after watching the video. Associations were tested between baseline health and information processing characteristics (health literacy, need for cognition), perceptions of the video (enjoyment, helpfulness, believability, novelty and relevance) and pre-post changes in behavioural determinants (self-efficacy for managing arthritis, attitude to self-management or ‘activation’, and importance/confidence for physical activity). Results All behavioural determinants improved immediately after watching the video. Positive perceptions were associated with greater improvements in self-efficacy for arthritis (Spearman’s rho, ρ = 0.26–0.47). Greater perceived relevance was associated with increased self-rated importance of being physically active (ρ = 0.43). There were small positive associations between health literacy domains related to health information and positive viewer perceptions of the video. People with higher need for cognition may achieve greater improvement in confidence to be physically active (ρ = 0.27). Conclusion The educational video may help achieve outcomes important for increasing self-management behaviours in people with knee osteoarthritis. Positive perceptions appear to be important in achieving these improvements. People with lower health literacy and lower need for cognition may respond less well to this information about knee osteoarthritis delivered in this way.

Objective To evaluate responses by people with knee osteoarthritis to a brief educational video about their condition that aimed to empower and motivate effective self-management. The video content addressed psychosocial contributors to pain and barriers to behaviour change. Methods A mixed methods design, including a survey and semi-structured interviews, was used to collect data from 118 people (46–83 years, 78% female) with knee osteoarthritis. Results Quantitative data analysis showed the video was rated positively on 0–6 scales for enjoyability (mean 5.0), helpfulness (4.9), relevance (5.0) and believability (5.4). The majority would recommend the video (89%), learned new information (78%) and/or reported intentions to change behaviour (78%). A minority disliked aspects of the video (23%). The thematic analyses identified three main themes: Reactions to the video, including emotions; Learning from the video, including new knowledge and empowerment, but also unmet information needs or disagreement; and Intentions, including behaviour changes, cognitive changes and help seeking. Conclusion Education about knee osteoarthritis with a focus on empowerment is well received by people with the condition, although some discordant views emerged. Practice implications The educational video about knee osteoarthritis can be recommended to promote effective self-management and counteract potential drawbacks associated with biomedical-based education.

Objective To determine the effectiveness of telehealth interventions in reducing community falls risk or rates compared to equivalent in-person interventions in adults with neurological conditions. Data Sources Eight electronic databases, trial registries and search engines were searched for the concepts ‘falls’, ‘neurological conditions’, and ‘telehealth’, limited to English language, from inception until August 2022. Review methods Search for original research where the intervention was delivered via synchronous videoconferencing with the aim of reducing falls and falls-related outcomes. Screening and risk of bias assessment were completed by two independent researchers. Outcome data included falls rates, falls-related outcomes, safety, feasibility, and acceptability. Risk of bias was assessed using the ROB-2 and ROBINS-I tools. Quality of evidence was rated with the grading of recommendations, assessment, development and evaluation (GRADE) approach. Results Seventeen studies with 581 participants were included; six were randomised controlled trials. Risk of bias ranged from low to high. Only one study ( n = 76) reported falls and did not find differences between telehealth and in-person physiotherapy. There was low-quality evidence that telehealth interventions improve balance outcomes more than face-to-face interventions (pooled between-group mean difference 2.48 Berg Balance Scale units, 95%CI 0.77 to 4.20). Fear of falling was not different between intervention delivery modes. Conclusion Findings suggest that telehealth delivered falls prevention interventions are safe, feasible and acceptable in community-dwelling adults with neurological conditions, however, data related to effectiveness in reducing falls is limited. Low-quality evidence suggests that telehealth may deliver similar or better outcomes for standing balance in this population. PROSPERO Registration: (CRD42021240167).

