Publications by authors named "Sita M A Bierma-Zeinstra"

257 Publications

Incidence and prediction of ankle injury risk: a prospective cohort study on 91 contemporary preprofessional dancers.

BMJ Open Sport Exerc Med 2021 8;7(2):e001060. Epub 2021 Jun 8.

Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands.

Objectives: This study examines the incidence of ankle injuries and identifies ankle injury risk among contemporary preprofessional dancers.

Methods: A total of 91 first-year contemporary preprofessional dancers were prospectively followed during one academic year. Self-reported ankle injuries, assessed with the Oslo Sports Trauma Research Centre questionnaire, were categorised as all complaint ankle injuries, substantial ankle injuries or time-loss ankle injuries. In addition, ankle injuries leading to medical attention were included. Regression analyses were used to determine the association between potential risk factors (dancer characteristics, history of ankle injury in the previous year, ankle range of motion and dorsiflexion) and ankle injuries.

Results: The 1-year ankle injury incidence proportion was 18.7% (n=17), 8.8% (n=8), 15.4% (n=14) and 7.7% (n=7), respectively, for all complaint ankle injuries, ankle injuries requiring medical attention, time-loss injuries and substantial injuries. Being male (OR=0.27; 95% CI 0.09 to 0.75) and being a student of the Bachelors in Dance and Education (OR=0.27; 95% CI 0.08 to 0.97) were univariately associated with a lower risk of an ankle injury.

Conclusion: Almost 20% of first-year preprofessional dancers reported an ankle injury, with more than 80% of the dancers reporting that their injury leads to dance time loss. Males and students of the bachelors in dance and education were at lower risk of ankle injuries. As ankle injuries are common among dancers, studies with larger sample sizes, a more heterogeneous population (eg, different dance styles) and longer follow-up periods are necessary to evaluate the impact of ankle injuries in further detail.
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http://dx.doi.org/10.1136/bmjsem-2021-001060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190045PMC
June 2021

Evaluation of intermediate care for knee and hip osteoarthritis: a mixed-methods study.

BMC Fam Pract 2021 Jun 24;22(1):131. Epub 2021 Jun 24.

Department of General Practice, Erasmus MC University Medical Center, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands.

Background: To evaluate intermediate care for knee and hip osteoarthritis (KHOA) in the general practice that incorporate specialist services into general practice to prevent unnecessary referrals to hospitals.

Methods: We used a mixed methods approach including semi-structured interviews, patient experience questionnaires and data from medical records from three intermediate care projects. Semi-structured interviews were conducted with patients, general practitioners (GPs), orthopaedists and a healthcare manager in intermediate care. Satisfaction of patients who received intermediate care (n = 100) was collected using questionnaires. Referral data and healthcare consumption from medical records were collected retrospectively from KHOA patients before (n = 96) and after (n = 208) the implementation of intermediate care.

Results: GPs and orthopaedists in intermediate care experienced more intensive collaboration compared to regular care. This led to a perceived increase in GPs' knowledge enabling better selection of referrals to orthopaedics and less healthcare consumption. Orthopaedists felt a higher workload and limited access to diagnostic facilities. Patients were satisfied and experienced better access to specialists' knowledge in a trusted environment compared to regular care. Referrals to physiotherapy increased significantly after the implementation of intermediate care (absolute difference = 15%; 95% CI = 7.19 to 22.8), but not significantly to orthopaedics (absolute difference = 5.9%; 95% CI = -6.18 to 17.9).

Conclusions: Orthopaedists and GPs perceived the benefits of an intensified collaboration in intermediate care. Intermediate care may contribute to high quality of care through more physiotherapy referrals. Further research with longer follow-up is needed to confirm these findings and give more insight in referrals and healthcare consumption.
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http://dx.doi.org/10.1186/s12875-021-01474-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8229342PMC
June 2021

Quality indicators for knee and hip osteoarthritis care: a systematic review.

RMD Open 2021 05;7(2)

General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands.

To provide an overview of quality indicators (QIs) for knee and hip osteoarthritis (KHOA) care and to highlight differences in healthcare settings. A database search was conducted in MEDLINE (PubMed), EMBASE, CINAHL, Web of Science, Cochrane CENTRAL and Google Scholar, OpenGrey and Prospective Trial Register, up to March 2020. Studies developing or adapting existing QI(s) for patients with osteoarthritis were eligible for inclusion. Included studies were categorised into healthcare settings. QIs from included studies were categorised into structure, process and outcome of care. Within these categories, QIs were grouped into themes (eg, physical therapy). A narrative synthesis was used to describe differences and similarities between healthcare settings. We included 20 studies with a total of 196 QIs mostly related to the process of care in different healthcare settings. Few studies included patients' perspectives. Rigorous methods for evidence synthesis to develop QIs were rarely used. Narrative analysis showed differences in QIs between healthcare settings with regard to exercise therapy, weight counselling, referral to laboratory tests and 'do not do' QIs. Differences within the same healthcare setting were identified on radiographic assessment. The heterogeneity in QIs emphasise the necessity to carefully select QIs for KHOA depending on the healthcare setting. This review provides an overview of QIs outlined to their healthcare settings to support healthcare providers and policy makers in selecting the contextually appropriate QIs to validly monitor the quality of KHOA care. We strongly recommend to review QIs against the most recent guidelines before implementing them into practice.
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http://dx.doi.org/10.1136/rmdopen-2021-001590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164978PMC
May 2021

Are pain coping strategies and neuropathic pain associated with a worse outcome after conservative treatment for Achilles tendinopathy? A prospective cohort study.

J Sci Med Sport 2021 Apr 19. Epub 2021 Apr 19.

Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands.

Objectives: To analyse whether (1) passive or active pain coping strategies and (2) presence of neuropathic pain component influences the change of Achilles tendinopathy (AT) symptoms over a course of 24 weeks in conservatively-treated patients.

Design: Prospective cohort study.

Methods: Patients with clinically-diagnosed chronic midportion AT were conservatively treated. At baseline, the Pain Coping Inventory (PCI) was used to determine scores of coping, which consisted of two domains, active and passive (score ranging from 0 to 1; the higher, the more active or passive). Presence of neuropathic pain (PainDETECT questionnaire, -1 to 38 points) was categorized as (a) unlikely (≤12 points), (b) unclear (13-18 points) and (c) likely (≥19 points). The symptom severity was determined with the validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire (0-100) at baseline, 6, 12 and 24 weeks. We analysed the correlation between (1) PCI and (2) PainDETECT baseline scores with change in VISA-A score using an adjusted Generalized Estimating Equations model.

Results: Of 80 included patients, 76 (95%) completed the 24-weeks follow-up. The mean VISA-A score (standard deviation) increased from 43 (16) points at baseline to 63 (23) points at 24 weeks. Patients had a mean (standard deviation) active coping score of 0.53 (0.13) and a passive score of 0.43 (0.10). Twelve patients (15%) had a likely neuropathic pain component. Active and passive coping mechanisms and presence of neuropathic pain did not influence the change in AT symptoms (p=0.459, p=0.478 and p=0.420, respectively).

