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Sensorimotor performance in hand osteoarthritis
S390
Abstracts / Osteoarthritis and Cartilage 25 (2017) S76eS444
Southern Denmark providing the skills needed to deliver OA treatment as described in clinical guidelines; 2) two to three sessions of group-based patient education and 12 sessions of group-based supervised neuromuscular exercise for patients with knee and hip OA symptoms; and 3) the national electronic GLA:D registry collecting data from baseline, 3 and 12 months. Outcomes reported are pain intensity (0 to 100, worst to best), objective physical function (30-second chair-stand test and 40-meter fast-paced walk test), physical activity (number of days per week being physically active for at least 30 minutes), quality of life (Knee injury and Osteoarthritis Outcome Score (KOOS) and the Hip disability and Osteoarthritis Outcome Score (HOOS) QOL subscale, 0e100, worst to best), the number of patients taking acetaminophen, NSAIDs or opioids/opioid-like painkillers, and the number of patients on sick leave. The analyses were adjusted for baseline scores, gender, age, and BMI and a sensitivity analysis was conducted excluding those undergoing total joint replacement during follow-up. Furthermore, the evaluation assessed access to evidence-based care in Denmark according to guidelines. Results: 9,825 participants were included in the GLA:D registry between January 31, 2013 and December 31, 2015. At 3 months, the patients (n ¼ 7,189) reported an adjusted mean improvement (95% CI) of 12.4 (11.8 to 13.1) in pain intensity. At 12 months, the patients (n ¼ 3,402 of which 192 (5.6%) had undergone total joint replacement) reported an adjusted mean improvement (95% CI) of 13.7 (12.6 to 14.9) in pain intensity. Including only patients who had not undergone a total joint replacement (n ¼ 3,210), the adjusted mean improvement (95% CI) was 12.0 (10.8 to 13.2). Quality of life improved (95% CI) by 5.4 (5.0 to 5.9) and 9.4 (8.6 to 10.2) at 3 months and 12 months, respectively, and physical function and physical activity (only at 3 months) also improved following treatment (p < 0.05). Furthermore, fewer knee (19% risk reduction) and hip (13 % risk reduction) patients took painkillers following the treatment, and fewer patients (9% risk reduction) were on sick leave at 12 months following GLA:D compared with the year prior to GLA:D (p < 0.0001). All analyses remained significant when excluding patients undergoing total joint replacement during follow-up (p < 0.05). GLA:D is offered in all five health care regions in Denmark at 286 GLA:D private and public units reporting data to the registry, but the uptake in the Danish public care is still low with only one out of five of the municipalities offering GLA:D. Conclusions: Three years after its inception, GLA:D has been rolled out nationwide and has a significant impact on patient symptoms and physical function, but also on consumption of painkillers and sick leave. The improvements introduced by education and supervised neuromuscular exercise were largely maintained at 1 year. 638 SENSORIMOTOR PERFORMANCE IN HAND OSTEOARTHRITIS P.J. McNair y, N.E. Magni y, D.A. Rice y, z. y Auckland Univ. of Technology, Auckland, New Zealand; z Waitemata District Hlth. Board, Auckland, New Zealand Purpose: Our aim was to determine whether motor imagery, tactile acuity, and body perception are disrupted in people with hand osteoarthritis. A further aim was to investigate the relationship between these measures and hand function in people with hand osteoarthritis. Methods: Twenty individuals with hand osteoarthritis and 19 age and gender matched controls participated. To evaluate implicit motor imagery performance, a customised computer software was utilised in which participants were asked to identify as quickly and as accurately as possible digital photographs of hands as belonging to either the left or right side of the body. Previous studies have shown people with chronic pain conditions are often slower and less accurate at this task when compared to healthy controls. Tactile acuity was measured through the two-point discrimination test using callipers. This has previously been shown to be impaired in a range of chronic pain conditions. The presence of neglect-like symptoms was investigated through the Neurobehavioral Questionnaire which assesses body perceptual disturbances. Self-perceived and objective measures of hand function were assessed using the Disability of the Arm, Shoulder and Hand questionnaire, the Functional Index of Hand Osteoarthritis questionnaire, as well as two performance tests: the Purdue Pegboard test and the Upper Extremity Performance Test for the Elderly. Comparisons across groups were assessed with ANOVA and relationships across sensorimotor measures and function were assessed by correlation coefficients. Results: Significant impairments (p<0.05) were identified in implicit motor imagery reaction time and accuracy in the hand osteoarthritis
