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Which patientswith osteoarthritis of hip and/or knee benefit most from behavioral graded activity?

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Abstract

Our objective was to investigate whether behavioral graded activity (BGA) has particular benefit in specific subgroups of osteoarthritis (OA) patients. Two hundred participants with OA of hip or knee, or both (clinical American College of Rheumatology, ACR, criteria) participated in a randomized clinical trial on the efficacy of BGA compared to treatment according to the Dutch physiotherapy guideline (usual care; UC). Changes in pain (Visual Analog Scale, VAS), physical functioning (Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC, and McMaster Toronto Arthritis Questionnaire, MACTAR), and patient global assessment were compared for specific subgroups. Subgroups were assigned by the median split method and were analyzed using analysis of covariance. Beneficial effects of BGA were found for patients with a relatively low level of physical functioning (p?0.03). Furthermore, beneficial effects of BGA in patients with a low level of internal locus of control were marginally significant (p =.05). Patients with a relatively low level of physical functioning benefit more from BGA compared to UC. Compared to UC, BGA is the preferred treatment option in patients with a low level of physical functioning.

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References

  • Altman, R., Alarcon, G., Appelrouth, D., Bloch, D., Borenstein, D., Brandt, K., et al. (1991). The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip.Arthritis and Rheumatism, 34(5), 505–514.

    Article  PubMed  Google Scholar 

  • Altman, R., Asch, E., Bloch, D., Bole, G., Borenstein, D., Brandt, K., et al. (1986). Development of criteria for the classification and reporting of osteoarthritis: Classification of osteoarthritis of the knee.Arthritis and Rheumatism, 29(8), 1039–1049.

    Article  PubMed  Google Scholar 

  • Bellamy, N., Buchanan, W. W., Goldsmith, C. H., Campbell, J., & Stitt, L. W. (1988). Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee.Journal of Rheumatology, 15(12), 1833–1840.

    PubMed  Google Scholar 

  • Bellamy, N., Kirwan, J., Boers, M., Brooks, P., Strand, V., Tugwell, P., et al. (1997). Recommendations for a core set of outcome measures for future phase III clinical trials in knee, hip, and hand osteoarthritis: Consensus development at OMERACT III.Journal of Rheumatology, 24(4), 799–802.

    PubMed  Google Scholar 

  • Dekker, J., Boot, B., van der Woude, L. H., & Bijlsma, J. W. (1992). Pain and disability in osteoarthritis: A review of biobehavioral mechanisms.Journal of Behavioral Medicine, 15(2), 189–214.

    Article  PubMed  Google Scholar 

  • Fransen, M., McConnel, S., & Bell, M. (2002). Therapeutic exercise for people with osteoarthritis of the hip or knee: A systematic review.Journal of Rheumatology, 29, 1737–1745.

    PubMed  Google Scholar 

  • Keefe, F. J., Smith, S. J., Buffington, A. L., Gibson, J., Studts, J. L., & Caldwell, D. S. (2002). Recent advances and future directions in the biopsychosocial assessment and treatment of arthritis.Journal of Consulting and Clinical Psychology, 70(3), 640–655.

    Article  PubMed  Google Scholar 

  • Kraaimaat, F. W., Bakker, A., & Evers, A. (1997). Pain coping strategies in chronic pain patients: The development of the Pain Coping Inventory(PCI).Gedragstherapie, 30, 185–201.

    Google Scholar 

  • Linton, S. J., Hellsing, A. L., & Andersson, D. (1993). A controlled study of the effects of an early intervention on acute musculoskeletal pain problems.Pain, 54, 353–359.

    Article  PubMed  Google Scholar 

  • Petersen, L., Schnohr, P., & Sorensen, T. I. (2004). Longitudinal study of the long-term relation between physical activity and obesity in adults.International Journal of Obesity and Related Metabolic Disorders, 28(1), 105–112.

    Article  PubMed  Google Scholar 

  • Roorda, L. D., Jones, C. A., Waltz, M., Lankhorst, G. J., Bouter, L. M., van der Eijken, J. W. et al. (2004). Satisfactory cross cultural equivalence of the Dutch WOMAC in patients with hip osteoarthritis waiting for arthroplasty.Annals of Rheumatic Diseases, 63(1), 36–42.