Conclusions: Contrary to widespread belief, coping strategy and presence of neuropathic pain are not associated with a worse clinical outcome in this homogeneous group of patients with clinically diagnosed AT.
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http://dx.doi.org/10.1016/j.jsams.2021.04.001DOI Listing
April 2021

Towards sex-specific osteoarthritis risk models: evaluation of risk factors for knee osteoarthritis in males and females.

Rheumatology (Oxford) 2021 Apr 24. Epub 2021 Apr 24.

Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands; e-mail:

Objectives: The aim of this study was to identify sex-specific prevalence and strength of risk factors for the incidence of radiographic knee osteoarthritis (incRKOA).

Methods: Our study population consisted of 10,958 Rotterdam Study participants free of knee OA in one/both knees at baseline. 1064 participants developed RKOA after a median follow-up time of 9.6 years. We estimated the association between each available risk factor and incRKOA using sex stratified multivariate regression models with generalized estimating equations. Subsequently, we statistically tested sex differences between risk estimates and calculated the population attributable fractions (PAFs) for modifiable risk factors.

Results: The prevalence of the investigated risk factors was, in general, higher in women compared to men, except alcohol intake and smoking was higher in men and high BMI showed equal prevalence. We found significantly different risk estimates between men and women: high level of PA (RR 1.76, 95% CI 1.29-2.40) or a KL-score 1 at baseline (RR 5.48, 95% CI 4.51-6.65) was higher in men. Among borderline significantly different risk estimates was BMI ≥27, associated with higher risk for incRKOA in women (RR 2.00, 95% CI 1.74-2.31). The PAF for higher BMI was 25.6% in women and 19.3% in men.

Conclusion: We found sex-specific differences in both presence and relative risks of several risk factors for incRKOA. Especially BMI, a modifiable risk factor, impacts women more strongly than men. These risk factors can be used in the development of personalized prevention strategies and in building sex-specific prediction tools to identify high-risk profile patients.
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http://dx.doi.org/10.1093/rheumatology/keab378DOI Listing
April 2021

T mapping of healthy knee cartilage: multicenter multivendor reproducibility.

Quant Imaging Med Surg 2021 Apr;11(4):1247-1255

Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, The Netherlands.

Background: T mapping is increasingly used to quantify cartilage degeneration in knee osteoarthritis (OA), yet reproducibility studies in a multicenter setting are limited. The purpose of this study was to determine the longitudinal reproducibility and multicenter variation of cartilage T mapping, using various MRI equipment and acquisition protocols.

Methods: In this prospective multicenter study, four traveling, healthy human subjects underwent T mapping twice at five different centers with a 6-month-interval. Centers had various MRI scanners, field strengths, and T mapping acquisition protocols. Mean T values were calculated in six cartilage regions of interest (ROIs) as well as an average value per patient. A phantom was scanned once at each center. To evaluate longitudinal reproducibility, intraclass correlation coefficients (ICC), root-mean-square coefficient of variation (RMS-CV), and a Bland-Altman plot were used. To assess the variation of and phantom T values across centers, ANOVA was performed.

Results: ICCs of the T mapping measurements per ROI and the ROI's combined ranged from 0.73 to 0.91, indicating good to excellent longitudinal reproducibility. RMS-CVs ranged from 1.1% to 1.5% (per ROI) and 0.6% to 1.6% (ROIs combined) across the centers. A Bland-Altman plot did not reveal a systematic error. Evident, but consistent, discrepancies in T values were observed across centers, both and in the phantom.

Conclusions: The results of this study suggest that T mapping can be used to longitudinal assess cartilage degeneration in multicenter studies. Given the differences in absolute cartilage T values across centers, absolute T values derived from various centers in multicenter multivendor trials should not be pooled.
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http://dx.doi.org/10.21037/qims-20-674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930682PMC
April 2021

Differences in Knee Shape between ACL Injured and Non-Injured: A Matched Case-Control Study of 168 Patients.

J Clin Med 2021 Mar 2;10(5). Epub 2021 Mar 2.

Department of Orthopedic Surgery, Erasmus MC University Medical Centre, 3015 CN Rotterdam, The Netherlands.

Objective: Anterior cruciate ligament (ACL) injury prevention programs could be more effective if we could select patients at risk for sustaining an ACL rupture. The purpose of this study is to identify radiographic shape variants of the knee between patients with and patients without an ACL rupture.

Methods: We compared the lateral and Rosenberg view X-rays of 168 prospectively followed patients with a ruptured ACL to a control group with intact ACLs, matched for gender, after knee trauma. We used statistical shape modeling software to examine knee shape and find differences in shape variants between both groups.

Results: In the Rosenberg view X-rays, we found five shape variants to be significantly different between patients with an ACL rupture and patients with an intact ACL but with knee trauma. Overall, patients who had ruptured their ACL had smaller, flatter intercondylar notches, a lower lateral tibia plateau, a lower medial spike of the eminence, and a smaller tibial eminence compared to control patients.

Conclusion: Patients with an ACL rupture have smaller intercondylar notches and smaller tibial eminences in comparison to patients with an intact ACL after knee trauma.
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http://dx.doi.org/10.3390/jcm10050968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957627PMC
March 2021

The influence of expectation modification in knee arthroplasty on satisfaction of patients: a randomized controlled trial.

Bone Joint J 2021 Apr;103-B(4):619-626

Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.

Aims: Meeting preoperative expectations is known to be of major influence on postoperative satisfaction after total knee arthroplasty (TKA). Improved management of expectation, resulting in more realistic expectations can potentially lead to higher postoperative satisfaction. The objective of this study was to assess the effect of an additional preoperative education module, addressing realistic expectations for long-term functional recovery, on postoperative satisfaction and expectation fulfilment.

Methods: In total, 204 primary TKA patients with osteoarthritis were enrolled in this randomized controlled trial (RCT). Patients were allocated to either usual preoperative education (control group) or usual education plus an additional module on realistic expectations (intervention group). Primary outcome was being very satisfied (numerical rating scale for satisfaction ≥ 8) with the treatment result at 12 months' follow-up. Other outcomes were change in preoperative expectations and postoperative expectation fulfilment.

Results: A total of 187 patients (91.7%) were available for analysis at follow-up. In the intention-to-treat analysis, 58.5% (55/94) of patients were very satisfied with the treatment result in the control group, and 69.9% (65/93) of patients in the intervention group (adjusted odds ratio (AOR) 1.72, 95% confidence interval (CI) 0.90 to 3.29). A per-protocol analysis for patients who attended the education session (92.0%, n = 172) showed that 56.9% (49/86) of patients were very satisfied in the control group and 74.4% (61/86) in the intervention group (AOR 2.44, 95% CI 1.21 to 4.91). After preoperative education, the expectation scores in the intervention group were significantly lower (mean difference -6.9 (95% CI -10.2 to -3.6)) and did not alter in the control group (mean difference 0.5 (95% CI -2.9 to 3.9)). Overall, fulfilment of expectations at 12 months was significantly higher in the intervention group (mean difference 11.4% (95% CI 2.3 to 20.5)).

