Abstract
Background
The purpose of this study was to examine whether select baseline characteristics influenced the likelihood of an overweight/obese, older adult experiencing a clinically meaningful ...gait speed response (±0.05 m/s) to caloric restriction (CR).
Methods
Individual level data from 1 188 older adults participating in 8, 5/6-month, weight loss interventions were pooled, with treatment arms collapsed into CR (n = 667) or no CR (NoCR; n = 521) categories. Exercise assignment was equally distributed across groups (CR: 65.3% vs NoCR: 65.4%) and did not interact with CR (p = .88). Poisson risk ratios (95% confidence interval CI) were used to examine whether CR assignment interacted with select baseline characteristic subgroups: age (≥65 years), sex (female/male), race (Black/White), body mass index (BMI; ≥35 kg/m2), comorbidity (diabetes, hypertension, cardiovascular disease) status (yes/no), gait speed (<1.0 m/s), or inflammatory burden (C-reactive protein ≥3 mg/L, interleukin-6 ≥2.5 pg/mL) to influence achievement of ±0.05 m/s fast-paced gait speed change. Main effects were also examined.
Results
The study sample (69.5% female, 80.1% White) was 67.6 ± 5.3 years old with a BMI of 33.8 ± 4.4 kg/m2. Average weight loss achieved in the CR versus NoCR group was −8.3 ± 5.9% versus −1.1 ± 3.8%; p < .01. No main effect of CR was observed on the likelihood of achieving a clinically meaningful gait speed improvement (risk ratio RR: 1.09 95% CI: 0.93, 1.27) or gait speed decrement (RR: 0.77 95% CI: 0.57, 1.04). Interaction effects were nonsignificant across all subgroups.
Conclusion
The proportion of individuals experiencing a clinically meaningful gait speed change was similar for CR and NoCR conditions. This finding is consistent across several baseline subgroupings.
The Intensive Diet and Exercise for Arthritis (IDEA) trial was an 18-month randomized controlled trial that enrolled 454 overweight and obese older adults with symptomatic and radiographic knee ...osteoarthritis (OA). Participants were randomized to either exercise (E), intensive diet-induced weight loss (D), or intensive diet-induced weight loss plus exercise (D + E) interventions. We previously reported that the clinical benefits of D + E were significantly greater than with either intervention alone (e.g., greater pain reduction, and better function, mobility, and health-related quality of life). We now test the hypothesis that D + E has greater overall benefit on gait mechanics compared to either intervention alone. Knee joint loading was analyzed using inverse dynamics and musculoskeletal modeling. Analysis of covariance determined the interventions’ effects on gait. The D + E group walked significantly faster at 18-month follow-up (1.35 m s−1) than E (1.29 m s−1, p = 0.0004) and D (1.31 m s−1, p = 0.0007). Tibiofemoral compressive impulse was significantly lower (p = 0.0007) in D (1069 N s) and D + E (1054 N s) compared to E (1130 N s). D had significantly lower peak hip external rotation moment (p = 0.01), hip abduction moment (p = 0.0003), and peak hip power production (p = 0.016) compared with E. Peak ankle plantar flexion moment was significantly less (p < 0.0001) in the two diet groups compared with E. There also was a significant dose-response to weight loss; participants that lost >10% of baseline body weight had significantly (p = 0.0001) lower resultant knee forces and lower muscle (quadriceps, hamstring, and gastrocnemius) forces than participants that had less weight loss. Compared to E, D produces significant load reductions at the hip, knee, and ankle; combining D with E attenuates these reductions, but most remain significantly better than with E alone.
Objective
Class III obesity (body mass index >40 kg/m2) is associated with higher complications following total knee replacement (TKR), and weight loss is recommended. We aimed to establish the ...cost‐effectiveness of Roux‐en‐Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), and lifestyle nonsurgical weight loss (LNSWL) interventions in knee osteoarthritis patients with class III obesity considering TKR.
Methods
Using the Osteoarthritis Policy model and data from published literature to derive model inputs for RYGB, LSG, LNSWL, and TKR, we assessed the long‐term clinical benefits, costs, and cost‐effectiveness of weight‐loss interventions for patients with class III obesity considering TKR. We assessed the following strategies with a health care sector perspective: 1) no weight loss/no TKR, 2) immediate TKR, 3) LNSWL, 4) LSG, and 5) RYGB. Each weight‐loss strategy was followed by annual TKR reevaluation. Primary outcomes were cost, quality‐adjusted life expectancy (QALE), and incremental cost‐effectiveness ratios (ICERs), discounted at 3% per year. We conducted deterministic and probabilistic sensitivity analyses to examine the robustness of conclusions to input uncertainty.
