Background
People today are living longer and want to remain active. While obesity is becoming an epidemic, the number of patients suffering from osteoarthritis (OA) is expected to grow exponentially ...in the coming decades. Patients with OA of the knee are progressively being restricted in their activities. Since a knee arthroplasty (KA) is a well accepted, cost-effective intervention to relieve pain, restore function and improve health-related quality of life, indications are expanding to younger and more active patients. However, evidence concerning return to sports (RTS) and physical activity (PA) after KA is sparse.
Objectives
Our aim was to systematically summarise the available literature concerning the extent to which patients can RTS and be physically active after total (TKA) and unicondylar knee arthroplasty (UKA), as well as the time it takes.
Methods
PRISMA guidelines were followed and our study protocol was published online at PROSPERO under registration number CRD42014009370. Based on the keywords (and synonyms of) ‘arthroplasty’, ‘sports’ and ‘recovery of function’, the databases MEDLINE, Embase and SPORTDiscus up to January 5, 2015 were searched. Articles concerning TKA or UKA patients who recovered their sporting capacity, or intended to, were included and were rated by outcomes of our interest. Methodological quality was assessed using Quality in Prognosis Studies (QUIPS) and data extraction was performed using a standardised extraction form, both conducted by two independent investigators.
Results
Out of 1115 hits, 18 original studies were included. According to QUIPS, three studies had a low risk of bias. Overall RTS varied from 36 to 89 % after TKA and from 75 to >100 % after UKA. The meta-analysis revealed that participation in sports seems more likely after UKA than after TKA, with mean numbers of sports per patient postoperatively of 1.1–4.6 after UKA and 0.2–1.0 after TKA. PA level was higher after UKA than after TKA, but a trend towards lower-impact sports was shown after both TKA and UKA. Mean time to RTS after TKA and UKA was 13 and 12 weeks, respectively, concerning low-impact types of sports in more than 90 % of cases.
Conclusions
Low- and higher-impact sports after both TKA and UKA are possible, but it is clear that more patients RTS (including higher-impact types of sports) after UKA than after TKA. However, the overall quality of included studies was limited, mainly because confounding factors were inadequately taken into account in most studies.
In the upcoming decades, hospitals and clinics around the world face a steep rise in demand from patients seeking knee replacement surgery. An absolute increase in knee replacement surgery of 297%-to ...57,893 procedures-is forecasted in The Netherlands between 2005 and 2030. The situation is similar in many countries: Sweden, 163% to 21,700 (2013-2030); Italy, 45% to about 100,000 (2017-2050), the UK, 916% to about 1.2 million (2015-2035); Australia, 276% to 65,569 (2013-2030); and the USA, 673% to 3.48 million (2005-2030). No projections are available for Asia, however, similar growth percentages have already been seen in Japan of 373% (2007-2014) and Korea (407%, 2001-2010). Here, Kuijer and Burdorf discuss how work might play a significant role in reducing the steep rise in replacement surgery for knee osteoarthritis across the world.
Purpose Indications for total and unicondylar knee arthroplasty (KA) have expanded to younger patients, in which Patient-Reported Outcome Measures (PROMs) often show ceiling effects. This might be ...due to higher expectations. Our aims were to explore expectations of younger patients concerning activities in daily life, work and leisure time after KA and to assess to what extent PROMs meet and evaluate these activities of importance. Methods Focus groups were performed among osteoarthritis (OA) patients <65 years awaiting KA, in which they indicated what activities they expected to perform better in daily life, work and leisure time after KA. Additionally, 28 activities of daily life, 17 of work and 27 of leisure time were depicted from seven PROMS, which were rated on importance, frequency and bother. A total score, representing motivation for surgery, was also calculated. Results Data saturation was reached after six focus groups including 37 patients. Younger OA patients expect to perform better on 16 activities after KA, including highimpact leisure time activities. From the PROMs, daily life and work activities were rated high in both importance and motivation for surgery, but for leisure time activities importance varied highly between patients. All seven PROMs score activities of importance, but no single PROM incorporates all activities rated important. Conclusion Younger patients expect to perform better on many activities of daily life, work and leisure time after KA, and often at demanding levels. To measure outcomes of younger patients, we suggest using PROMs that include work and leisure time activities besides daily life activities, in which preferably scored activities can be individualized.
This study aimed to quantify the absenteeism costs of knee and hip osteoarthritis in the Netherlands for the Dutch workforce and specific groups of workers.
We used a longitudinal, dynamic database ...from a large occupational health service in which occupational physicians register information about personal information and sick leave of workers with the diagnosis of knee- and/or hip osteoarthritis. We included all employees aged 15 to 75 years performing paid work and diagnosed with knee and/or hip osteoarthritis. Costs were calculated annually and per episode for different subgroups from an employer's perspective using the Human Capital Approach. In the Netherlands, the employer has to pay 70% of the employee's wage out of pocket for the first two years of sick leave and also for the occupational health care. In this way, employers receive information about the costs of workers on sick leave due to knee or hip osteoarthritis. This might stimulate investments in targeted prevention and work-directed care.