Conclusion: Improved preoperative patient education can modify patient expectations, resulting in higher postoperative fulfilment of expectation and higher satisfaction in the group that attended the preoperative education. This is the first RCT to confirm the potential of improved expectation management on satisfaction after TKA. Cite this article:  2021;103-B(4):619-626.
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http://dx.doi.org/10.1302/0301-620X.103B4.BJJ-2020-0629.R3DOI Listing
April 2021

Factors associated with longitudinal change of meniscal extrusion in overweight women without clinical signs of osteoarthritis.

Rheumatology (Oxford) 2021 Mar 10. Epub 2021 Mar 10.

Dept. of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.

Objectives: To identify variables associated with longitudinal change in meniscal extrusion, which might be used as possible targets for knee osteoarthritis (KOA) prevention.

Methods: In a high-risk population of middle-aged overweight women, meniscal extrusion was assessed with magnetic resonance imaging (1.5 T, coronal proton density, in-plane resolution 0.5 mm2, Sante DICOM Editor) at baseline and after 30 months. Outcomes were the absolute change in medial and lateral extrusion (mm) and relative change in extrusion (%). Based upon literature, eleven factors were hypothesized to be associated with longitudinal change. Generalized estimating equations were used to model the effect on meniscal change (p< 0.05).

Results: 677 knees of 343 women were available for analysis, with a mean age of 55.7 years (+/- 3.2) and a mean body mass index (BMI) of 32.3 kg/m2 (+/- 4.2). The greatest change in meniscal extrusion appeared medially with incident meniscal tear (4.4%; absolute 0.9 mm (95% CI: 0.3, 1.5; p= 0.004); relative 14.5% (4.4, 24.7; 0.005)). Varus malalignment was associated with an increase of medial extrusion of 0.6 mm (37.6%; 0.1, 1.0; 0.009)). A 5 kg/m2 higher baseline BMI was associated with absolute and relative increase of medial extrusion of 0.2 mm and 2.96% (0.1, 0.3; <0.001 and 1.3, 4.8; 0.002). Less explicit but significant changes in extrusion appeared with longitudinal change in BMI.

Conclusion: Meniscal tears, varus malalignment and BMI were significantly associated with change in meniscal extrusion in middle-aged overweight women, providing viable therapeutic targets to prevent or reduce extrusion and thereby decelerate KOA development.
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http://dx.doi.org/10.1093/rheumatology/keab228DOI Listing
March 2021

Diagnostic criteria for early hip osteoarthritis; first steps, based on the CHECK study.

Rheumatology (Oxford) 2021 Feb 12. Epub 2021 Feb 12.

Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.

Objectives: Although there is a general focus on early diagnosis and treatment of hip osteoarthritis, there are no validated diagnostic criteria for early-stage hip OA. The current study aimed to take the first steps in developing diagnostic criteria for early-stage hip OA, using factors obtained through history taking, physical examination, radiography and blood testing at the first consultation in individuals presenting with hip pain, suspicious for hip OA, in primary care.

Methods: Data of the 543 individuals with 735 symptomatic hips at baseline who had any follow-up data available from the prospective CHECK cohort study were used. A group of 26 clinical experts (GPs, Rheumatologists and Orthopedic surgeons) evaluated standardized clinical assessment forms of all subjects on the presence of clinically relevant hip OA 5 to 10 years after baseline. Using the expert based diagnoses as reference standard, a backward selection method was used to create predictive models based on pre-defined baseline factors from history taking, physical examination, radiography and blood testing.

Results: Prevalence of clinically relevant hip OA during follow-up was 22%. Created models contained 4 to 8 baseline factors (mainly WOMAC pain items, painful/restricted movements, and radiographic features) and obtained area under the curve between 0.62 ± 0.002 and 0.71 ± 0.002.

Conclusion: Based on clinical and radiographic features of hip OA obtained at first consultation at a GP for pain/stiffness of the hip, the prediction of clinically relevant hip OA within 5 to 10 years was 'poor' to 'fair'.
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http://dx.doi.org/10.1093/rheumatology/keab111DOI Listing
February 2021

Characteristics associated between the incidence of hip osteoarthritis and early hip complaints (CHECK study) within 10 years.

Rheumatology (Oxford) 2021 Feb 11. Epub 2021 Feb 11.

Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands.

Objective: To determine which baseline characteristics, especially clinically variables like pain, stiffness, physical functioning and disease variables, are associated with incident hip osteoarthritis (OA) within 10-years in first presenters with hip complaints.

Methods: Data were obtained from the nationwide prospective Cohort Hip and Cohort Knee (CHECK) study (n = 1002). Incident hip OA was defined as fulfilling the clinical ACR criteria for hip OA, a Kellgren and Lawrence score ≥2 with hip pain, or received a hip replacement during follow-up. Baseline measurements were used of participants with hip complaints and without hip OA. Principal component analysis (PCA) was used to reduce the number of correlated variables. Associations between baseline characteristics (including PCA components) and incident hip OA were investigated using logistic regression analysis, adjusted for age, sex and BMI.

Results: In total 312 participants (85% female and 98% Caucasian) were included, 181 developed hip OA. PCA resulted in four components. Incident hip OA was associated with i) component 1 [general presence of pain and symptoms] [OR = 1.46 (95%CI 1.08-1.98)], ii) component 3 [relatively high levels of pain during shopping/walking combined with less difficulty with putting socks on/off and rising from bed] [OR = 1.58 (95%CI 1.18-2.12)] and iii) knee pain [OR = 0.34 (95%CI 0.17-0.66)].

Conclusion: In first presenters with hip complaints, use of a few history taking variables might allow better recognition of those at higher odds for incident hip OA within 10-year.
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http://dx.doi.org/10.1093/rheumatology/keab137DOI Listing
February 2021

Effects of mechanical interventions in the management of knee osteoarthritis: protocol for an OA Trial Bank systematic review and individual participant data meta-analysis.

BMJ Open 2021 02 5;11(2):e043026. Epub 2021 Feb 5.

Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.

Introduction: Knee osteoarthritis (OA) is a prevalent and disabling musculoskeletal condition. Biomechanical factors may play a key role in the aetiology of knee OA, therefore, a broad class of interventions involves the application or wear of devices designed to mechanically support knees with OA. These include gait aids, bracing, taping, orthotics and footwear. The literature regarding efficacy of mechanical interventions has been conflicting or inconclusive, and this may be because certain subgroups with knee OA respond better to mechanical interventions. Our primary aim is to identify subgroups with knee OA who respond favourably to mechanical interventions.

Methods And Analysis: We will conduct a systematic review to identify randomised clinical trials of any mechanical intervention for the treatment of knee OA. We will invite lead authors of eligible studies to share individual participant data (IPD). We will perform an IPD meta-analysis for each type of mechanical intervention to evaluate efficacy, with our main outcome being pain. Where IPD are not available, this will be achieved using aggregate data. We will then evaluate five potential treatment effect modifiers using a two-stage approach. If data permit, we will also evaluate whether biomechanics mediate the effects of mechanical interventions on pain in knee OA.

Ethics And Dissemination: No new data will be collected in this study. We will adhere to institutional, national and international regulations regarding the secure and confidential sharing of IPD, addressing ethics as indicated. We will disseminate findings via international conferences, open-source publication in peer-reviewed journals and summaries posted on websites serving the public and clinicians.