To evaluate effects of general osteoarthritis (OA) information in addition to a treatment option grid and general practitioner (GP) recommendation to exercise on treatment beliefs and intentions.An online randomized trial of 735 people 45 years old or older without OA who were recruited from a consumer survey network. Participants read a hypothetical scenario about visiting their GP for knee problems and were randomized to the following: i) 'general information', ii) 'option grid' (general information plus option grid), or iii) 'option grid plus recommendation' (general information plus option grid plus GP exercise recommendation). The primary outcome was an agreement that exercise is the best management option (0-10 numeric rating scale; higher scores indicating higher agreement that exercise is best). The secondary outcomes were beliefs about other management options and management intentions. Linear regression models estimated the mean (95% confidence interval [CI]) between-group difference in postintervention scores, adjusted for baseline.Option grid plus recommendation led to higher agreement that exercise is the best management by a mean of 0.4 units (95% CI: 0.1-0.6) compared with general information. There were no other between-group differences for the primary outcome. Option grid led to higher agreement that surgery was best, and x-rays were necessary, compared with general information (mean between-group differences: 0.7 [CI: 0.2-1.1] and 0.5 [CI: 0.1-1.0], respectively) and option grid plus recommendation (0.5 [CI: 0.1-0.9] and 0.9 [CI: 0.4-1.3]).Addition of an option grid and GP exercise recommendation to general OA information led to more favorable views that exercise was best for the hypothetical knee problem. However, differences were small and of unclear clinical importance.

Evaluate the cost-effectiveness of telehealth-delivered Exercise and Diet+Exercise programs within 12 months.An economic evaluation within a 12 month, three-arm, parallel randomised trial of two 6-month telehealth-delivered exercise programs, with and without a dietary component. 415 people with knee osteoarthritis aged 45-80 years and body mass index 28-40 kg/mThe clinical trial demonstrated greater improvements in pain and function compared to information only for individuals with knee osteoarthritis and overweight/obesity. We can be 88% confident that Diet+Exercise is cost effective ($45,500 per QALY), 53% confident that Exercise is cost-effective ($67,600 per QALY) compared to Control, and 86% confident that augmenting Exercise with the Diet program is cost effective ($21,100 per QALY).Telehealth-delivered programs targeting exercise with dietary intervention for people with knee OA who have overweight/obesity are likely to be cost-effective, particularly if potential long-term gains from weight loss and work productivity are realised.

What is the effect of therapeutic exercise or tailored physical activity programs supported by a mobile app (compared with exercise or physical activity programs delivered using other modes) for people with musculoskeletal pain conditions?Systematic review of published randomised controlled trials with meta-analysis.People of all ages with musculoskeletal pain conditions.Therapeutic exercise or tailored physical activity programs supported by a mobile app.Pain intensity, pain interference, self-reported physical function, physical performance, adherence, psychosocial outcomes, health-related quality of life, work participation, physical activity, goal attainment and satisfaction.Eleven studies were eligible for inclusion, with a total of 845 participants. There was low certainty evidence that using mobile apps to deliver exercise programs helps to reduce pain intensity to a worthwhile extent (SMD -0.60, 95% CI -0.93 to -0.27). There was low certainty evidence that using mobile apps to deliver exercise programs helps to improve self-reported physical function to a worthwhile extent (SMD -0.92, 95% CI -1.57 to -0.27). Although the effect of using mobile apps to deliver exercise programs on pain interference was also estimated to be a worthwhile benefit (SMD -0.66), this estimate came with marked uncertainty (95% CI -1.52 to 0.19) so the effect remains unclear. The remainder of the outcomes were unclear due to sparse evidence. The most common behaviour change intervention functions in the mobile app interventions were: training, enablement and environmental restructuring.Mobile apps supporting therapeutic exercise or tailored physical activity programs for musculoskeletal pain conditions may help in reducing pain intensity and improving physical function. The mobile apps utilised a limited range of behaviour change intervention functions.CRD42021248046.