For the period 2015-2017, 1399 workers fulfilled the inclusion criteria. An average sick leave episode of knee osteoarthritis had a duration of 186 calendar days and was associated with €15,550 in costs. For hip osteoarthritis these data were 159 calendar days and €12,482 in costs. These costs are particularly high among male workers and workers with a higher number of weekly working hours. The average annual costs for the Dutch workforce due to sick leave for knee and hip osteoarthritis were €26.9 million and €13.8 million, respectively. Sick leave costs decreased for hip and not for knee osteoarthritis during 2015-2017.
Annual sick leave costs due to knee and hip osteoarthritis are about €40 million for the Dutch workforce and approximately twice as high for knee compared to hip osteoarthritis. Average costs per sick leave episode are particularly high among male workers and workers with a higher number of weekly working hours.
Clinicians need to know whether lumbosacral radiculopathy syndrome (LRS) can be attributed to work. This review describes what work-related risk factors are associated with LRS.
A systematic review ...was performed in PubMed and Embase. Inclusion criteria were that LRS was diagnosed by a clinician and workers exposed to work-related risk factors were compared to workers less or not exposed. A quality assessment and a meta-analysis were performed, including a dose-response analysis.
The search resulted in 7,350 references and 24 studies that fulfilled the inclusion criteria: 19 studies were rated as having a high risk of bias and 5 as having a low risk of bias. The median number of LRS patients per study were 209 (interquartile range 124-504) and the total number of participants was 10,142. The meta-analysis revealed significant associations with heavy physically demanding work (odds ratio OR 2.03, 95% confidence interval CI 1.48-2.79), bending or twisting of the trunk (OR 2.43, 95% CI 1.67-3.55), and lifting and carrying in combination with bending or twisting of the trunk (OR 2.84, 95% CI 2.18-3.69). No significant associations were found for professional driving (OR 1.46, 95% CI 0.90-2.35) or sitting (OR 1.08, 95% CI 0.49-2.38). A dose-response relation was present per 5 years of exposure for bending (OR 1.12, 95% CI 1.04-1.20), lifting (OR 1.08, 95% CI 1.02-1.14) and the combination of bending and lifting (OR 1.14, 95% CI 1.01-1.29).
Moderate to high-quality evidence is available that LRS can be classified as a work-related disease depending on the level of exposure to bending of the trunk or lifting and carrying. Professional driving and sitting were not significantly associated with LRS.
The objective of this systematic review and meta-analysis is to examine which work-related risk factors are associated with specific soft tissue shoulder disorders. We searched the electronic ...databases of Medline and Embase for articles published between 2009 and 24 March 2016 and included the references of a systematic review performed for the period before 2009. Primary cross-sectional and longitudinal studies were included when outcome data were described in terms of clinically assessed soft tissue shoulder disorders and at least two levels of work-related exposure were mentioned (exposed vs less or non-exposed). Two authors independently selected studies, extracted data and assessed study quality. For longitudinal studies, we performed meta-analyses and used GRADE (Grades of Recommendations, Assessment, Development and Evaluation) to assess the evidence for the associations between risk factors and the onset of shoulder disorders. Twenty-seven studies met the inclusion criteria. In total, 16 300 patients with specific soft tissue shoulder disorders from a population of 2 413 722 workers from Denmark, Finland, France, Germany and Poland were included in the meta-analysis of one case–control and six prospective cohort studies. This meta-analysis revealed moderate evidence for associations between shoulder disorders and arm-hand elevation (OR=1.9, 95% CI 1.47 to 2.47) and shoulder load (OR=2.0, 95% CI 1.90 to 2.10) and low to very low evidence for hand force exertion (OR=1.5, 95% CI 1.25 to 1.87), hand-arm vibration (OR=1.3, 95% CI 1.01 to 1.77), psychosocial job demands (OR=1.1, 95% CI 1.01 to 1.25) and working together with temporary workers (OR=2.2, 95% CI 1.2 to 4.2). Low-quality evidence for no associations was found for arm repetition, social support, decision latitude, job control and job security. Moderate evidence was found that arm-hand elevation and shoulder load double the risk of specific shoulder disorders. Low to very-low-quality evidence was found for an association between hand force exertion, hand-arm vibration, psychosocial job demands and working together with temporary workers and the incidence of specific shoulder disorders.
Knee arthroplasty (KA) is increasingly performed in relatively young, active patients. This heterogeneous patient population often has high expectations, including work resumption and performance of ...knee-demanding leisure-time activities. Goal attainment scaling (GAS) may personalize rehabilitation by using patient-specific, activity-oriented rehabilitation goals. Since unmet expectations are a leading cause of dissatisfaction after KA, personalized rehabilitation may improve patient satisfaction. We hypothesized that, compared with standard rehabilitation, GAS-based rehabilitation would result in younger, active patients having higher satisfaction regarding activities after KA.
