Browsing by Author "Knoop, J."

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Physiotherapy with integrated virtual reality for patients with complex chronic low back pain: protocol for a pragmatic cluster randomized controlled trial (VARIETY study).
Slatman, S. ; Ostelo, R. ; Goor, H. van ; Staal, J.B. ; Knoop, J.
2023, Article / Letter to editor (BMC Musculoskeletal Disorders, vol. 24, iss. 1, (2023), pp. 132)BACKGROUND: Chronic low back pain (CLBP) is the most common chronic pain condition worldwide. Currently, primary care physiotherapy is one of the main treatment options, but effects of this treatment are small. Virtual Reality (VR) could be an adjunct to physiotherapy care, due to its multimodal features. The primary aim of this study is to assess the (cost-)effectiveness of physiotherapy with integrated multimodal VR for patients with complex CLBP, compared to usual primary physiotherapy care. METHODS: A multicenter, two-arm, cluster randomized controlled trial (RCT) including 120 patients with CLBP from 20 physiotherapists will be conducted. Patients in the control group will receive 12nweeks of usual primary physiotherapy care for CLBP. Patients in the experimental group will receive treatment consisting of 12nweeks of physiotherapy with integrated, immersive, multimodal, therapeutic VR. The therapeutic VR consists of the following modules: pain education, activation, relaxation and distraction. The primary outcome measure is physical functioning. Secondary outcome measures include pain intensity, pain-related fears, pain self-efficacy and economic measures. Effectiveness of the experimental intervention compared to the control intervention on primary and secondary outcome measures will be analyzed on an intention-to-treat principle, using linear mixed-model analyses. DISCUSSION: This pragmatic, multicenter cluster randomized controlled trial, will determine the clinical and cost-effectiveness of physiotherapy with integrated, personalized, multimodal, immersive VR in favor of usual physiotherapy care for patients with CLBP. TRIAL REGISTRATION: This study is prospectively registered at ClinicalTrials.gov (identifier: NCT05701891).
Development and internal validation of a machine learning prediction model for low back pain non-recovery in patients with an acute episode consulting a physiotherapist in primary care
Knoop, J. ; Lankveld, W.G.J.M. van ; Beijer, L.J. ; Geerdink, F.J.B ; Heymans, M.W. ; Hoogeboom, T.J. ; Hoppenbrouwers, S.J.B.A. ; van Overmeeren, E. ; Soer, R ; Veenhof, C. ; Vissers, K.C.P ; van der Wees, P. J. ; Sappelli, M. ; Staal, J.B. et al. sine al.
2022, Article / Letter to editor (BMC Musculoskeletal Disorders, (2022))Background While low back pain occurs in nearly everybody and is the leading cause of disability worldwide, we lack instruments to accurately predict persistence of acute low back pain. We aimed to develop and internally validate a machine learning model predicting non-recovery in acute low back pain and to compare this with current practice and ‘traditional’ prediction modeling. Methods Prognostic cohort-study in primary care physiotherapy. Patients (n = 247) with acute low back pain (≤ one month) consulting physiotherapists were included. Candidate predictors were assessed by questionnaire at baseline and (to capture early recovery) after one and two weeks. Primary outcome was non-recovery after three months, defined as at least mild pain (Numeric Rating Scale > 2/10). Machine learning models to predict non-recovery were developed and internally validated, and compared with two current practices in physiotherapy (STarT Back tool and physiotherapists’ expectation) and ‘traditional’ logistic regression analysis. Results Forty-seven percent of the participants did not recover at three months. The best performing machine learning model showed acceptable predictive performance (area under the curve: 0.66). Although this was no better than a’traditional’ logistic regression model, it outperformed current practice. Conclusions We developed two prognostic models containing partially different predictors, with acceptable performance for predicting (non-)recovery in patients with acute LBP, which was better than current practice. Our prognostic models have the potential of integration in a clinical decision support system to facilitate data-driven, personalized treatment of acute low back pain, but needs external validation first.
How does hip osteoarthritis differ from knee osteoarthritis?
Hall, M. ; Esch, M. van der ; Hinman, R.S. ; Peat, G. ; Zwart, A. de ; Quicke, J.G. ; Runhaar, J. ; Knoop, J. ; Leeden, M van der ; Rooij, M. de ; Meulenbelt, I. ; Vliet Vlieland, T. ; Lems, W.F. ; Holden, M.A. ; Foster, N.E. ; Bennell, K.L. et al. sine al.