group when compared to healthy controls. Additionally, neglect like symptoms were more frequently experienced (p<0.05) in people with hand osteoarthritis. These are novel findings for this patient cohort. Despite these differences, implicit motor imagery performance was not correlated to measures of hand function. Though we reaffirm previous findings that tactile acuity is correlated to ability to perform fine motor tasks with the hand (r ¼ 0.54), we could not demonstrate an impairment in tactile acuity in those with hand osteoarthritis compared to healthy controls. Conclusions: This is the first study to show brain related sensorimotor changes in hand osteoarthritis. This is indicative of a disrupted working body schema as has been shown in other chronic pain populations. However, there was no strong evidence of their relationship to both perceived and performance based measures of hand function. The lack of a difference across the groups in two point discrimination suggests limited disruption to the sensory representation of the hand in the primary somatosensory cortex in those with osteoarthritis. This finding was surprising and suggests a degree of independence in the processing of tactile acuity and working body schema. 639 EFFECT OF SOFT BRACES ON PAIN AND PHYSICAL FUNCTION IN PATIENTS WITH KNEE OSTEOARTHRITIS: SYSTEMATIC REVIEW WITH META-ANALYSES T. Cudejko y, z, M. van der Esch z, M. van der Leeden y, z, L. Roorda z, J. Pallari x, K. Bennell k, H. Lund ¶, #, J. Dekker y, yy. y Deparment of Rehabilitation Med., VU Univ. Med. Ctr. Amsterdam, Amsterdam, Netherlands; z Amsterdam Rehabilitation Res. Ctr. j Reade, Amsterdam, Netherlands; x Dept. of Res. & Dev., Peacocks Med. Group, Newcastle upon Tyne, United Kingdom; k Ctr. for Hlth., Exercise and Sports Med., Dept. of Physiotherapy, The Univ. of Melbourne, Melbourne, Australia; ¶ Res. Unit for Musculoskeletal Function and Physiotherapy, Dept. of Sports Sci. and Clinical Biomechanics, Univ. of Southern Denmark, Odense, Denmark; # Ctr. for Evidence-Based Practice, Bergen Univ. Coll., Bergen, Norway; yy Dept. of Psychiatry, VU Univ. Med. Ctr., Amsterdam, Netherlands Purpose: Soft braces (knee sleeves) are elastic non-adhesive orthoses. They are commonly used because of their ease of use and low cost and are recommended as appropriate treatment for non-surgical management of knee osteoarthritis (OA). Nevertheless, to our knowledge a comprehensive overview of the effects of soft braces in patients with knee OA is not available. Thus, the aim of the study was to systematically review and synthesize the effects of soft braces on self-reported pain and physical function in patients with knee OA. Methods: Randomized controlled trials (RCT) and non-randomized controlled trials (non-RCTs), reporting on the effects of soft braces on self-reported pain and physical function in human adults ( > 18 years) with knee OA were included. The following electronic databases were searched from inception to April 20, 2016: The Cochrane Central Registry for Controlled Trials (CENTRAL), PubMed, EMBASE, CINAHL, SportDiscuss, Web of Science and PEDro. Cocharne Risk of Bias Tool for RCTs and the Downs and Black Scale for nonRCTs and for within design comparison of RCTs was used to assess the methodological quality of the included studies. We synthesized data with meta-analyses. Results: Eleven studies were identified, including six randomized controlled trials (RCTs) and five non-RCTs (figure 1). The methodological quality of included RCTs was low. There was a moderate improvement in pain (SMD 0.52, 95% CI 0.14 to 0.89; P ¼ 0.007; 284 participants) in favor of wearing a brace compared to not wearing a brace for the immediate, within-group comparison. There was a moderate improvement in pain (SMD 0.55, 95% CI 0.34 to 0.76; P < 0.001; 372 participants) and small to moderate improvement in physical function (SMD 0.37, 95% CI 0.15 to 0.59; P ¼ 0.001; 325 participants) between-group comparisons in favor of patients receiving soft brace versus standard care or no treatment for prolonged effects (figure 2). Conclusions: This review presents the first comprehensive synthesis of studies investigating the effects of soft braces on pain and physical function in patients with knee OA. The results available at present indicate that soft braces have moderate effects on pain and small to moderate effects on physical function in knee OA. The results highlight the importance of soft braces as a technique to affect pain and physical function in both, short and long-term. Further, high quality studies are warranted to enhance confidence in the results.