Questions What are the experiences of physiotherapists delivering care for people with knee osteoarthritis? How do these experiences align with the national Clinical Care Standard? Design A qualitative study using individual interviews. Participants Twenty-two Australian physiotherapists (mean age 34 years, 50% female) with experience in providing care for people with knee osteoarthritis. Methods Physiotherapists participated in semi-structured individual telephone interviews. Questions were informed by seven quality statements from the national Knee Osteoarthritis Clinical Care Standard. Thematic analysis was undertaken, with themes/subthemes inductively derived. Interview data were also deductively analysed according to the Clinical Care Standard. Results Five themes emerged. First, physiotherapists focused on biomedical assessment with little psychosocial consideration. They managed ‘mechanical’ aspects of knee osteoarthritis, aiming to restore functional ability. Second, physiotherapists’ perceived their role as primarily providing goal-orientated personalised exercise via short-term episodic care. Knee surgery was considered a last option, but physiotherapists ‘prepped’ patients who decided on surgery. Third, clinical challenges included patient comorbidity, unsatisfactory patient adherence and a patient’s desire for a ‘quick fix’. The other two themes were: physiotherapists described a mismatch between what they know and what they do regarding imaging, weight management and manual therapy; and physiotherapists viewed weight loss, medication and surgical advice as outside of their professional role. Conclusion Physiotherapists’ reported experiences of delivering care for people with knee osteoarthritis were mostly consistent with the quality care standard. Care may be improved by increasing the focus on psychosocial aspects of care, offering longer-term reviews, and being more proactive with advice and/or referral regarding weight loss, pain medications and knee surgery. By describing the potential benefits and harms of common osteoarthritis medications and surgical interventions, physiotherapists will ensure that their patients are fully informed about all their treatment options.

BACKGROUND Osteoarthritis (OA) is a major problem globally. First-line management comprises education and self-management strategies. Online support groups may be a low-cost method of facilitating self-management. OBJECTIVE The aim of this randomized controlled pilot study is to evaluate the feasibility of the study design and implementation of an evidence-informed, expert-moderated, peer-to-peer online support group (My Knee Community) for people with knee OA. The impacts on psychological determinants of self-management, selected self-management behaviors, and health outcomes were secondary investigations. METHODS This mixed methods study evaluated study feasibility (participant recruitment, retention, and costs), experimental intervention feasibility (acceptability and fidelity to the proposed design, including perceived benefit, satisfaction, and member engagement), psychological determinants (eg, self-efficacy and social support), behavioral measures, health outcomes, and harms. Of a total of 186, 63 (33.9%) participants (41/63, 65% experimental and 22/63, 35% control) with self-reported knee OA were recruited from 186 volunteers. Experimental group participants were provided membership to My Knee Community, which already had existing nonstudy members, and were recommended a web-based education resource (My Joint Pain). The control group received the My Joint Pain website recommendation only. Participants were not blinded to their group allocation or the study interventions. Participant-reported data were collected remotely using web-based questionnaires. A total of 10 experimental group participants also participated in semistructured interviews. The transcribed interview data and all forum posts by the study participants were thematically analyzed. RESULTS Study feasibility was supported by acceptable levels of retention; however, there were low levels of engagement with the support group by participants: 15% (6/41) of participants did not log in at all; the median number of times visited was 4 times per participant; only 29% (12/41) of participants posted, and there were relatively low levels of activity overall on the forum. This affected the results for satisfaction (overall mean 5.9/10, SD 2.7) and perceived benefit (17/31, 55%: yes). There were no differences among groups for quantitative outcomes. The themes discussed in the interviews were connections and support, information and advice, and barriers and facilitators. Qualitative data suggest that there is potential for people to derive benefit from connecting with others with knee OA by receiving support and assisting with unmet informational needs. CONCLUSIONS Although a large-scale study is feasible, the intervention implementation was considered unsatisfactory because of low levels of activity and engagement by members. We recommend that expectations about the support group need to be made clear from the outset. Additionally, the platform design needs to be more engaging and rewarding, and membership should only be offered to people willing to share their personal stories and who are interested in learning from the experiences of others. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12619001230145; http://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377958