Results
LSG increased QALE by 1.64 quality‐adjusted life‐years (QALYs) and lifetime medical costs by $17,347 compared to no intervention, leading to an ICER of $10,600/QALY. RYGB increased QALE by 0.22 and costs by $4,607 beyond LSG, resulting in an ICER of $20,500/QALY. Relative to immediate TKR, LSG and RYGB delayed and decreased TKR utilization. In the probabilistic sensitivity analysis, RYGB was cost‐effective in 67% of iterations at a willingness‐to‐pay threshold of $50,000/QALY.
Conclusion
For patients with class III obesity considering TKR, RYGB provides good value while immediate TKR without weight loss is not economically efficient.
Hip osteoarthritis (OA) is a leading cause of musculoskeletal pain. Exercise is a core recommended treatment. Despite some clinical guidelines also recommending weight loss for hip OA, there is no ...evidence from randomised controlled trials (RCT) to substantiate these recommendations. This superiority, 2-group, parallel RCT will compare a combined diet and exercise program to an exercise only program, over 6 months.
One hundred people with symptomatic and radiographic hip OA will be recruited from the community. Following baseline assessment, participants will be randomly allocated to either, i) diet and exercise or; ii) exercise only. Participants in the diet and exercise group will have six consultations with a dietitian and five consultations with a physiotherapist via videoconferencing over 6 months. The exercise only group will have five consultations with a physiotherapist via videoconferencing over 6 months. The exercise program for both groups will include prescription of strengthening exercise and a physical activity plan, advice about OA management and additional educational resources. The diet intervention includes prescription of a ketogenic very low-calorie diet with meal replacements and educational resources to support weight loss and healthy eating. Primary outcome is self-reported hip pain via an 11-point numeric rating scale (0 = 'no pain' and 10 = 'worst pain possible') at 6 months. Secondary outcomes include self-reported body weight (at 0, 6 and 12 months) and body mass index (at 0, 6 and 12 months), visceral fat (measured using dual energy x-ray absorptiometry at 0 and 6 months), pain, physical function, quality of life (all measured using subscales of the Hip Osteoarthritis Outcome Scale at 0, 6 and 12 months), and change in pain and physical activity (measured using 7-point global rating of change Likert scale at 6 and 12 months). Additional measures include adherence, adverse events and cost-effectiveness.
This study will determine whether a diet intervention in addition to exercise provides greater hip pain-relief, compared to exercise alone. Findings will assist clinicians in providing evidence-based advice regarding the effect of a dietary intervention on hip OA pain.
ClinicalTrials.gov . Identifier: NCT04825483 . Registered 31st March 2021.
Objective
Class III obesity (body mass index BMI ≥40 kg/m2) is associated with worse knee pain and total knee replacement (TKR) outcomes. Because bariatric surgery yields sustainable weight loss for ...individuals with BMI ≥40 kg/m2, our objective was to establish the value of Roux‐en‐Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) in conjunction with usual care for knee osteoarthritis (OA) patients with BMI ≥40 kg/m2.
Methods
We used the Osteoarthritis Policy model to assess long‐term clinical benefits, costs, and cost‐effectiveness of RYGB and LSG. We derived model inputs for efficacy, costs, and complications associated with these treatments from published data. Primary outcomes included quality‐adjusted life‐years (QALYs), lifetime costs, and incremental cost‐effectiveness ratios (ICERs), all discounted at 3%/year. This analysis was conducted from a health care sector perspective. We performed sensitivity analyses to evaluate uncertainty in input parameters.
Results
The usual care + RYGB strategy increased the quality‐adjusted life expectancy by 1.35 years and lifetime costs by $7,209, compared to usual care alone (ICER = $5,300/QALY). The usual care + LSG strategy yielded less benefit than usual care + RYGB and was dominated. Relative to usual care alone, both usual care + RYGB and usual care + LSG reduced opioid use from 13% to 4%, and increased TKR usage from 30% to 50% and 41%, respectively. For cohorts with BMI between 38 and 41 kg/m2, usual care + LSG dominated usual care + RYGB. In the probabilistic sensitivity analysis, at a willingness‐to‐pay threshold of $50,000/QALY, usual care + RYGB and usual care + LSG were cost‐effective in 70% and 30% of iterations, respectively.