Abstracts / Osteoarthritis and Cartilage 25 (2017) S76eS444
Southern Denmark providing the skills needed to deliver OA treatment as described in clinical guidelines; 2) two to three sessions of group-based patient education and 12 sessions of group-based supervised neuromuscular exercise for patients with knee and hip OA symptoms; and 3) the national electronic GLA:D registry collecting data from baseline, 3 and 12 months. Outcomes reported are pain intensity (0 to 100, worst to best), objective physical function (30-second chair-stand test and 40-meter fast-paced walk test), physical activity (number of days per week being physically active for at least 30 minutes), quality of life (Knee injury and Osteoarthritis Outcome Score (KOOS) and the Hip disability and Osteoarthritis Outcome Score (HOOS) QOL subscale, 0e100, worst to best), the number of patients taking acetaminophen, NSAIDs or opioids/opioid-like painkillers, and the number of patients on sick leave. The analyses were adjusted for baseline scores, gender, age, and BMI and a sensitivity analysis was conducted excluding those undergoing total joint replacement during follow-up. Furthermore, the evaluation assessed access to evidence-based care in Denmark according to guidelines. Results: 9,825 participants were included in the GLA:D registry between January 31, 2013 and December 31, 2015. At 3 months, the patients (n ¼ 7,189) reported an adjusted mean improvement (95% CI) of 12.4 (11.8 to 13.1) in pain intensity. At 12 months, the patients (n ¼ 3,402 of which 192 (5.6%) had undergone total joint replacement) reported an adjusted mean improvement (95% CI) of 13.7 (12.6 to 14.9) in pain intensity. Including only patients who had not undergone a total joint replacement (n ¼ 3,210), the adjusted mean improvement (95% CI) was 12.0 (10.8 to 13.2). Quality of life improved (95% CI) by 5.4 (5.0 to 5.9) and 9.4 (8.6 to 10.2) at 3 months and 12 months, respectively, and physical function and physical activity (only at 3 months) also improved following treatment (p < 0.05). Furthermore, fewer knee (19% risk reduction) and hip (13 % risk reduction) patients took painkillers following the treatment, and fewer patients (9% risk reduction) were on sick leave at 12 months following GLA:D compared with the year prior to GLA:D (p < 0.0001). All analyses remained significant when excluding patients undergoing total joint replacement during follow-up (p < 0.05). GLA:D is offered in all five health care regions in Denmark at 286 GLA:D private and public units reporting data to the registry, but the uptake in the Danish public care is still low with only one out of five of the municipalities offering GLA:D. Conclusions: Three years after its inception, GLA:D has been rolled out nationwide and has a significant impact on patient symptoms and physical function, but also on consumption of painkillers and sick leave. The improvements introduced by education and supervised neuromuscular exercise were largely maintained at 1 year. 638 SENSORIMOTOR PERFORMANCE IN HAND OSTEOARTHRITIS P.J. McNair y, N.E. Magni y, D.A. Rice y, z. y Auckland Univ. of Technology, Auckland, New Zealand; z Waitemata District Hlth. Board, Auckland, New Zealand Purpose: Our aim was to determine whether motor imagery, tactile acuity, and body perception are disrupted in people with hand osteoarthritis. A further aim was to investigate the relationship between these measures and hand function in people with hand osteoarthritis. Methods: Twenty individuals with hand osteoarthritis and 19 age and gender matched controls participated. To evaluate implicit motor imagery performance, a customised computer software was utilised in which participants were asked to identify as quickly and as accurately as possible digital photographs of hands as belonging to either the left or right side of the body. Previous studies have shown people with chronic pain conditions are often slower and less accurate at this task when compared to healthy controls. Tactile acuity was measured through the two-point discrimination test using callipers. This has previously been shown to be impaired in a range of chronic pain conditions. The presence of neglect-like symptoms was investigated through the Neurobehavioral Questionnaire which assesses body perceptual disturbances. Self-perceived and objective measures of hand function were assessed using the Disability of the Arm, Shoulder and Hand questionnaire, the Functional Index of Hand Osteoarthritis questionnaire, as well as two performance tests: the Purdue Pegboard test and the Upper Extremity Performance Test for the Elderly. Comparisons across groups were assessed with ANOVA and relationships across sensorimotor measures and function were assessed by correlation coefficients. Results: Significant impairments (p<0.05) were identified in implicit motor imagery reaction time and accuracy in the hand osteoarthritis