Prospero Registration Number: CRD42020155466.
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http://dx.doi.org/10.1136/bmjopen-2020-043026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925922PMC
February 2021

T2 relaxation times of knee cartilage in 109 patients with knee pain and its association with disease characteristics.

Acta Orthop 2021 06 4;92(3):335-340. Epub 2021 Feb 4.

Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, The Netherlands;

Background and purpose - Quantitative T2 mapping MRI of cartilage has proven value for the assessment of early osteoarthritis changes in research. We evaluated knee cartilage T2 relaxation times in a clinical population with knee complaints and its association with patients and disease characteristics and clinical symptoms.Patients and methods - In this cross-sectional study, T2 mapping knee scans of 109 patients with knee pain who were referred for an MRI by an orthopedic surgeon were collected. T2 relaxation times were calculated in 6 femoral and tibial regions of interest of full-thickness tibiofemoral cartilage. Its associations with age, sex, BMI, duration of complaints, disease onset (acute/chronic), and clinical symptoms were assessed with multivariate regression analysis. Subgroups were created of patients with abnormalities expected to cause predominantly medial or lateral tibiofemoral cartilage changes.Results - T2 relaxation times increased statistically significantly with higher age and BMI. In patients with expected medial cartilage damage, the medial femoral T2 values were significantly higher than the lateral; in patients with expected lateral cartilage damage the lateral tibial T2 values were significantly higher. A traumatic onset of knee complaints was associated with an acute elevation. No significant association was found with clinical symptoms.Interpretation - Our study demonstrates age, BMI, and type of injury-dependent T2 relaxation times and emphasizes the importance of acknowledging these variations when performing T2 mapping in a clinical population.
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http://dx.doi.org/10.1080/17453674.2021.1882131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8231385PMC
June 2021

Association between Baseline Osteoarthritic Features on MR Imaging and Clinical Outcome after Genicular Artery Embolization for Knee Osteoarthritis.

J Vasc Interv Radiol 2021 04 29;32(4):497-503. Epub 2021 Jan 29.

Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, P.O. box 2040, 3000 CA Rotterdam, the Netherlands. Electronic address:

Purpose: To explore the association between baseline osteoarthritis (OA)-related magnetic resonance (MR) imaging features and pain reduction after genicular artery embolization (GAE) in patients with mild-to-moderate symptomatic knee OA resistant to conservative therapy.

Materials And Methods: This was a retrospective analysis of patients with mild-to-moderate symptomatic knee OA treated with GAE using imipenem-cilastatin sodium. The clinical outcome was scored at baseline and 6 months after treatment using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). MR images were scored using the MR imaging osteoarthritis knee score. Linear regression was used to evaluate associations of before-treatment MR imaging scores with WOMAC and WOMAC reduction after 6 months.

Results: Fifty-four patients (22.2% male; median age, 69.4 years; median WOMAC at baseline, 12) were evaluated. Of all OA features scored, a higher cartilage full-thickness defect score showed the strongest association with less reduction of both WOMAC (B,-0.63 [95% confidence interval (CI), -0.91 to -0.34]; P < .001) and WOMAC scores (B, -1.77 [95% CI, -2.87 to -0.67]; P < .001) following treatment. The presence of grade 2-3 effusion synovitis (B, -2.99 [95% CI, -5.39 to -0.60]) bone marrow lesions (B, -0.52 [95% CI, -0.86 to -0.19]), osteophytes (B, -0.21 [95% CI, -0.36 to -0.06]), and cartilage defect surface area score (B, -0.25 [95% CI -0.42 to -0.08]) all showed a significant association with less WOMAC reduction (all P < .05).

Conclusions: In patients with mild-to-moderate symptomatic knee OA treated with GAE, the presence and severity of full-thickness cartilage defects, effusion synovitis, bone marrow lesions, osteophytes, and cartilage surface area scores at baseline are associated with less favorable clinical outcomes at 6 months.
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http://dx.doi.org/10.1016/j.jvir.2020.12.008DOI Listing
April 2021

Temporal relationship between osteoarthritis and comorbidities: a combined case control and cohort study in the UK primary care setting.

Rheumatology (Oxford) 2021 Jan 28. Epub 2021 Jan 28.

Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, UK.

Objective: To determine the burden of comorbidities in osteoarthritis (OA) and their temporal relationships in the UK.

Methods: The Clinical Practice Research Datalink (CPRD) GOLD was used to identify people with incident OA and age, gender and practice matched non-OA controls from UK primary care. Controls were assigned the same index date as matched cases (date of OA diagnosis). Associations between OA and 49 individual comorbidities and multimorbidity (≥2 comorbidities excluding OA) both before and after OA diagnosis were estimated, adjusting for covariates, using odds ratios (aOR) and hazard ratios (aHR) respectively.

Results: During 1997-2017, we identified 221 807 incident OA cases and 221 807 matched controls. Of 49 comorbidities examined, 38 were associated with OA both prior to, and following, the diagnosis of OA, and 2 (dementia and SLE) were associated with OA only following the diagnosis of OA. People with OA had higher risk of developing heart failure (aHR 1.63; 95% CI 1.56-1.71), dementia (aHR 1.62; 95% CI 1.56-1.68), liver diseases (aHR 1.51; 95% CI 1.37-1.67), irritable bowel syndrome (aHR 1.51; 95% CI 1.45-1.58), gastrointestinal bleeding (aHR 1.49; 95% CI 1.39-1.59), 10 musculoskeletal conditions and 25 other conditions following OA diagnosis. The aOR for multimorbidity prior to the index date was 1.71 (95% CI 1.69-1.74), whereas the aHR for multimorbidity after the index date was 1.29 (95% CI 1.28-1.30).

Conclusions: People with OA are more likely to have other chronic conditions both before and after the OA diagnosis. Further study on shared aetiology and causality of these associations is needed.
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http://dx.doi.org/10.1093/rheumatology/keab067DOI Listing
January 2021

10-Year natural course of early hip osteoarthritis in middle-aged persons with hip pain: a CHECK study.

Ann Rheum Dis 2021 Jan 15. Epub 2021 Jan 15.

Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.

Objective: To explore the natural course of hip osteoarthritis (OA) in a population of first-time presenters with hip complaints.

Methods: Data were collected at baseline and after 2, 5, 8 and 10 years on participants from the Cohort Hip and Cohort Knee study with early symptomatic hip OA. Descriptive statistics were used to analyse the natural course of the hip complaints with respect to clinical signs and symptoms, physical functioning and radiographic osteoarthritis (ROA) features.

Results: In total, 588 participants were included with hip complaints and 86% completed the 10-year follow-up. The 10-year follow-up showed that 12% (69 participants) underwent hip replacement (HR), an increase of ROA of the hip (Kellgren and Lawrence score≥2) from 19% to 49%, and an increase in clinical hip OA according to the American College of Rheumatology criteria from 27% to 43%. All Western Ontario and McMaster Osteoarthritis Index subscales and physical activity remained on average constant during the 10-year follow-up for those who did not undergo an HR. The use of pain medication increased from 43% at baseline to 50% after 10 years.