Physical therapists are key providers of conservative management for hip and/or knee osteoarthritis (OA), yet not all guideline recommendations are tailored to their scope of practice.To identify and prioritize the most important recommendations relevant to physical therapy practice for hip and/or knee OA.International physical therapists (n = 132) were invited to participate in an online modified Delphi survey, followed by a priority-ranking exercise. A total of 63 recommendations were extracted from 2 recent high-quality clinical guidelines. In 3 Delphi rounds, the panel identified those recommendations they considered to be most relevant to physical therapy practice for hip and knee OA. Any new recommendations were ascertained. For a recommendation to be included, at least 70% of respondents had to rate the recommendation as 7 or above on a numeric rating scale (0 is not important and 10 is extremely important). The panel prioritized recommendations that remained after the final round using decision-making software.Of 132 therapists from 14 countries, 62 completed round 1, 52 completed round 2, 45 completed round 3, and 35 completed the priority-ranking exercise. From an initial list of 70 potential recommendations (including 7 new recommendations), 30 were included in the priority-ranking exercise. The top recommendations were related to providing education and prescribing exercise and weight loss as core treatments, followed by individualized OA assessment and treatment and communication strategies.This study identified and ranked the most important recommendations relevant to physical therapy practice for hip and/or knee OA.

Objectives: The aim of the present study was to explore the attitudes of individuals with knee osteoarthritis (OA) towards the role of physiotherapists in weight management in knee OA. Methods: The study took the form of a qualitative semi-structured telephone interview study. Participants included 13 purposively sampled individuals with symptomatic knee OA who were overweight or obese by body mass index. Each participated in a semi-structured telephone interview exploring their perspectives regarding the potential role of physiotherapists in weight management in knee OA. Data were transcribed and analysed using a thematic approach. Results: Three main themes were identified, which highlighted that individuals with knee OA: (a) recognize that weight management is complex; (b) consider that a special skill set is required by clinicians for weight management; and (c) expressed ambivalence towards physiotherapists' role in weight management, with a focus on the role of exercise prescription. Conclusions: Although participants were open to physiotherapists taking on a weight management role within a multidisciplinary team, they were uncertain about whether physiotherapists had the skills and scope of practice needed to address this complex issue. The findings highlight the importance of engagement by physiotherapists in meaningful dialogue with patients, to understand better their experiences, expectations and preferences, and establish if, when and how to integrate patients in weight management discussions in the treatment plan for their knee OA.

ObjectivePhysiotherapists commonly provide non-surgical care for people with knee osteoarthritis (OA). It is unknown if patients are receiving high-quality physiotherapy care for their knee OA. This study aimed to explore the experiences of people who had recently received physiotherapy care for their knee OA in Australia and how these experiences aligned with the national Clinical Care Standard for knee OA.DesignQualitative study using semistructured individual telephone interviews and thematic analysis, where themes/subthemes were inductively derived. Questions were informed by seven quality statements of the OA of the Knee Clinical Care Standard. Interview data were also deductively analysed according to the Standard.SettingParticipants were recruited from around Australia via Facebook and our research volunteer database.ParticipantsInterviews were conducted with 24 people with recent experience receiving physiotherapy care for their knee OA. They were required to be aged 45 years or above, had activity-related knee pain and any knee-related morning stiffness lasted no longer than 30 min. Participants were excluded if they had self-reported inflammatory arthritis and/or had undergone knee replacement surgery for the affected knee.ResultsSix themes emerged: (1) presented with a pre-existing OA diagnosis (prior OA care from other health professionals; perception of adequate OA knowledge); (2) wide variation in access and provision of physiotherapy care (referral pathways; funding models; individual vs group sessions); (3) seeking physiotherapy care for pain and functional limitations (knee symptoms; functional problems); (4) physiotherapy management focused on function and exercise (assessment of function; various types of exercises prescribed; surgery, medications and injections are for doctors; adjunctive treatments); (5) professional and personalised care (trust and/or confidence; personalised care) and (6) physiotherapy to postpone or prepare for surgery.ConclusionPatients’ experiences with receiving physiotherapy care for their knee OA were partly aligned with the standard, particularly regarding comprehensive assessment, self-management, and exercise.