Conclusion
RYGB offers good value among knee OA patients with BMI ≥40 kg/m2, while LSG may provide good value among those with BMI between 35 and 41 kg/m2.
Introduction:
Ankle sprains are among the most common injuries in dancers. Following one or more severe sprains, some individuals will experience residual mechanical and functional deficits, ...otherwise known as chronic ankle instability (CAI). Dancers who suffer from CAI may have weaker musculature surrounding the ankle and altered landing mechanics. The purpose of this study was to compare ankle strength and saut de chat landing mechanics between dancers with and without CAI.
Methods:
Dancers with and without CAI, defined by the Identification of Functional Ankle Instability (IdFAI), participated in the study (CAI n = 8; IdFAI = 18.75 ± 5.50 points; age = 20 ± 1.5 years; training = 15.5 ± 3.5 years) (Control n = 8; IdFAI = 7.13 ± 3.40 points; age = 19 ± 0.6 years; training = 15.9 ± 2.5 years). Strength and leap landing mechanics were measured on the affected ankle for the CAI group and on the preferred landing leg of a leap for the control group. Concentric and eccentric ankle plantar flexion, and subtalar inversion and eversion strength were determined with dynamometry set at an angular velocity of 60°•s−1. Force plates and motion capture cameras were used to calculate lower extremity kinematic and kinetic data as participants performed 3 saut de chat leaps. Independent t-tests were calculated to determine differences between groups.
Results:
Compared to dancers without CAI, dancers with CAI had lower eccentric plantar flexor strength, landed with higher vertical ground reaction forces, and absorbed greater power at the knee-joint during landing.
Conclusion:
Whether dancers who are weaker are more prone to injury or ankle-joint injury leads to muscular weakness is unknown. Dancers with CAI appear to lack control during leap landing while concomitantly shifting loads proximally away from the ankle-joint. We encourage dancers with and without CAI to engage in additional training that enhances ankle strength.
Objective
The Intensive Diet and Exercise for Arthritis (IDEA) trial showed that an intensive diet and exercise (D+E) program led to a mean 10.6‐kg weight reduction and 51% pain reduction in patients ...with knee osteoarthritis (OA). The aim of the current study was to investigate the cost‐effectiveness of adding this D+E program to treatment in overweight and obese (body mass index >27 kg/m2) patients with knee OA.
Methods
We used the Osteoarthritis Policy Model to estimate quality‐adjusted life‐years (QALYs) and lifetime costs for overweight and obese patients with knee OA, with and without the D+E program. We evaluated cost‐effectiveness with the incremental cost‐effectiveness ratio (ICER), a ratio of the differences in lifetime cost and QALYs between treatment strategies. We considered 3 cost‐effectiveness thresholds: $50,000/QALY, $100,000/QALY, and $200,000/QALY. Analyses were conducted from health care sector and societal perspectives and used a lifetime horizon. Costs and QALYs were discounted at 3% per year. D+E characteristics were derived from the IDEA trial. Deterministic and probabilistic sensitivity analyses (PSAs) were used to evaluate parameter uncertainty and the effect of extending the duration of the D+E program.
Results
In the base case, D+E led to 0.054 QALYs gained per person and cost $1,845 from the health care sector perspective and $1,624 from the societal perspective. This resulted in ICERs of $34,100/QALY and $30,000/QALY. In the health care sector perspective PSA, D+E had 58% and 100% likelihoods of being cost‐effective with thresholds of $50,000/QALY and $100,000/QALY, respectively.
Conclusion
Adding D+E to usual care for overweight and obese patients with knee OA is cost‐effective and should be implemented in clinical practice.
Objective
The purpose of this study was to determine whether clinical, health‐related quality of life (HRQL), and gait characteristics in adults with knee osteoarthritis (OA) differed by obesity ...category.
Methods
This cross‐sectional analysis of 823 older adults (mean age 64.6 years, SD 7.8 years) with knee OA and overweight or obesity compared clinical, HRQL, and gait outcomes among obesity classifications (overweight or class I, body mass index BMI 27.0–34.9; class II, BMI 35.0–39.9; class III BMI ≥40.0).
