Physiotherapy - Research Publications
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ItemThe FOOTPATH study: protocol for a multicentre, participant- and assessor-blind, parallel group randomised clinical trial of foot orthoses for patellofemoral osteoarthritis(BMJ PUBLISHING GROUP, 2019-06)INTRODUCTION: Patellofemoral (PF) osteoarthritis (OA) is a common and burdensome subgroup of knee OA, with very little evidence for effective treatments. Prefabricated foot orthoses are an affordable and accessible intervention that have been shown to reduce PF pain in younger adults. Similarities between PF pain and PFOA, as well as our pilot work, suggest that foot orthoses may also be an effective intervention for PFOA. The primary objective of this study is to compare the 3 month efficacy of prefabricated foot orthoses and flat shoe inserts in people with PFOA, on knee pain severity. METHODS AND ANALYSIS: The FOOTPATH Study (FOot OrThoses for PAtellofemoral osteoarTHritis) is a multicentre, randomised, participant- and assessor-blinded superiority trial with two parallel groups, a 3 month observation period (pre-randomisation) and 12 month follow-up. 160 participants with a clinical diagnosis of PFOA will be recruited from three sites in Australia, and randomised to one of two groups (prefabricated foot orthoses or flat shoe inserts). The primary outcome is worst knee pain severity during a self-nominated aggravating activity in the previous week (100 mm visual analogue scale) at 3 months, with a secondary endpoint at 12 months. Secondary outcomes include global rating of change, symptoms, function, health-related quality of life, kinesiophobia, self-efficacy and use of co-interventions for knee pain. Blinded, intention-to-treat analyses of primary and secondary patient-reported outcomes will be performed, as well as economic analyses. ETHICS AND DISSEMINATION: Ethical approval has been granted by La Trobe University's Human Ethics Committee and The University of Queensland's Medical Research Ethics Committee. Study outcomes will be disseminated via peer-reviewed journals, conference presentations targeting a range of healthcare disciplines and an open access website with clinician resources. TRIAL REGISTRATION NUMBER: ANZCTRN12617000385347; Pre-results.
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ItemIs Patellofemoral Osteoarthritis Common in Middle-Aged People With Chronic Patellofemoral Pain?(WILEY-BLACKWELL, 2014-08)OBJECTIVE: To document the prevalence of radiographic osteoarthritis (OA) in the medial and lateral patellofemoral (PF) joint compartments relative to the prevalence of tibiofemoral (TF) joint OA in middle-aged and older adults with chronic PF knee pain. METHODS: A convenience sample of 224 people who volunteered for a clinical trial underwent weight-bearing posteroanterior and skyline knee radiographs of their most symptomatic eligible knee. Radiographic severity in the TF joint and in the medial and lateral PF joint compartments was independently graded by 2 examiners using the Kellgren/Lawrence (K/L) grading system. K/L grades ≥2 were considered evidence of OA. RESULTS: OA was common in this cohort, and the most prevalent pattern was combined TF joint and PF joint OA (n = 98 [44%]), followed by isolated PF joint OA (n = 57 [25%]). Isolated TF joint OA was rare. Overall, more people demonstrated radiographic OA in the PF joint (n = 155 [69%]) than in the TF joint (n = 100 [45%]). The majority of people with PF joint OA had OA in both the medial and lateral PF joint compartments (n = 98 [63%]). Even in people ages <50 years, radiographic OA was common (isolated PF joint OA, 26% [n = 21]; combined TF joint and PF joint OA, 29% [n = 23]). The severity of PF joint OA was similar across men and women. CONCLUSION: PF joint OA was highly prevalent, more so than TF joint OA, and even in individuals ages <50 years. Further research is needed to elucidate the cause and effect relationship between chronic PF pain and PF joint OA.
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ItemEfficacy of acupuncture for chronic knee pain: protocol for a randomised controlled trial using a Zelen design(BMC, 2012-09-19)BACKGROUND: Chronic knee pain is a common and disabling condition in people over 50 years of age, with knee joint osteoarthritis being a major cause. Acupuncture is a popular form of complementary and alternative medicine for treating pain and dysfunction associated with musculoskeletal conditions. This pragmatic Zelen-design randomised controlled trial is investigating the efficacy and cost-effectiveness of needle and laser acupuncture, administered by medical practitioners, in people with chronic knee pain. METHODS/DESIGN: Two hundred and eighty two people aged over 50 years with chronic knee pain have been recruited from metropolitan Melbourne and regional Victoria, Australia. Participants originally consented to participate in a longitudinal natural history study but were then covertly randomised into one of four treatment groups. One group continued as originally consented (ie natural history group) and received no acupuncture treatment. The other three were treatment groups: i) laser acupuncture, ii) sham laser or, iii) needle acupuncture. Acupuncture treatments used a combined Western and Traditional Chinese Medicine style, were delivered by general practitioners and comprised 8-12 visits over 12 weeks. Follow-up is currently ongoing. The primary outcomes are pain measured by an 11-point numeric rating scale (NRS) and self-reported physical function measured by the Western Ontario and McMaster (WOMAC) Universities Osteoarthritis Index subscale at the completion of treatment at 12 weeks. Secondary outcomes include quality of life, global rating of change scores and additional measures of pain (other NRS and WOMAC subscale) and physical function (NRS). Additional parameters include a range of psychosocial measures in order to evaluate potential relationships with acupuncture treatment outcomes. Relative cost-effectiveness will be determined from health service usage and outcome data. Follow-up assessments will also occur at 12 months. DISCUSSION: The findings from this study will help determine whether laser and/or needle acupuncture is efficacious, and cost-effective, in the management of chronic knee pain in older people. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry reference: ACTRN12609001001280.