Objectives Conceptualisation of a clinically-relevant group of conditions as a region-based, load-related musculoskeletal pain condition (‘tibial loading pain’) to enable identification of evidence of treatment effect from load-modifying interventions. Design Systematic review and evidence synthesis based on a developed and justified theoretical position. Methods Musculoskeletal pain localised to the tibial (shin) region and consistent with clinical presentations of an exercise/activity-related onset mechanism, was conceptualised as a group of conditions (‘tibial loading pain’) that could be reasoned to respond to load modifying interventions. Five databases were searched for randomized controlled studies investigating any load-modifying intervention for pain in the anterior–anteromedial lower leg (shin). Study quality was evaluated (Risk of Bias Tool Version 2) and level of certainty for the findings assessed. Results Six studies reporting seven comparisons were included. Interventions included braces, anti-pronation taping, compression stocking and a stretch + strengthening programme. All included studies were assessed as having unclear or high risk of bias. The review found no evidence of beneficial effect from any of the load-modifying interventions on symptoms, physical performance or biomechanical measures, apart from a possible benefit of anti-pronation ‘kinesio’ taping. There was very low certainty evidence that kinesio taping improves pain and pain-free hopping distance after one week. The braces were associated with minor adverse effects and problems with acceptability. Conclusions None of the treatments investigated by the included studies can be recommended. Conceptualisation of the problem as regional, primarily loading-related pain rather than as multiple distinct pathoanatomically-based conditions, and clearer load-modifying hypotheses for interventions are recommended.

ObjectiveImplementation strategies, such as new models of service delivery, are needed to address evidence practice gaps. This paper describes the process of developing and operationalising a new model of service delivery to implement recommended care for people with knee osteoarthritis (OA) in a primary care setting.MethodsThree development stages occurred concurrently and iteratively. Each stage considered the healthcare context and was informed by stakeholder input. Stage 1 involved the design of a new model of service delivery (PARTNER). Stage 2 developed a behavioural change intervention targeting general practitioners (GPs) using the behavioural change wheel framework. In stage 3, the ‘Care Support Team’ component of the service delivery model was operationalised.ResultsThe focus of PARTNER is to provide patients with education, exercise and/or weight loss advice, and facilitate effective self-management through behavioural change support. Stage 1 model design: based on clinical practice guidelines, known evidence practice gaps in current care, chronic disease management frameworks, input from stakeholders and the opportunities and constraints afforded by the Australian primary care context, we developed the PARTNER service-delivery model. The key components are: (1) an effective GP consultation and (2) follow-up and ongoing care provided remotely (telephone/email/online resources) by a ‘Care Support Team’. Stage 2 GP behavioural change intervention: a multimodal behavioural change intervention was developed comprising a self-audit/feedback activity, online professional development and desktop software to provide decision support, patient information resources and a referral mechanism to the ‘Care Support Team’. Stage 3 operationalising the ‘care support team’—staff recruited and trained in evidence-based knee OA management and behavioural change methodology.ConclusionThe PARTNER model is the result of a comprehensive implementation strategy development process using evidence, behavioural change theory and intervention development guidelines. Technologies for scalable delivery were harnessed and new primary evidence was generated as part of the process.Trial registration number ACTRN12617001595303 (UTN U1111-1197-4809)