Results
Patients with class III obesity had worse Western Ontario McMasters Universities Arthritis Index knee pain (0–20) than the overweight or class I (mean 8.6 vs 7.0; difference 1.5; 95% confidence interval CI 1.0–2.1; P < 0.0001) and class II (mean 8.6 vs 7.4; difference 1.1; 95% CI 0.6–1.7; P = 0.0002) obesity groups. The Short Form 36 physical HRQL measure was lower in the class III obesity group compared to the overweight or class I (mean 31.0 vs 37.3; difference −6.2; 95% CI −7.8 to −4.7; P < 0.0001) and class II (mean 31.0 vs 35.0; difference −3.9; 95% CI −5.6 to −2.2; P < 0.0001) obesity groups. The class III obesity group had a base of support (cm) during gait that was wider than that for the overweight or class I (mean 14.0 vs 11.6; difference 3.3; 95% CI 2.6–4.0; P < 0.0001) and class II (mean 14.0 vs 11.6; difference 2.4; 95% CI 1.6–3.2; P < 0.0001) obesity groups.
Conclusion
Among adults with knee OA, those with class III obesity had significantly higher pain levels and worse physical HRQL and gait characteristics compared to adults with overweight or class I or class II obesity.
Objective
To determine whether long‐term diet (D) and exercise (E) interventions, alone or in combination (D+E), have beneficial effects for older adults with knee osteoarthritis (OA) 3.5 years after ...the interventions end.
Methods
This is a secondary analysis of a subset (n = 94) of the first 184 participants who had successfully completed the Intensive Diet and Exercise in Arthritis (IDEA) trial (n = 399) and who consented to follow‐up testing. Participants were older (age ≥55 years), overweight, and obese adults with radiographic and symptomatic knee OA in at least 1 knee who completed 1.5‐year D+E (n = 27), D (n = 35), or E (n = 32) interventions and returned for 5‐year follow‐up testing an average of 3.5 years later.
Results
During the 3.5‐years following the interventions, weight regain in D+E and D was 5.9 kg (7%) and 3.1 kg (4%), respectively, with a 1‐kg (1%) weight loss in E. Compared to baseline, weight (D+E –3.7 kg P = 0.0007, D –5.8 kg P < 0.0001, E –2.9 kg P = 0.003) and Western Ontario and McMaster Universities Osteoarthritis Index pain subscale scores (D+E –1.2 P = 0.03, D –1.5 P = 0.001, E –1.6 P = 0.0008) were lower in each group at the 5‐year follow‐up. The effect of group assignment at the 5‐year follow‐up was significant for body weight, with D being less than E (–3.5 kg; P = 0.04).
Conclusion
Older adults with knee OA who completed 1.5‐year D or D+E interventions experienced partial weight regain 3.5 years later; yet, relative to baseline, they preserved statistically significant changes in weight loss and reductions in knee pain.
Objective
One‐half of the 14 million persons in the US with knee osteoarthritis (OA) are not physically active, despite evidence that physical activity (PA) is associated with improved health. We ...undertook this study to estimate both the quality‐adjusted life‐year (QALY) losses in a US population with knee OA due to physical inactivity and the health benefits associated with higher PA levels.
Methods
We used data from the Osteoarthritis Initiative and the Centers for Disease Control and Prevention to estimate the proportions of a US population with knee OA ages ≥45 years that are inactive, insufficiently active, and active, and the likelihood of a shift in their PA level. We used the OA Policy Model, a computer simulation of knee OA, to determine QALYs lost due to inactivity and to measure potential benefits of increased PA (comorbidities averted and QALYs saved).
Results
Among 13.7 million persons with knee OA, a total of 7.5 million QALYs, or 0.55 QALYs per person, were lost due to inactivity or insufficient PA relative to activity over their remaining lifetimes. Black Hispanic women experienced the highest losses, at 0.76 QALYs per person. Women of all races/ethnicities had ~20% higher loss burdens than men. According to our model, if 20% of the inactive population were instead active, 95,920 cases of cancer, 222,413 of cardiovascular disease, and 214,725 of diabetes mellitus would potentially be averted, and 871,541 potential QALYs would be saved.
Conclusion
Physical inactivity leads to substantial QALY losses in a US population with knee OA. Increases in the activity levels in even a fraction of this population may have considerable collateral health benefits, potentially averting cases of cancer, cardiovascular disease, and diabetes mellitus.
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