Controled Trials : A Review Of Controlled Trials

Joint pain, particularly in the knees and shoulders as well as back pain constitute the large majority of patients who present to their doctor's office with a complaint of pain. Many of these patients proceed to have surgery, all too often with less than optimal outcomes. Many of these patients still have the same pain

Osteoarthritis, the most common type of arthritis, is most prevalent in older patients. Osteoarthritis is a degenerative bone disease due to the gradual loss of cartilage. A primary type of osteoarthritis is hip arthritis where it is caused by joint injury, increasing age, and being overweight (“Hip Osteoarthritis,” n.d.). However, osteoarthritis can also be caused by immature joints, inherited defects in cartilage, and extra stress on a patient’s joints (Hip Osteoarthritis,” n.d.). As a result, hip arthritis becomes a huge detriment in patient’s social, emotional, physical lifestyles. In order to treat hip arthritis, doctors choose from a variety of non-drug treatments, medications, and surgeries. Uniquely, I was inspired to research about the treatments of hip arthritis because my very own brother was pronounced with hip arthritis a few years back. Therefore, his determination to battle this disease encouraged me to investigate about the treatment of hip arthritis.

As stated earlier, the patient admitting challenge was right total knee replacement related to history of osteoarthritis as evidenced by unrelieved pain. Osteoarthritis (OA) is a disease that “results from cartilage damage that triggers a metabolic response at the level of the chondrocytes” (Lewis, Dirksen, Heitkemper, Barry, Goldsworthy & Goodridge, 2011, p. 1881). As it progress, it causes the cartilage to become “dull, yellow, and granular” instead of being “smooth, white, translucent” (Lewis et al., 2011; Gulanick & Myers, 2014, p. 1881).As a result, it eventually becomes softer, less elastic, and less capable to resist wear during heavy use. Moreover, as the “central cartilage becomes thinner, cartilage and bony growth increases at the joint margins … that results to uneven distribution of stress across the joint” that contributes to a decrease in motion. (Lewis et al., 2011; Gulanick & Myers, 2014, p. 1882). According to this patient, OA has been giving her pain for about two years that lead her to the decision of having the knee replacement.

The fifth article critiqued is the first update of a clinical practice guideline (CPG) authored by the American Academy of Orthopedic Surgeons (AAOS). The purpose of this systematic review is to evaluate the best available evidence associated with nonsurgical treatment of knee OA. To be included in this study, the subjects must be original research treating knee OA with pain, function, and disability status as the primary outcome measures. Studies were excluded based on design and if they were of very limited strength of evidence. The authors searched the databases PubMed, EMBASE, CINAHL, and Cochrane Register of Controlled Trials. The recommendations in this CPG are based upon the evidence found in these studies. When critiquing the articles, the authors analyzed the quality and applicability of the studies using the Grade Evidence Appraisal System and the PRECIS Instrument. The authors made the following recommendations for braces and insoles.

Osteoarthritis is degenerative joint disease caused by mechanical wear and tear. Damage manifest as breakdown of cartilage, injury of subhondral bone and changes to all articular surfaces. it presents as pain in weight bearing joints that worsen with use. The joints that are mostly affected are the distal interphalanges, knees, hips, toes and spine [1]. Knee osteoarthritis is suspected after a medical history and physical examination is done. During the physical examination the doctor will examine the knee and its series of motion. He will pay close attention to areas that are swollen, tender and painful [2]. There are a variety of diagnostic tests that may help confirm the diagnosis if patient’s knee is affected. There is X-ray that

The knee has the highest prevalence of OA of all of the joints in the human body. Knee OA regularly causes people to experience troubling pain and/or loss of physical function to varying degrees,5 and often results in total knee arthroplasty8 after years of distress and economic burden to the patient and society.9 During 2005 in Ontario, Canada, knee OA costs for an individual averaged $12,200 annually, including personal expenses as well as lost wages.10 It is estimated that as the world’s population ages and as the obesity epidemic grows, the burden of OA on the healthcare system, and therefore the economy, will continue to increase, barring improvements in knee OA management.8

In one study, a randomized trial was conducted in which half of a group of arthritis patients were given 200 mg of Celebrex daily and half were given 1,200 mg of SAM-e joint health supplements daily over the course of 16 weeks. The study found that the Celebrex group showed far more pain reduction during the first month than the SAM-e group, but by the second month, both groups showed an equal and significant lessening of pain. The research concluded that although slower-acting, SAM-e joint health supplements are just as effective as Celebrex for osteoarthritis-related knee

Study 1 primarily focused on functional and clinical outcomes and knee ROM. Half of the patients in this study undergoing a TKA surgery received an inflated tourniquet, whereas the other half received an un-inflated tourniquet. The primary outcome measurements were Knee Injury and Osteoarthritis Outcome Score (KOOS), a knee specific questionnaire, and knee ROM measurements. KOOS feedback evaluated functional and clinical outcomes, which were expressed as the change in the average score over the period of 12 months for each subscale: pain, symptom, activities of daily living (ADL), sport/recreation, quality of life (QOL). This review will focus on ADL, sports and recreation, and QOL, because these subscales pertain to the knee ROM.