2022, Article / Letter to editor (Osteoarthritis and Cartilage, vol. 30, iss. 1, (2022), pp. 32-41)Hip and knee osteoarthritis (OA) are leading causes of global disability. Most research to date has focused on the knee, with results often extrapolated to the hip, and this extends to treatment recommendations in clinical guidelines. Extrapolating results from research on knee OA may limit our understanding of disease characteristics specific to hip OA, thereby constraining development and implementation of effective treatments. This review highlights differences between hip and knee OA with respect to prevalence, prognosis, epigenetics, pathophysiology, anatomical and biomechanical factors, clinical presentation, pain and non-surgical treatment recommendations and management.
No evidence for stratified exercise therapy being cost-effective compared to usual exercise therapy in patients with knee osteoarthritis: Economic evaluation alongside cluster randomized controlled trial.
Knoop, J. ; Esser, J. ; Dekker, J ; Joode, J.W. de ; Ostelo, R.W.J.G. ; Dongen, J.M. van
2022, Article / Letter to editor (Braz J Phys Ther, vol. 27, iss. 1, (2022), pp. 100469)BACKGROUND: A stratified approach to exercise therapy may yield superior clinical and economic outcomes, given the large heterogeneity of individuals with knee osteoarthritis (OA). OBJECTIVE: To evaluate the cost-effectiveness during a 12-month follow-up of a model of stratified exercise therapy compared to usual exercise therapy in patients with knee OA, from a societal and healthcare perspective. METHODS: An economic evaluation was conducted alongside a cluster-randomized controlled trial in patients with knee OA (n = 335), comparing subgroup-specific exercise therapy for a 'high muscle strength subgroup', 'low muscle strength subgroup', and 'obesity subgroup' supplemented by a dietary intervention for the 'obesity subgroup' (experimental group), with usual ('non-stratified') exercise therapy (control group). Clinical outcomes included quality-adjusted life years - QALYs (EuroQol-5D-5 L), knee pain (Numerical Rating Scale) and physical functioning (Knee Injury and Osteoarthritis Outcome Score in daily living). Costs were measured by self-reported questionnaires at 3, 6, 9 and 12-month follow-up. Missing data were imputed using multiple imputation. Data were analyzed through linear regression. Bootstrapping techniques were applied to estimate statistical uncertainty. RESULTS: During 12-month follow-up, there were no significant between-group differences in clinical outcomes. The total societal costs of the experimental group were on average lower compared to the control group (mean [95% confidence interval]: € 405 [-1728, 918]), albeit with a high level of uncertainty. We found a negligible difference in QALYs between groups (mean [95% confidence interval]: 0.006 [-0.011, 0.023]). The probability of stratified exercise therapy being cost-effective compared to usual exercise therapy from the societal perspective was around 73%, regardless of the willingness-to-pay threshold. However, this probability decreased substantially to 50% (willingness-to-pay threshold of €20.000/QALY) when using the healthcare perspective. Similar results were found for knee pain and physical functioning. CONCLUSIONS: We found no clear evidence that stratified exercise therapy is likely to be cost-effective compared to usual exercise therapy in patients with knee OA. However, results should be interpreted with caution as the study power was lower than intended, due to the Coronavirus disease (COVID-19) pandemic.
Patients' and clinicians' experiences with stratified exercise therapy in knee osteoarthritis: a qualitative study.
Knoop, J. ; Joode, J.W. de ; Brandt, H. ; Dekker, J ; Ostelo, R.W.J.G.
2022, Article / Letter to editor (BMC Musculoskeletal Disorders, vol. 23, iss. 1, (2022), pp. 559)BACKGROUND: We have developed a model of stratified exercise therapy that distinguishes three knee osteoarthritis (OA) subgroups ('high muscle strength subgroup', 'low muscle strength subgroup', 'obesity subgroup'), which are provided subgroup-specific exercise therapy (supplemented by a dietary intervention for the 'obesity subgroup'). In a large clinical trial, this intervention was found to be no more effective than usual exercise therapy. The present qualitative study aimed to explore experiences from users of this intervention, in order to identify possible improvements. METHODS: Qualitative research design embedded within a cluster randomized controlled trial in a primary care setting. A random sample from the experimental arm (i.e., 15 patients, 11 physiotherapists and 5 dieticians) was interviewed on their experiences with receiving or applying the intervention. Qualitative data from these semi-structured interviews were thematically analysed. RESULTS: We identified four themes: one theme regarding the positive experiences with the intervention and three themes regarding perceived barriers. Although users from all 3 perspectives (patients, physiotherapists and dieticians) generally perceived the intervention as having added value, we also identified several barriers, especially for the 'obesity subgroup'. In this 'obesity subgroup', physiotherapists perceived obesity as difficult to address, dieticians reported that more consultations are needed to reach sustainable weight loss and both physiotherapists and dieticians reported a lack of interprofessional collaboration. In the 'high muscle strength subgroup', the low number of supervised sessions was perceived as a barrier by some patients and physiotherapists, but as a facilitator by others. A final theme addressed barriers to knee OA treatment in general, with lack of motivation as the most prominent of these. CONCLUSION: Our qualitative study revealed a number of barriers to effective application of the stratified exercise therapy, especially for the 'obesity subgroup'. Based on these barriers, the intervention and its implementation could possibly be improved. Moreover, these barriers are likely to account at least partly for the lack of superiority over usual exercise therapy. TRIAL REGISTRATION: The Netherlands National Trial Register (NTR): NL7463 (date of registration: 8 January 2019).