BackgroundThe aim of this study was to investigate differences in psychological characteristics between people with knee osteoarthritis (OA) from Japan and Australia.Methods A total of 62 adults from Japan and 168 adults from Australia aged over 50 years with knee pain were included. Japanese data were collected from patients with knee OA diagnosed by medical doctors. Australian data were baseline data from a randomized controlled trial. Psychological characteristics evaluated were depressive symptoms (depression subscale of the 21-item short-form of Depression Anxiety Stress Scale), fear of movement (Brief Fear of Movement Scale for Osteoarthritis), and pain catastrophizing (Pain Catastrophizing Scale). Psychological characteristics were compared between the Japanese and Australian cohorts by calculating 95% confidence intervals (CIs) for difference of the mean. To test for equivalence of the average values of characteristics, the equivalence margin was set at 0.5 standard deviations (SD) of the mean, where these SDs were based on the Australian data. When the 95%CI for the difference of the mean value lay entirely within the range of equivalence margin (i.e. between -0.5 and 0.5 times the Australian SD), the outcome was considered equivalent.ResultsThere were no significant differences between the groups from Japan and Australia for depressive symptoms (mean ± SD; Japan 4.9±5.4, Australia 4.2±4.7) and fear of movement (11.7±3.8, 12.5±3.2, respectively). Mean (95%CI) between group differences were 0.75 (-0.79 to 2.28) for depressive symptoms and -0.77 (-1.77 to 0.22) for fear of movement. Based on the equivalence test, 95%CIs of mean difference between groups for depressive symptoms was within the range of equivalence margin (±2.35). However, the lower limit of the 95% CI of difference in mean for fear of movement (-1.77) was just outside the lower equivalence margin (-1.60). People from Japan with knee OA showed significantly higher pain catastrophizing (20.7±11.0) than those from Australia (14.8±9.6).ConclusionsPeople from Japan with knee OA showed higher pain catastrophizing than people from Australia. The level of depressive symptoms and fear of movement appeared to be equivalent between people from the two countries.

Background: Independent ambulation is a common rehabilitation goal after stroke, requiring adequate balance and efficiency of gait. Spatiotemporal gait parameters are expected to improve in the first 3 months and their association with balance and efficiency of gait may provide useful insights into the recovery of safe and independent mobility. Objective: Examine the associations between changes in spatiotemporal gait parameters, balance, and walking capacity during the first 3 months after stroke. Methods: This prospective observational study included participants diagnosed with stroke. Within the first 2 weeks after stroke onset and again 3 months (±2 weeks) later, gait was assessed using a GAITRite mat at self-selected gait speed, balance using the Berg Balance Scale (BBS), and walking capacity using the 6-minute walk test (6 MWT). Changes in gait parameters, balance, and walking capacity were assessed using paired sample t-tests, and linear regression analyses were used to assess associations between changes in spatiotemporal gait parameters, BBS, and 6MWT. Results: Seventy-nine participants (mean (SD) age 75.4 (8.5) years; 44 men) were included. Gait parameters, balance, and walking capacity all improved during follow-up. The bivariate regression analyses showed associations between improvements in all gait parameters, except walk ratio, with improvement in balance, and in all gait parameters with improvement in walking capacity. Only gait speed was associated with balance (13.8 points, 95% CI 0.5, 27.8, p = .0042) and walking capacity (256 m, 95% CI 173,340, p < .001) in the multivariate analyses. Conclusion: Improved spatiotemporal gait parameters were associated with improved balance and walking capacity within the first 3 months after stroke.

Background Online support groups (OSGs) are one way for people with chronic diseases, their family or friends, and health professionals to communicate, gain information, and provide social support. As the number of peer-to-peer OSGs for chronic musculoskeletal conditions grows, it is important to gain insight into the different designs of groups available, who is accessing them, if and how they may be effective, and what strategies are being used to implement or increase consumer engagement. Objective The objectives of this systematic review of people with musculoskeletal conditions were to (1) describe the design features (functions, usage options, moderation, and expert input) of peer-to-peer OSGs, (2) describe the characteristics of the individuals using peer-to-peer OSGs, (3) synthesize the evidence on outcomes of participation, and (4) identify strategies used in the delivery and maintenance of OSGs. Methods A search comprising terms related to the population (people with musculoskeletal disorders) and the intervention (peer-to-peer OSGs) was conducted in 6 databases. Results were filtered from 1990 (internet inception) to February 2019. Studies identified in the search were screened according to predefined eligibility criteria using a 2-step process. Quantitative studies were appraised by 2 reviewers using the Risk Of Bias In Non-Randomized Studies of Interventions tool. Qualitative studies were appraised by 2 different reviewers using the Critical Appraisal Skills Programme checklist. Extracted data were synthesized narratively. Results We examined 21 studies with low to moderate risk of bias. Of these studies, 13 studies included OSGs hosted on public platforms, 11 studies examined OSGs that were conducted in English, and 6 studies used moderators or peer leaders to facilitate engagement. Studies either reported the number of OSG members (n=1985 across all studies) or the number of posts (range: 223-200,000). The majority of OSG members were females who were not full-time employees and with varied levels of education. There were no randomized controlled trials measuring the efficacy of OSGs. Qualitative and quantitative studies identified empowerment, social support, self-management behavior, and health literacy as primary constructs to measure OSG efficacy. Neutral or marginal improvement was reported in these constructs. Sharing experiences and a greater level of engagement appeared to have an important influence on OSGs efficacy. The extent to which members posted on the website influenced engagement. Conclusions Across a diverse range of designs, languages, included features, and delivery platforms, peer-to-peer OSGs for chronic musculoskeletal conditions attract predominantly female participants of all ages and education levels. The level of participation of a member appears to be related to their perceived benefit, health literacy, and empowerment. Future studies are needed to identify which design and maintenance strategies have superior efficacy and whether there are concomitant improvements in health outcomes for people with chronic musculoskeletal conditions resulting from participation in OSGs. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42018090326; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018090326