    Article  Google Scholar 

  • Steultjens, M. P., Dekker, J., & Bijlsma, J. W. (2002). Avoidance of activity and disability in patients with osteoarthritis of the knee: The mediating role of muscle strength.Arthritis and Rheumatism, 46(7), 1784–1788.

    Article  PubMed  Google Scholar 

  • Tugwell, P., Bombardier, C., Buchanan, W. W., Goldsmith, C. H., Grace, E., & Hanna, B. (1987). The MACTAR Patient Preference Disability Questionnaire: Anindividualized functional priority approach for assessing improvement in physical disability in clinical trials in rheumatoid arthritis.Journal of Rheumatology, 14(3), 446–451.

    PubMed  Google Scholar 

  • Van Baar, M. E., Assendelft, W. J., Dekker, J., Oostendorp, R. A., & Bijlsma, J. W. (1999). Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: A systematic review of randomized clinical trials.Arthritis and Rheumatism, 42(7), 1361–1369.

    Article  PubMed  Google Scholar 

  • Van Baar, M. E., Dekker, J., Bijl, D., Oostendorp, R. A., Voorn, T. B., & Bijlsma, J. W. (1998a). Exercise therapy in patients with osteoarthritis of hip or knee: Outcome in specific subgroups of patients. In M. E. van Baar (Ed.),Effectiveness of exercise therapy in osteoarthritis of hip or knee (pp. 55–73). Utrecht, The Netherlands: Netherlands Institute for Health Services Research(NIVEL).

    Google Scholar 

  • Van Baar, M. E., Dekker, J., Lemmens, J. A., Oostendorp, R. A., & Bijlsma, J. W. (1998b). Pain and disability in patients with osteoarthritis of hip or knee: The relationship with articular, kinesiological, and psychological characteristics.Journal of Rheumatology, 25(1), 125–133.

    Google Scholar 

  • Van der Heijden, G. (1996).Shoulder disorder treatment: Efficacy of ultrasound therapy and electrotherapy. Maastricht, The Netherlands: Maastricht University Press.

    Google Scholar 

  • Veenhof, C., Köke, A. J. A., Dekker, J., Oostendorp, R. A., Bijlsma, J. W. J., van Tulder, M. W., Van den Ende, C. H. M. (2006).Effectiveness of behavioral graded activity in patients with osteoarthritis of hip and/or knee:A randomized controlled trial. Arthritis & Rheumatism (Arthritis Care & Research), 55(6), 925–934.

    Google Scholar 

  • Vlaeyen, J. W., & Crombez, G. (1999). Fear of movement/(re)injury, avoidance and pain disability in chronic low back pain patients.Manual Therapy, 4(4), 187–195.

    Article  PubMed  Google Scholar 

  • Vlaeyen, J. W., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art.Pain, 85(3), 317–332.

    Article  PubMed  Google Scholar 

  • Vogels, E., Hendriks, H., van Baar, M. E., Dekker, J., Hopman-Rock, M., Oostendorp, R. A., et al. (2001).Clinical practice guidelines for physical therapy in patients with osteoarthritis of the hip or knee. Amersfoort, The Netherlands: Royal Dutch College for Physiotherapy (KNGF).

    Google Scholar 

  • Wallston, K. A., Wallston, B. S., & DeVellis, R. (1978). Development of the Multidimensional Health Locus of Control(MHLC) scales.Health Education Monographs, 6(2), 160–170.

    PubMed  Google Scholar 

  • Wendel-Vos, G. C., Schuit, A. J., Saris, W. H., & Kromhout, D. (2003). Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity.Journal of Clinical Epidemiology, 56(12), 1163–1169.

    Article  PubMed  Google Scholar 

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Correspondence to Cindy Veenhof.

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Veenhof, C., Van den Ende, C.H., Dekker, J. et al. Which patientswith osteoarthritis of hip and/or knee benefit most from behavioral graded activity?. Int. J. Behav. Med. 14, 86–91 (2007). https://doi.org/10.1007/BF03004173

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