Conclusion: One out of nine participants with early hip problems received an HR during the 10-year follow-up. Prevalence of clinical hip OA and hip ROA increased steadily during the 10-year follow-up. Overall, we observed more hip OA, but fewer or stable complaints with respect to clinical signs and symptoms, and physical functioning. So it could be cautiously concluded that after 10 years, first-time presenters with hip complaints either received an HR or their symptoms remained stable.
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http://dx.doi.org/10.1136/annrheumdis-2020-218625DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7958083PMC
January 2021

Developing clinical prediction models for nonrecovery in older patients seeking care for back pain: the back complaints in the elders prospective cohort study.

Pain 2021 06;162(6):1632-1640

Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.

Abstract: Back pain is a leading cause of disability worldwide and is common in older adults. No clinical prediction models for poor long-term outcomes have been developed in older patients with back pain. This study aimed to develop and internally validate 3 clinical prediction models for nonrecovery in this population. A prospective cohort study in general practice was conducted (Back Complaints in the Elders, Netherlands), including 675 patients >55 years with a new episode of care for back pain. Three definitions of nonrecovery were used combining 6-month and 12-month follow-up data: (1) persistent back pain, (2) persistent disability, and (3) perceived nonrecovery. Sample size calculation resulted in a maximum of 14 candidate predictors that were selected from back pain prognostic literature and clinical experience. Multivariable logistic regression was used to develop the models (backward selection procedure). Models' performance was evaluated with explained variance (Nagelkerke's R2), calibration (Hosmer-Lemeshow test), and discrimination (area under the curve [AUC]) measures. The models were internally validated in 250 bootstrapped samples to correct for overoptimism. All 3 models displayed good overall performance during development and internal validation (ie, R2 > 30%; AUC > 0.77). The model predicting persistent disability performed best, showing good calibration, discrimination (AUC 0.86, 95% confidence interval 0.83-0.89; optimism-adjusted AUC 0.85), and explained variance (R2 49%, optimism-adjusted R2 46%). Common predictors in all models were: age, chronic duration, disability, a recent back pain episode, and patients' recovery expectations. Spinal morning stiffness and pain during spinal rotation were included in 2 of 3 models. These models should be externally validated before being used in a clinical primary care setting.
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http://dx.doi.org/10.1097/j.pain.0000000000002161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120685PMC
June 2021

Quantitative volume and dynamic contrast-enhanced MRI derived perfusion of the infrapatellar fat pad in patellofemoral pain.

Quant Imaging Med Surg 2021 Jan;11(1):133-142

Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.

Background: Patellofemoral pain (PFP) is a common knee condition and possible precursor of knee osteoarthritis (OA). Inflammation, leading to an increased perfusion, or increased volume of the infrapatellar fat pad (IPFP) may induce knee pain. The aim of the study was to compare quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters, as imaging biomarkers of inflammation, and volume of the IPFP between patients with PFP and controls and between patients with and without IPFP edema or joint effusion.

Methods: Patients with PFP and healthy controls were included and underwent non-fat suppressed 3D fast-spoiled gradient-echo (FSPGR) and DCE-MRI. Image registration was applied to correct for motion. The IPFP was delineated on FSPGR using Horos software. Volume was calculated and quantitative perfusion parameters were extracted by fitting extended Tofts' pharmacokinetic model. Differences in volume and DCE-MRI parameters between patients and controls were tested by linear regression analyses. IPFP edema and effusion were analyzed identically.

Results: Forty-three controls and 35 PFP patients were included. Mean IPFP volume was 26.04 (4.18) mL in control subjects and 27.52 (5.37) mL in patients. Median K was 0.017 (0.016) min in control subjects and 0.016 (0.020) min in patients. None of the differences in volume and perfusion parameters were statistically significant. Knees with effusion showed a higher perfusion of the IPFP compared to knees without effusion in patients only.

Conclusions: The IPFP has been implicated as source of knee pain, but higher DCE-MR blood perfusion, an imaging biomarker of inflammation, and larger volume are not associated with PFP. Patient's knees with effusion showed a higher perfusion, pointing towards inflammation.
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http://dx.doi.org/10.21037/qims-20-441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719925PMC
January 2021

Patellofemoral alignment, morphology and structural features are not related to sitting pain in individuals with patellofemoral pain.

Knee 2021 Jan 14;28:104-109. Epub 2020 Dec 14.

Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands.

Background: Sitting-related pain is a common feature of patellofemoral pain (PFP). However, little is known regarding features associated with sitting-related PFP. The aim of this study was to determine whether sitting-related PFP is associated with patellofemoral alignment, morphology and structural magnetic resonance imaging (MRI) features of the patellofemoral joint (cartilage lesions, bone marrow lesions, fat pad synovitis).

Methods: 133 individuals with PFP were included from two unique but similar cohorts. Participants were classified into one of three groups based on their response to item 8 of the Anterior Knee Pain Scale: (i) problems with sitting; (ii) sitting pain after exercise; and (iii) no difficulty with sitting. All participants underwent 3T Magnetic Resonance Imaging (MRI) to enable: (i) scoring of structural features of the patellofemoral joint with MRI Osteoarthritis Knee Score (MOAKS); and (ii) patellofemoral alignment and morphology measurements using standardised methods. The association of sitting pain to bony alignment, morphology and MOAKS features were evaluated using multinomial logistic regression (adjusted for age, sex, BMI; reference group = no difficulty with sitting).

Results: 82 (61.7%) participants reported problems with sitting, and 24 (18%) participants reported sitting pain after exercise. There were no significant associations between the presence of sitting pain and any morphology, alignment or structural characteristics.

Conclusions: Findings indicate that PFP related to sitting is not associated with patellofemoral alignment, morphology, or structural MRI features of the patellofemoral joint. Further research to determine mechanisms of sitting-related PFP, and inform targeted treatments, are required.
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http://dx.doi.org/10.1016/j.knee.2020.10.009DOI Listing
January 2021

Effectiveness of a high volume injection as treatment for chronic Achilles tendinopathy: randomised controlled trial.

BMJ 2020 09 9;370:m3027. Epub 2020 Sep 9.

Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, Netherlands

Objective: To study whether a high volume injection without corticosteroids improves clinical outcome in addition to usual care for adults with chronic midportion Achilles tendinopathy.

Design: Patient and assessor blinded, placebo controlled randomised clinical trial.

Setting: Sports medicine department of a large district general hospital, the Netherlands.

Participants: 80 adults (aged 18-70 years) with clinically diagnosed chronic midportion Achilles tendinopathy and neovascularisation on ultrasonography. 39 were randomised to a high volume injection without corticosteroids and 41 to placebo.

Interventions: Participants were instructed to perform an exercise programme for 24 weeks (usual care) combined with one 50 mL high volume injection of saline and lidocaine (intervention group) or one 2 mL placebo injection of saline and lidocaine (placebo group) at baseline.

Main Outcome Measures: Primary outcome was pain and function assessed using the validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire at 24 weeks (analysed using a generalised estimation equations model). Secondary outcomes were patient satisfaction, return to sport, degree of ultrasonographic Doppler flow, visual analogue scale on 10 hop test, power and flexibility of the gastrocnemius and soleus muscles, pain detect questionnaire for neuropathic pain, and pain coping inventory. Participants were evaluated at baseline and at 2, 6, 12, and 24 weeks.