Stratified exercise therapy does not improve outcomes compared with usual exercise therapy in people with knee osteoarthritis (OCTOPuS study): a cluster randomised trial.
Knoop, J. ; Dekker, J ; Dongen, J.M. van ; Leeden, M van der ; Rooij, M. de ; Peter, W.F. ; Joode, W. de ; Bodegom-Vos, L. van ; Lopuhaä, N. ; Bennell, K.L. ; Lems, W.F. ; Esch, M. van der ; Vliet Vlieland, T.P. ; Ostelo, R.W.J.G. et al. sine al.
2022, Article / Letter to editor (Journal of Physiotherapy, vol. 68, iss. 3, (2022), pp. 182-190)QUESTION: In people with knee osteoarthritis, how much more effective is stratified exercise therapy that distinguishes three subgroups (high muscle strength subgroup, low muscle strength subgroup, obesity subgroup) in reducing knee pain and improving physical function than usual exercise therapy? DESIGN: Pragmatic cluster randomised controlled trial in a primary care setting. PARTICIPANTS: A total of 335 people with knee osteoarthritis: 153 in an experimental arm and 182 in a control arm. INTERVENTION: Physiotherapy practices were randomised into an experimental arm providing stratified exercise therapy (supplemented by a dietary intervention from a dietician for the obesity subgroup) or a control arm providing usual, non-stratified exercise therapy. OUTCOME MEASURES: Primary outcomes were knee pain severity (numerical rating scale for pain, 0 to 10) and physical function (Knee Injury and Osteoarthritis Outcome Score subscale activities of daily living, 0 to 100). Measurements were performed at baseline, 3 months (primary endpoint) and 6 and 12 months (follow-up). Intention-to-treat, multilevel, regression analysis was performed. RESULTS: Negligible differences were found between the experimental and control groups in knee pain (mean adjusted difference 0.2, 95% CI -0.4 to 0.7) and physical function (-0.8, 95% CI -4.3 to 2.6) at 3 months. Similar effects between groups were also found for each subgroup separately, as well as at other time points and for nearly all secondary outcome measures. CONCLUSION: This pragmatic trial demonstrated no added value regarding clinical outcomes of the model of stratified exercise therapy compared with usual exercise therapy. This could be attributed to the experimental arm therapists facing difficulty in effectively applying the model (especially in the obesity subgroup) and to elements of stratified exercise therapy possibly being applied in the control arm. REGISTRATION: Netherlands National Trial Register NL7463.
Lack of consensus across clinical guidelines regarding the role of psychosocial factors within low back pain care: a systematic review.
Knoop, J. ; Rutten, G. ; Lever, C. ; Leemeijer, J. ; Jong, L.J. de ; Verhagen, A.P. ; Lankveld, W.G.J.M. van ; Staal, J.B.