01/06/16 Pain management Report described that the patient has a history of chronic low back pain and right lower extremity pain. The patient has a spinal cord stimulator since 01/30/15. The patient visited today for follow-up and medication refill. He reported that his pain has been stable since the last month. His pain is 5/10-scale level with the use of medications and 8/10-scale levels without the use of medication. The patient reported that the medications, activity restriction,

The first study reviewed was a randomized control trial of treatment for ACL tears by, Frobell, Roos, Roos, Ranstam, & Lohmander (2010)

All patients included in the study were recalled for subjective, objective, and functional evaluation; the study protocol involved the range of motion (ROM), ligamentous stability, Tegner-Lysholm Score, Modified Cincinnati Rating System Questionnaire, Short Form-12 (SF-12) in addition to the plain radiograph, computed tomography (CT), and magnetic resonance imaging (MRI) of the knee. According to international knee documentation committee (IKDC) score, any development of arthrosis was assessed at the final follow-up.

Any potential reduction in weight can also help reduce the pain from OA. When the patient is walking, the downward pressure on their knees is not just equal to their body weight, but is multiplied. The pressure going down on the knee on average is 4.85 lbs. extra exerted per pound of body weight. This means that if the patient is able to lose around 6 lbs. of body weight, there would be a reduction of around 29.1 pounds of pressure on the joint. This pressure was found to be reduced in the posted by the Osteoarthritis Research Society International. To note, the pressure the pressure was lowered upon altering the speed of gait. Researches had found that due to the reduction in irritation from less pressure, patients were speeding up their gait, which was amplifying pressure. The results of this study can be beneficial in helping the patient realize that the sooner they can take control of their situation, the more control they can have over their diagnosis. Often, it is not uncommon for the patient to just be thinking of the reduction of weight influencing secondary conditions like hypertension and diabetes, but do not take into consideration the positive impact it can have on their joints. Inflammation can also be altered by helping reduce the chemicals in circulation. Weight reduction has been shown to help reduce the circulation of IL-6 and CRP, which are two main components in contributing to

Osteoarthritis is the most common joint disorder, and more than half of all Americans who are older than 65 have been diagnosed with osteoarthritis. However, recent US data has revealed knee osteoarthritis does not discriminate age, and there is growing evidence that osteoarthritis affects individuals at a young age. The annual cost of osteoarthritis due to treatment and loss of productivity in the US is estimated to be more than 65 billion dollars.1 With no cure currently available for osteoarthritis, current treatments focus on management of symptoms. The primary goals of therapy include improved joint function, pain relief, and increased joint stability. Although the exact cause of osteoarthritis is unknown, many risk factors have been identified including increased age, female gender, obesity, and trauma.2 Within these risk factors, the etiology of osteoarthritis has been divided into anatomy, body mass, and gender.

According to Goodman and Fuller (2009) Osteoarthritis is divided into 2 classifications: Primary and secondary. Primary OA is a disorder of unknown cause which in the cascade of joint degeneration it is believed to be a related defect in the articular cartilage. Secondary OA has a known cause, which may be trauma, infection, hemarthrosis, osteonecrosis, or some condition Primary Osteoarthritis (OA) is the most common joint disorder in the world and often affects the knee and hip joints (Rubak, Svendsen, Soballe, & Frost, 2013). For patients with primary hip OA, pain and disability are the most important indications for total hip replacement (THR) (Rubake et al., 2013, p.486) Primary symptoms of OA include joint pain, stiffness, and limitation of movement. Disease progression is usually slow but can

Osteoarthritis (OA) is one of the most common arthritic diseases which cause the joint pain and physical disabilities in daily life. More and more researchers focus on the pathogenic mechanism of the OA and relationship between the OA and pain. However，there has still not clarified about the mechanism and not have universally acknowledged standard to measure the pain. Thus, it is a pressing demand to establish the objective scale of the OA pain and the deeper understand about the pathogenic mechanism of The OA generation. Our purpose of the study is to explore the relationship between the vascular function and OA pain in the OA knee joints.