Results: Only one participant (1%) was lost to follow-up. The estimated mean VISA-A score improved significantly, from 40.4 (95% confidence interval 32.0 to 48.7) at baseline to 59.1 (50.4 to 67.8) at 24 weeks in the high volume injection group and from 36.9 (27.1 to 46.8) to 58.5 (47.9 to 69.1) in the placebo group. The VISA-A score over time did not differ between the groups (adjusted between group difference at 24 weeks 0.5 points, 95% confidence interval -17.8 to 18.8). No significant between group differences were found for patient satisfaction (21/37 (57%) 19/39 (49%) patients, P=0.50) and return to desired sport (15/29 (52%) 19/31 (61%) patients active in sports, P=0.65) at 24 weeks. None of the other secondary outcomes differed between the two groups.

Conclusions: A high volume injection without corticosteroids in addition to usual care is not effective for symptom reduction in patients with chronic midportion Achilles tendinopathy. On the basis of our findings, we cannot recommend the use of a high volume injection in this patient group.

Trial Registration: ClinicalTrials.gov NCT02996409.
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http://dx.doi.org/10.1136/bmj.m3027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7479639PMC
September 2020

Antidepressant and anticonvulsant prescription rates in patients with osteoarthritis: a population-based cohort study.

Rheumatology (Oxford) 2021 05;60(5):2206-2216

Department of General Practice.

Objectives: There are signs that antidepressants and anticonvulsants are being prescribed more often for OA patients, despite limited evidence. Our objectives were to examine prescription rates and time trends for antidepressants and anticonvulsants in OA patients, to assess the percentage of long-term prescriptions, and to determine patient characteristics associated with antidepressant or anticonvulsant prescription.

Methods: A population-based cohort study was conducted using the Integrated Primary Care Information database. First, episodic and prevalent prescription rates for antidepressants (amitriptyline, nortriptyline and duloxetine) and anticonvulsants (gabapentinoids) in OA patients were calculated for the period 2008-17. Logistic regression was used to assess which patient characteristics were associated with prescriptions.

Results: In total, 164 292 OA patients were included. The prescription rates of amitriptyline, gabapentin and pregabalin increased over time. The increase in prescription rates for pregabalin was most pronounced. Episodic prescription rate increased from 7.1 to 13.9 per 1000 person-years between 2008 and 2017. Amitriptyline was prescribed most (15.1 episodic prescriptions per 1000 person-years in 2017). Prescription rates of nortriptyline and duloxetine remained stable at 3.0 and 2.0 episodic prescriptions per 1000 person-years, respectively. For ≤3% of patients with incident OA, medication was prescribed long-term (≥3 months). In general, all medication was prescribed more frequently for older patients (except duloxetine), women, patients with OA in ≥2 joints, patients with spinal OA and patients with musculoskeletal disorders.

Conclusion: Prescription rates of amitriptyline, gabapentin and pregabalin increased over time. Since there is little evidence to support prescription in OA, caution is necessary when prescribing.
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http://dx.doi.org/10.1093/rheumatology/keaa544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8121444PMC
May 2021

Diagnostic accuracy of history taking, physical examination and imaging for non-chronic finger, hand and wrist ligament and tendon injuries: a systematic review update.

BMJ Open 2020 11 5;10(11):e037810. Epub 2020 Nov 5.

Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands.

Objective: The diagnostic work-up for ligament and tendon injuries of the finger, hand and wrist consists of history taking, physical examination and imaging if needed, but the supporting evidence is limited. The main purpose of this study was to systematically update the literature for studies on the diagnostic accuracy of tests for detecting non-chronic ligament and tendon injuries of the finger, hand and wrist.

Methods: Medline, Embase, Cochrane Library, Web of Science, Google Scholar ProQuest and Cinahl were searched from 2000 up to 6 February 2019 for identifying studies. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 checklist, and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted.

Results: None of the studies involved history taking. Physical examination, for diagnosing lesions of the triangular fibrocartilage complex (TFCC), showed Se, Sp, accuracy, PPV and NPV ranging from 58% to 90%, 20% to 69%, 56% to 73%, 53% to 71% and 55% to 65%, respectively. Physical examination in hand and finger injuries the Se, Sp, accuracy, PPV and NPV ranged from 88% to 99%, 75% to 100%, 34% to 88%, 91% to 100% and 75% to 95%, respectively. The accuracy of MRI with high-resolution (3 T) techniques for TFCC and interosseous ligaments of the proximal carpal row ranged from 89% to 91% and 75% to 100%, respectively. The accuracy of MRI with low-resolution (1.5 T) techniques for TFCC and interosseous ligaments of the proximal carpal row ranged from 81% to 100% and 67% to 95%, respectively.

Conclusions: There is limited evidence on the diagnostic accuracy of history taking and physical examination for non-chronic finger, hand and wrist ligament and tendon injuries. Although some imaging modalities seemed to be acceptable for the diagnosis of ligament and tendon injuries in the wrist in patients presenting to secondary care, there is no evidence-based advise possible for the diagnosis of non-chronic finger, hand or wrist ligament and tendon injuries in primary care.
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http://dx.doi.org/10.1136/bmjopen-2020-037810DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646346PMC
November 2020

Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review.

J Clin Med 2020 Oct 23;9(11). Epub 2020 Oct 23.

Department of General Practice, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.

Patellofemoral pain (PFP) and patellofemoral osteoarthritis (PFOA) are common, persistent conditions that may lie along a pathological spectrum. While evidence supports exercise-therapy as a core treatment for PFP and PFOA, primary care physicians commonly prescribe medication, or refer for surgical consults in persistent cases. We conducted a systematic review of medical interventions (pharmaceutical, nutraceutical, and surgical) for PFP and PFOA to inform primary care decision making.

Methods: Following protocol registration, we searched seven databases for randomized clinical trials of our target interventions for PFP and PFOA. Our primary outcome was pain. We assessed risk of bias, calculated standardized mean differences (SMDs) and determined the level of evidence for each intervention.

Results: We included 14 publications investigating pharmaceutical or nutraceutical interventions, and eight publications investigating surgical interventions. Two randomized control trials (RCTs) provided moderate evidence of patellofemoral arthroplasty having similar pain outcomes compared to total knee arthroplasty in isolated PFOA, with SMDs ranging from -0.3 (95% CI -0.8, 0.2, Western Ontario McMaster Pain Subscale, 1 year post-surgery) to 0.3 (-0.1, 0.7, SF-36 Bodily Pain, 2 years post-surgery). Remaining studies provided, at most, limited evidence. No efficacy was demonstrated for oral nonsteroidal anti-inflammatories or arthroscopic surgery.

Conclusions: Pharmaceutical and nutraceutical prescriptions, and surgical referrals are currently being made with little supporting evidence, with some interventions showing limited efficacy. This should be considered within the broader context of evidence supporting exercise-therapy as a core treatment for PFP and PFOA.
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http://dx.doi.org/10.3390/jcm9113397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690719PMC
October 2020

The Added Value of Radiographs in Diagnosing Knee Osteoarthritis Is Similar for General Practitioners and Secondary Care Physicians; Data from the CHECK Early Osteoarthritis Cohort.

J Clin Med 2020 10 21;9(10). Epub 2020 Oct 21.

Department of General Practice, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands.