We performed a single-center randomized controlled trial. Eligible patients were <65 years of age, working outside the home, and scheduled to undergo unicompartmental or total KA. The required sample size was 120 patients. Using GAS, patients developed personal activity goals with a physiotherapist preoperatively. These goals were used to monitor patients' goal attainment and provide goal-specific feedback during postoperative outpatient rehabilitation. Standard rehabilitation consisted of regular outpatient physiotherapy visits. The primary outcome measures were visual analogue scale (VAS) scores (scale of 0 to 100) for satisfaction regarding activities of daily living and work and leisure-time activities 1 year postoperatively, which were analyzed using generalized estimating equation models.
Patient satisfaction with work activities was significantly higher in the GAS group (β = 10.7 points, 98% confidence interval CI = 2.0 to 19.4 points) than in the control group. Patient satisfaction with activities of daily living and leisure-time activities did not differ between groups. We found no differences in VAS satisfaction scores between unicompartmental KA and total KA.
Personalized, goal-specific rehabilitation using GAS resulted in higher patient satisfaction with work activities, compared with standard rehabilitation, 1 year after KA.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Sand-cement-bound screed floor layers are at risk of work-related lower back pain, lumbosacral radicular syndrome and knee osteoarthritis, given their working technique of levelling screed with their ...trunk bent while mainly supported by their hands and knees. To reduce the physical demands of bending of the trunk and kneeling, a manually movable screed-levelling machine was developed for floor layers in the Netherlands. The aim of this paper is to estimate the potential health gains of working with a manually movable screed-levelling machine on the risk of lower back pain (LBP), lumbosacral radicular syndrome (LRS) and knee osteoarthritis (KOA) compared to traditional working techniques. This potential health gain was assessed using the epidemiological population estimates of the Population Attributable Fraction (PAF) and the Potential Impact Fraction (PIF), combined with work-related risk estimates for these three disorders from systematic reviews. The percentage of workers exceeding these risk estimates was based on worksite observations among 28 floor layers. For LBP, 16/18 workers were at risk when using traditional working techniques, with a PAF = 38%, and for those using a manually movable screed-levelling machine, this was 6/10 with a PIF = 13%. For LRS, these data were 16/18 with a PAF = 55% and 14/18 with a PIF = 18%, and for KOA, 8/10 with a PAF = 35% and 2/10 with a PIF = 26%. A manually movable screed-levelling machine might have a significant impact on the prevention of LBP, LRS and KOA among floor layers in the Netherlands, and health-impact assessments are a feasible approach for assessing health gains in an efficient way.
In a previous scoping review, eight categories of interventions in individual work practice were defined. The aim of the present study is to evaluate the relevance and completeness of these eight ...categories and to increase the clarity of the nomenclature and definitions of each category. An international expert consultation has been carried out for this purpose. Thirty-eight experts from 13 countries participated. Data collection was conducted using a survey design comprising structured questions. Consensus was reached if 75% of the experts answered ‘Strongly agree’ or ‘Agree’ on a 5-point Likert scale. For the topic ‘Relevance’, there was consensus for six of the eight categories (range 78%–86%), the exceptions were the categories: ‘Exercising’ (72%) and ‘Professional manners' (64%). With regard to the topic ‘Nomenclature’, consensus was reached for six categories and for the topic ‘Definition’ this was five categories. The present definitions have been improved based on the expert recommendations. With respect to the topic ‘Completeness’: although a limited number of suggestions were given, this did not lead to one or more categories being added to the existing eight categories. The final ‘Nomenclature’ for the categories is: ‘Variation’, ‘Professional behaviour’, ‘Motoric skills’, ‘Vocational working techniques’, ‘Physical workplace’, ‘Physical training’, ‘Assistive devices and tools’ and ‘Task content and task organisation’. This expert consultation has provided a solid basis for endorsing the categorisation of interventions in IWP and is an important step in building a framework to develop and evaluate interventions in IWP.
Objectives
To investigate arterial spin-labelling (ASL) cerebral blood flow (CBF) changes in predementia stages of Alzheimer’s disease (AD).
Methods
Data were obtained from 177 patients with ...subjective complaints, mild cognitive impairment and AD from the Amsterdam Dementia Cohort. AD stages were based on diagnosis and cerebrospinal fluid biomarkers amyloid-β (Aβ) and total-tau (tau). General-linear-models were used to assess relationships between AD stages and total and regional CBF, correcting for age and sex.
Results
Decreasing CBF was related to more advanced AD stages in all supratentorial regions (p for trend < 0.05). Post-hoc testing revealed that CBF was lower in AD compared to controls and stage-1 predementia patients (i.e. abnormal Aβ and normal tau) in temporal and parietal regions, and compared to stage-2 predementia patients (i.e. abnormal Aβ and tau) in temporal regions. CBF values of stage-2 predementia patients were numerically in between those of stage-1 predementia patients and AD.
Conclusion
The continuing decrease of CBF along the continuum of AD indicates the potential of ASL-CBF as a measure for disease progression.
Key Points
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Decreasing CBF relates to more advanced AD stages in all supratentorial regions
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The reduction of CBF does not reach a bottom level
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ASL-CBF has potential as a measure for disease progression in AD
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