Background There is no physiotherapy-specific quality indicator tool available to evaluate physiotherapy care for people with hip and/or knee osteoarthritis (OA). This study aimed to develop a patient-reported quality indicator tool (QUIPA) for physiotherapy management of hip and knee OA and to assess its reliability and validity. Methods To develop the QUIPA tool, quality indicators were initially developed based on clinical guideline recommendations most relevant to physiotherapy practice and those of an existing generic OA quality indicator tool. Draft items were then further refined using patient focus groups. Test-retest reliability, construct validity (hypothesis testing) and criterion validity were then evaluated. Sixty-five people with hip and/or knee OA attended a single physiotherapy consultation and completed the QUIPA tool one, twelve- and thirteen-weeks after. Physiotherapists (n = 9) completed the tool post-consultation. Patient test-retest reliability was assessed between weeks twelve and thirteen. Construct validity was assessed with three predefined hypotheses and criterion validity was based on agreement between physiotherapists and participants at week one. Results A draft list of 23 clinical guideline recommendations most relevant to physiotherapy was developed. Following feedback from three patient focus groups, the final QUIPA tool contained 18 items (three subscales) expressed in lay language. The test-retest reliability estimates (Cohen’s Kappa) for single items ranged from 0.30–0.83 with observed agreement of 64–94%. The intraclass correlation coefficient (ICC) and 95% confidence interval (CI) for the Assessment and Management Planning subscale was 0.70 (0.54, 0.81), Core Recommended Treatments subscale was 0.84 (0.75, 0.90), Adjunctive Treatments subscale was 0.70 (0.39, 0.87) and for the total QUIPA score was 0.80 (0.69, 0.88). All predefined hypotheses regarding construct validity were confirmed. However, agreement between physiotherapists and participants for single items showed large measurement error (Cohen’s Kappa estimates ranged from − 0.04-0.59) with the ICC (95% CI) for the total score being 0.11 (− 0.14, 0.34). Conclusions The QUIPA tool showed acceptable test-retest reliability for subscales and total score but inadequate reliability for individual items. Construct validity was confirmed but criterion validity for individual items, subscales and the total score was inadequate. Further research is needed to refine the QUIPA tool to improve its clinimetric properties before implementation.

Additional file 4. Characteristics of participants in the validation study.

Additional file 3. Results of multiple regression analyses

Additional file 10. The Quality Indicators for Physiotherapy Management of Hip and Knee Osteoarthritis (QUIPA).

Additional file 1. Flow chart describing participant recruitment

Additional file 2. Scatter plots for number of steps per day and psychological characteristics

Additional file 3. Characteristics of participants in the focus groups.

Additional file 6. Construct validity analyses based on three predefined hypotheses.

Additional file 7. Pass rates for individual quality indicators reported by physiotherapists.

Additional file 9. Quality indicator example for statistical prevalence.