Objective: The purpose of this study was to evaluate the added value of radiographs for diagnosing knee osteoarthritis (KOA) by general practitioners (GPs) and secondary care physicians (SPs).

Methods: Seventeen GPs and nineteen SPs were recruited to evaluate 1185 knees from the CHECK cohort (presenters with knee pain in primary care) for the presence of clinically relevant osteoarthritis (OA) during follow-up. Experts were required to make diagnoses independently, first based on clinical data only and then on clinical plus radiographic data, and to provide certainty scores (ranging from 1 to 100, where 1 was "certainly no OA" and 100 was "certainly OA"). Next, experts held consensus meetings to agree on the final diagnosis. With the final diagnosis as gold standard, diagnostic indicators were calculated (sensitivity, specificity, positive/negative predictive value, accuracy and positive/negative likelihood ratio) for all knees, as well as for clinically "certain" and "uncertain" knees, respectively. Student paired -tests compared certainty scores.

Results: Most diagnoses of GPs (86%) and SPs (82%) were "consistent" after assessment of radiographic data. Diagnostic indicators improved similarly for GPs and SPs after evaluating the radiographic data, but only improved relevantly in clinically "uncertain" knees. Radiographs added some certainty to "consistent" OA knees (GP 69 vs. 72, < 0.001; SP 70 vs. 77, < 0.001), but not to the consistent no OA knees (GP 21 vs. 22, = 0.16; SP 20 vs. 21, = 0.04).

Conclusions: The added value of radiographs is similar for GP and SP, in terms of diagnostic accuracy and certainty. Radiographs appear to be redundant when clinicians are certain of their clinical diagnosis.
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http://dx.doi.org/10.3390/jcm9103374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594082PMC
October 2020

Responders to Exercise Therapy in Patients with Osteoarthritis of the Hip: A Systematic Review and Meta-Analysis.

Int J Environ Res Public Health 2020 10 10;17(20). Epub 2020 Oct 10.

Department of General Practice, Erasmus MC University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands.

The Outcome Measures in Rheumatology workgroup (OMERACT), together with the Osteoarthritis Research Society International (OARSI) developed the OMERACT-OARSI responder criteria. These criteria are used to determine if a patient with osteoarthritis (OA) 'responds' to therapy, meaning experiences a clinically relevant effect of therapy. Recently, more clinical OA trials report on this outcome and most OA trials have data to calculate the number of responders according to these criteria. A systematic review and meta-analysis were performed on the response to exercise therapy, compared to no or minimal intervention in patients with hip OA using the OMERACT-OARSI responder criteria. The literature was searched for relevant randomized trials. If a trial fit the inclusion criteria, but number of responders was not reported, the first author was contacted. This way the numbers of responders of 14 trials were collected and a meta-analysis on short term (directly after treatment, 12 trials = 1178) and long term (6-8 months after treatment, six trials = 519) outcomes was performed. At short term, the risk difference (RD) was 0.14 (95% confidence interval (CI) 0.06-0.22) and number needed to treat (NNT) 7.1 (95% CI 4.5-17); at long term RD was 0.14 (95% CI 0.07-0.20) and NNT 7.1 (95% CI 5.0-14.3). Quality of evidence was moderate for the short term and high for the long term. In conclusion, 14% more hip OA patients responded to exercise therapy than to no therapy.
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http://dx.doi.org/10.3390/ijerph17207380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600967PMC
October 2020

Structural spinal abnormalities on MRI and associations with weight status in a general pediatric population.

Spine J 2021 03 10;21(3):465-476. Epub 2020 Oct 10.

Department of General Practice, Erasmus MC University Medical Center Rotterdam. P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.

Background Context: Several spinal abnormalities have been studied using magnetic resonance imaging (MRI). However, in children these studies were sparsely performed in general populations. Examining young children's spines is important since the shape of the bone is largely determined during the growth spurt. Furthermore, it is so far unknown if associations between weight status and spinal abnormalities, which are known for adolescents and adults, are already present in young children.

Purpose: We aimed to present the prevalence of structural abnormalities in the prepubertal pediatric spine on MRI and their association with measures of the children's body weight and body composition.

Study Design: Cross-sectional study embedded in a prospective population-based birth cohort study.

Patient Sample: For this study, participants from the Generation R Study were selected based on the availability of MRI data of the lumbar spine and accelerometry data at the age of 9 years.

Outcome Measures: The presence of structural abnormalities of intervertebral discs and vertebrae was scored on MRI. The body mass index-standard deviation [BMI-SD] score was calculated from objectively measured weight and height, and body composition measurements were obtained by a dual-energy X-ray absorptiometry scan.

Methods: A semiquantitative scoring tool to assess the intervertebral discs and vertebrae of the lumbar spine on conventional MRI was designed for this purpose. Proportions of children with spinal abnormalities on at least one lumbar vertebral level were presented. Logistic regression was used to analyze associations between abnormalities and weight and body composition. We declare not to have any financial conflicts of interests.

Results: We included 559 children (median age of 9.88 years (interquartile range 6.74-10.02), 48.5% boys). Most frequently observed abnormalities of the intervertebral discs were abnormal signal intensity (24.9%), decreased or collapsed disc height (37.6%), disc bulging (73.3%), and abnormal nuclear shape (29.1%). Vertebral endplate irregularities and lumbosacral transitional vertebrae were seen in respectively 40% and 9.3% of the participants. Except for disc bulging, all abnormalities were predominantly present at the L5 level. Only the presence of endplate irregularities was associated with a higher body weight (BMI SD score (odds ratio [OR] 1.50 [95% confidence interval [CI] 1.21-1.86]) and BMI SD change (OR 1.48 [95% CI 1.07-2.03])) and increased body mass values in body composition measurements (% body fat (OR 1.05 [95% CI 1.02-1.09), fat mass index (OR 1.23 [95% CI 1.09-1.39]), and fat-free mass index (OR 1.30 [95% CI 1.06-1.59])) in adjusted analyses.

Conclusions: Structural spinal abnormalities, especially disc bulging, endplate irregularities, and an abnormal disc height, are already present in children aged 9 years from a Dutch population-based cohort. Of those abnormalities, endplate irregularities are associated with various weight and body composition measurements.
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http://dx.doi.org/10.1016/j.spinee.2020.10.003DOI Listing
March 2021

Consequences and Prognosis of Running-Related Knee Injuries Among Recreational Runners.

Clin J Sport Med 2020 Sep 15. Epub 2020 Sep 15.

Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Objective: To investigate the consequences and prognostic factors of running-related knee injuries (RRKIs) among recreational runners.

Design: Prospective cohort study.

Setting: This study is part of a randomized-controlled trial (RCT) on running injury prevention among recreational runners. At baseline during registration for a running event (5-42 km), demographic and training variables were collected. Participants who reported a new RRKI during follow-up were sent a knee-specific questionnaire at 16 months (range 11.7-18.6) after baseline.

Participants: One hundred thirty-eight runners who reported a new RRKI during the RCT on injury prevention responded to the knee-specific questionnaire.

Assessment Of Risk Factors: To determine the association between potential prognostic factors and time to recovery of an RRKI, a Cox regression analysis was performed.

Main Outcome Measures: Time to recovery and prognostic factors of RRKIs.