group when compared to healthy controls. Additionally, neglect like symptoms were more frequently experienced (p<0.05) in people with hand osteoarthritis. These are novel findings for this patient cohort. Despite these differences, implicit motor imagery performance was not correlated to measures of hand function. Though we reaffirm previous findings that tactile acuity is correlated to ability to perform fine motor tasks with the hand (r ¼ 0.54), we could not demonstrate an impairment in tactile acuity in those with hand osteoarthritis compared to healthy controls. Conclusions: This is the first study to show brain related sensorimotor changes in hand osteoarthritis. This is indicative of a disrupted working body schema as has been shown in other chronic pain populations. However, there was no strong evidence of their relationship to both perceived and performance based measures of hand function. The lack of a difference across the groups in two point discrimination suggests limited disruption to the sensory representation of the hand in the primary somatosensory cortex in those with osteoarthritis. This finding was surprising and suggests a degree of independence in the processing of tactile acuity and working body schema. 639 EFFECT OF SOFT BRACES ON PAIN AND PHYSICAL FUNCTION IN PATIENTS WITH KNEE OSTEOARTHRITIS: SYSTEMATIC REVIEW WITH META-ANALYSES T. Cudejko y, z, M. van der Esch z, M. van der Leeden y, z, L. Roorda z, J. Pallari x, K. Bennell k, H. Lund ¶, #, J. Dekker y, yy. y Deparment of Rehabilitation Med., VU Univ. Med. Ctr. Amsterdam, Amsterdam, Netherlands; z Amsterdam Rehabilitation Res. Ctr. j Reade, Amsterdam, Netherlands; x Dept. of Res. & Dev., Peacocks Med. Group, Newcastle upon Tyne, United Kingdom; k Ctr. for Hlth., Exercise and Sports Med., Dept. of Physiotherapy, The Univ. of Melbourne, Melbourne, Australia; ¶ Res. Unit for Musculoskeletal Function and Physiotherapy, Dept. of Sports Sci. and Clinical Biomechanics, Univ. of Southern Denmark, Odense, Denmark; # Ctr. for Evidence-Based Practice, Bergen Univ. Coll., Bergen, Norway; yy Dept. of Psychiatry, VU Univ. Med. Ctr., Amsterdam, Netherlands Purpose: Soft braces (knee sleeves) are elastic non-adhesive orthoses. They are commonly used because of their ease of use and low cost and are recommended as appropriate treatment for non-surgical management of knee osteoarthritis (OA). Nevertheless, to our knowledge a comprehensive overview of the effects of soft braces in patients with knee OA is not available. Thus, the aim of the study was to systematically review and synthesize the effects of soft braces on self-reported pain and physical function in patients with knee OA. Methods: Randomized controlled trials (RCT) and non-randomized controlled trials (non-RCTs), reporting on the effects of soft braces on self-reported pain and physical function in human adults ( > 18 years) with knee OA were included. The following electronic databases were searched from inception to April 20, 2016: The Cochrane Central Registry for Controlled Trials (CENTRAL), PubMed, EMBASE, CINAHL, SportDiscuss, Web of Science and PEDro. Cocharne Risk of Bias Tool for RCTs and the Downs and Black Scale for nonRCTs and for within design comparison of RCTs was used to assess the methodological quality of the included studies. We synthesized data with meta-analyses. Results: Eleven studies were identified, including six randomized controlled trials (RCTs) and five non-RCTs (figure 1). The methodological quality of included RCTs was low. There was a moderate improvement in pain (SMD 0.52, 95% CI 0.14 to 0.89; P ¼ 0.007; 284 participants) in favor of wearing a brace compared to not wearing a brace for the immediate, within-group comparison. There was a moderate improvement in pain (SMD 0.55, 95% CI 0.34 to 0.76; P < 0.001; 372 participants) and small to moderate improvement in physical function (SMD 0.37, 95% CI 0.15 to 0.59; P ¼ 0.001; 325 participants) between-group comparisons in favor of patients receiving soft brace versus standard care or no treatment for prolonged effects (figure 2). Conclusions: This review presents the first comprehensive synthesis of studies investigating the effects of soft braces on pain and physical function in patients with knee OA. The results available at present indicate that soft braces have moderate effects on pain and small to moderate effects on physical function in knee OA. The results highlight the importance of soft braces as a technique to affect pain and physical function in both, short and long-term. Further, high quality studies are warranted to enhance confidence in the results.