2021, Article / Letter to editor (Journal of Pain, (2021))It is widely accepted that psychosocial prognostic factors should be addressed by clinicians in their assessment and management of patient suffering from low back pain (LBP). On the other hand, an overview is missing how these factors are addressed in clinical LBP guidelines. Therefore, our objective was to summarize and compare recommendations regarding the assessment and management of psychosocial prognostic factors for LBP chronicity, as reported in clinical LBP guidelines. We performed a systematic search of clinical LBP guidelines (PROSPERO registration number 154730). This search consisted of a combination of previously published systematic review articles and a new systematic search in medical or guideline-related databases. From the included guidelines, we extracted recommendations regarding the assessment and management of LBP which addressed psychosocial prognostic factors (i.e., psychological factors ('yellow flags'), perceptions about the relationship between work and health, ('blue flags'), system or contextual obstacles ('black flags') and psychiatric symptoms ('orange flags')). In addition, we evaluated the level or quality of evidence of these recommendations. In total, we included 15 guidelines. Psychosocial prognostic factors were addressed in 13/15 guidelines regarding their assessment and in 14/15 guidelines regarding their management. Recommendations addressing psychosocial factors almost exclusively concerned 'yellow' or 'black flags', and varied widely across guidelines. The supporting evidence was generally of very low quality. We conclude that in general, clinical LBP guidelines do not provide clinicians with clear instructions about how to incorporate psychosocial factors in LBP care and should be optimized in this respect. More specifically, clinical guidelines vary widely in whether and how they address psychosocial factors, and recommendations regarding these factors generally require better evidence support. This emphasizes a need for a stronger evidence-base underlying the role of psychosocial risk factors within LBP care, and a need for uniformity in methodology and terminology across guidelines. Perspective This systematic review summarized clinical guidelines on low back pain (LBP) on how they addressed the identification and management of psychosocial factors. This review revealed a large amount of variety across guidelines in whether and how psychosocial factors were addressed. Moreover, recommendations generally lacked details and were based on low quality evidence.
PHYSIOTHERAPY WORKS: RCT ON THE (COST-)EFFECTIVENESS OF A PHYSICAL THERAPIST-LED, WORK-ORIENTED INTERVENTION IN PEOPLE WITH AXIAL SPONDYLOARTHRITIS AND RHEUMATOID ARTHRITIS
Bakker, NF ; Knoop, J. ; Hutting, N. ; Heerkens, Y.F. ; Engels, J.A. ; Staal, J.B. ; Leeden, M van der ; Boonen, A ; Vlieland, TPMV ; Weely, SFE van
2021, Article / Letter to editor (Clinical and Experimental Rheumatology, vol. 39, iss. 5, (2021), pp. 1240)
Construct validity of the OCTOPuS stratification algorithm for allocating patients with knee osteoarthritis into subgroups.
Knoop, J. ; Ostelo, R.W.J.G. ; Esch, M. van der ; Zwart, A. de ; Bennell, K.L. ; Leeden, M van der ; Dekker, J
2021, Article / Letter to editor (BMC Musculoskeletal Disorders, vol. 22, iss. 1, (2021), pp. 633)BACKGROUND: We recently developed a model of stratified exercise therapy, consisting of (i) a stratification algorithm allocating patients with knee osteoarthritis (OA) into one of the three subgroups ('high muscle strength subgroup' representing a post-traumatic phenotype, 'low muscle strength subgroup' representing an age-induced phenotype, and 'obesity subgroup' representing a metabolic phenotype) and (ii) subgroup-specific exercise therapy. In the present study, we aimed to test the construct validity of this algorithm. METHODS: Data from five studies (four exercise therapy trial cohorts and one cross-sectional cohort) were used to test the construct validity of our algorithm by 63 a priori formulated hypotheses regarding three research questions: (i) are the proportions of patients in each subgroup similar across cohorts? (15 hypotheses); (ii) are the characteristics of each of the subgroups in line with their proposed underlying phenotypes? (30 hypotheses); (iii) are the effects of usual exercise therapy in the 3 subgroups in line with the proposed effect sizes? (18 hypotheses). RESULTS: Baseline data from a total of 1211 patients with knee OA were analyzed for the first and second research question, and follow-up data from 584 patients who were part of an exercise therapy arm within a trial for the third research question. In total, the vast majority (73%) of the hypotheses were confirmed. Regarding our first research question, we found similar proportions in each of the three subgroups across cohorts, especially for three cohorts. Regarding our second research question, subgroup characteristics were almost completely in line with the proposed underlying phenotypes. Regarding our third research question, usual exercise therapy resulted in similar, medium to large effect sizes for knee pain and physical function for all three subgroups. CONCLUSION: We found mixed results regarding the construct validity of our stratification algorithm. On the one hand, it is a valid instrument to consistently allocate patients into subgroups that aligned our hypotheses. On the other hand, in contrast to our hypotheses, subgroups did not differ substantially in effects of usual exercise therapy. An ongoing trial will assess whether this algorithm accompanied by subgroup-specific exercise therapy improves clinical and economic outcomes.
Use and perceived added value of patient-reported measurement instruments by physiotherapists treating acute low back pain: a survey study among Dutch physiotherapists
Knoop, J. ; Lankveld, W.G.J.M. van ; Geerdink, G. ; Soer, R ; Staal, J.B.
2020, Article / Letter to editor (BMC Musculoskeletal Disorders, (2020))
A consensus-based framework for conducting and reporting osteoarthritis phenotype research.