Results: At 16 months after registration, 71.0% of the participants reported full recovery, with a median time to recovery of 8.0 weeks. Most participants reported iliotibial band syndrome (23.2%) or osteoarthritis (OA)/degenerative meniscopathy (23.2%) as cause of their injury. Male sex was associated with a shorter time to recovery [hazard ratio (HR) 1.84; 95% confidence interval (CI), 1.14-2.97], while suffering knee OA was associated with a longer time to recovery (HR 0.17; 95% CI, 0.06-0.46).

Conclusions: Nonrecovered participants adjusted running speed more often and had knee imaging more often than recovered participants. At follow-up, one-third of the participants were not recovered. This emphasizes the need for injury prevention programs for runners. More knowledge on the role of running in knee OA seems important, given the high number of participants with knee OA symptoms.
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http://dx.doi.org/10.1097/JSM.0000000000000861DOI Listing
September 2020

Custom insoles versus sham and GP-led usual care in patients with plantar heel pain: results of the STAP-study - a randomised controlled trial.

Br J Sports Med 2021 Mar 2;55(5):272-278. Epub 2020 Sep 2.

Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands

Objectives: To compare custom-made insoles to sham insoles and general practice (GP)-led usual care in terms of pain at rest and during activity at 12 weeks follow-up in individuals with plantar heel pain.

Methods: In this randomised clinical trial 185 patients aged 18 to 65 years, with a clinical diagnosis of plantar heel pain for at least 2 weeks, but no longer than 2 years were recruited. Patients were randomly allocated into three groups: (1) GP-led treatment, plus an information booklet with exercises (usual care; n=46), (2) referral to a podiatrist for treatment with a custom-made insole plus an information booklet with exercises (custom-made insole; n=70) and (3) referral to a podiatrist and treatment with a sham insole plus an information booklet with exercises (sham insole; n=69). As well as the primary outcome of pain severity (11-point Numerical Rating Scale) we used the Foot Function Index (0 to 100) as a secondary outcome.

Results: Of 185 randomised participants, 176 completed the 12-week follow-up. There was no difference in pain or function between the insole and the sham groups at 12 weeks. Participants in the GP-led usual care group reported less pain during activity at 12 weeks, (mean difference (MD) 0.94, 95% CI 0.23 to 1.65), less first step pain (MD 1.48, 95% CI 0.65 to 2.31), better function (MD 7.37, 95% CI 1.27 to 13.46) and higher recovery rates (RR 0.48, 95% CI 0.24 to 0.96) compared with participants in the custom insole group.

Conclusions: Referral to a podiatrist for a custom-made insole does not lead to a better outcome compared to sham insoles or compared to GP-led usual care.

Trial Registration Number: NTR5346.
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http://dx.doi.org/10.1136/bjsports-2019-101409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907578PMC
March 2021

Clinical and radiographic features of spinal osteoarthritis predict long-term persistence and severity of back pain in older adults.

Ann Phys Rehabil Med 2020 Aug 27:101427. Epub 2020 Aug 27.

Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands; Department of Orthopedics, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.

Background: Patients with back pain can show one or more features of spinal osteoarthritis (OA), such as morning stiffness, limited or painful range of motion (ROM), and lumbar disc degeneration (LDD). However, it has not been investigated whether these features are prognostic of long-term back pain.

Objectives: This study assessed whether spinal morning stiffness, ROM and LDD are prognostic factors for back pain after 1 year in older adults with back pain.

Methods: This prospective observational study (BACE cohort) included patients aged>55 years visiting a general practitioner for a back-pain episode. Baseline patient-reported morning stiffness, physical examined ROM and radiographic LDD features (i.e., multilevel osteophytes and disc space narrowing) were analysed as potential prognostic factors in unadjusted and adjusted regression models with the outcomes of persistent back pain (yes/no) and back pain severity after 1-year follow-up.

Results: This study included 543 patients with mean (SD) age 67 (8) years, 59% female, and 62% reporting back pain at 1-year follow-up. When studied in separate adjusted models, persistent back pain was associated with morning stiffness>30min (OR 3.0, 95%CI 1.3; 5.5), restricted lateroflexion (OR 1.8, 95%CI 1.0; 3.2), pain during rotation (OR=1.7, 95%CI 1.0; 2.9), multilevel osteophytes (OR 2.4, 95%CI 1.4; 4.1), and multilevel disc space narrowing (OR 1.5, 95%CI 0.9; 2.4). When investigated in the same adjusted model, persistent back pain remained associated with only morning stiffness>30min (OR 2.4, 95%CI 1.0; 3.9), pain during rotation (OR 1.6, 95%CI 0.9; 2.8), and multilevel osteophytes (OR 2.1, 95%CI 1.2; 3.7). The same spinal OA-related features were associated with back pain severity.

Conclusions: Spinal morning stiffness, painful rotation, and multilevel osteophytes are prognostic factors for persistent back pain and back pain severity after 1 year. Evaluating these clinical and radiographic features of spinal OA could help clinicians identify older patients who will experience long-term back pain.
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http://dx.doi.org/10.1016/j.rehab.2020.07.010DOI Listing
August 2020

The impact of injury definitions on measures of injury occurrence in classical music students: a prospective cohort study.

BMC Musculoskelet Disord 2020 Aug 11;21(1):534. Epub 2020 Aug 11.

Codarts Rotterdam, University of the Arts, Kruisplein 26, 3012 CC, Rotterdam, The Netherlands.

Background: Multiple definitions are used to investigate injuries in musicians, resulting in a wide range of prevalence rates. The aim of this study is to establish the impact of different injury definitions on the prevalence of injuries and disability in classical music students. Moreover, the practical implications of using different injury definitions are considered.

Methods: A prospective cohort study among first-year classical music students was performed using bi-monthly questionnaires focusing on injuries. Three injury definitions were used: 1) all MSK complaints injury (any MSK complaint resulting in a VAS pain score > 0 in the past eight weeks), 2) medical attention injury (any MSK complaint that resulted in a student consulting a health provider in the past eight weeks), 3) time-loss injury (any MSK complaint that resulted in partly/completely missing music classes or activities in the past eight weeks). For all injury definitions prevalences were calculated and compared. Furthermore, the Disabilities of the Arm, Shoulder and Hand performing arts module (DASH-pa) was used to calculate disability scores for all three injury definitions.

Results: Twenty-nine classical music students participated in the current study. The total response rate over one academic year was 85.3%. One year prevalences of all MSK complaints, medical attention and time-loss were 96.6, 17.2 and 13.8% respectively. The bi-monthly prevalences ranged from 74.1 to 96.0% for all MSK complaints, from 5.6 to 11.5% for medical attention injuries and from 0 to 11.5% for time loss injuries. Scores on the DASH-pa ranged from 15.6 to 26.9 for MSK complaints, 33.3 to 50 for medical attention and 47.9 to 62.5 for time-loss injuries.

Conclusion: The choice of injury definition is a critical factor affecting the outcome of music injury surveillance studies. To reach a consensus, it is therefore important to consider the different injury definitions depending on the goal of the injury surveillance and the practical implications.
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http://dx.doi.org/10.1186/s12891-020-03490-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7418301PMC
August 2020
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