Spil, W.E. van ; Bierma-Zeinstra, S.M.A. ; Deveza, L.A. ; Arden, N.K. ; Bay-Jensen, A.C. ; Kraus, V.B. ; Carlesso, L. ; Christensen, R. ; Esch, M. van der ; Kent, P. ; Knoop, J. ; Ladel, C. ; Little, C.B. ; Loeser, R.F. ; Losina, E. ; Mills, K. ; Mobasheri, A. ; Nelson, A.E. ; Neogi, T. ; Peat, G.M. ; Rat, A.C. ; Steultjens, M. ; Thomas, M.J. ; Valdes, A.M. ; Hunter, D.J. et al. sine al.
2020, Article / Letter to editor (Arthritis Research & Therapy, vol. 22, iss. 1, (2020), pp. 54)BACKGROUND: The concept of osteoarthritis (OA) heterogeneity is evolving and gaining renewed interest. According to this concept, distinct subtypes of OA need to be defined that will likely require recognition in research design and different approaches to clinical management. Although seemingly plausible, a wide range of views exist on how best to operationalize this concept. The current project aimed to provide consensus-based definitions and recommendations that together create a framework for conducting and reporting OA phenotype research. METHODS: A panel of 25 members with expertise in OA phenotype research was composed. First, panel members participated in an online Delphi exercise to provide a number of basic definitions and statements relating to OA phenotypes and OA phenotype research. Second, panel members provided input on a set of recommendations for reporting on OA phenotype studies. RESULTS: Four Delphi rounds were required to achieve sufficient agreement on 11 definitions and statements. OA phenotypes were defined as subtypes of OA that share distinct underlying pathobiological and pain mechanisms and their structural and functional consequences. Reporting recommendations pertaining to the study characteristics, study population, data collection, statistical analysis, and appraisal of OA phenotype studies were provided. CONCLUSIONS: This study provides a number of consensus-based definitions and recommendations relating to OA phenotypes. The resulting framework is intended to facilitate research on OA phenotypes and increase combined efforts to develop effective OA phenotype classification. Success in this endeavor will hopefully translate into more effective, differentiated OA management that will benefit a multitude of OA patients.
Is a model of stratified exercise therapy by physical therapists in primary care feasible in patients with knee osteoarthritis? : a mixed methods study.
Knoop, J. ; Leeden, M van der ; Esch, M. van der ; Rooij, M. de ; Peter, W.F. ; Bennell, K.L. ; Steultjens, M.P.M. ; Hakkinen, A. ; Roorda, L.D. ; Lems, W.F. ; Dekker, J et al. sine al.
2020, Article / Letter to editor (Physiotherapy, vol. 106, (2020), pp. 101-110)OBJECTIVES: To explore the feasibility of a newly developed model of stratified exercise therapy in primary care for patients with knee osteoarthritis (OA). DESIGN: Mixed method design (process, outcome and qualitative evaluation). SETTING: Six physical therapy practices in primary care around Amsterdam. PARTICIPANTS: Fifty eligible patients with knee OA, visiting one of the participating physical therapists (PTs). INTERVENTION: Patients were allocated to a subgroup based on a simple stratification tool and received subgroup-specific, protocolized, 4-month, exercise therapy. MAIN OUTCOME MEASURES: Feasibility of this model of stratified exercise therapy was explored by multiple process parameters, outcome measures (physical functioning and knee pain; at baseline and 4-months follow-up) and experiences from patients and PTs. RESULTS: From 97 potentially eligible patients, fifty patients were included and allocated to the 'high muscle strength subgroup' (n=17), 'depression subgroup' (n=4), 'obesity subgroup' (n=6) or 'low muscle strength subgroup' (n=23). Three patients dropped out during the study period. PTs provided relatively low numbers of sessions (on average 10 sessions), although exceedance of the recommended maximum number of sessions did occur frequently. We found clinically relevant improvements on physical functioning and knee pain (P<0.001 for both) for the total group. In general, the model of stratified exercise therapy was considered to be easily applicable and of added value for daily practice. CONCLUSIONS: Our model of stratified exercise therapy seems to be feasible in primary care, although a number of limitations were reported. Future research should determine the (cost-)effectiveness of an adapted model, compared to usual, non-stratified exercise therapy.
Stratified exercise therapy compared with usual care by physical therapists in patients with knee osteoarthritis: A randomized controlled trial protocol (OCTOPuS study).
Knoop, J. ; Dekker, J ; Leeden, M van der ; Rooij, M. de ; Peter, W.F. ; Bodegom-Vos, L. van ; Dongen, J.M. van ; Lopuhäa, N. ; Bennell, K.L. ; Lems, W.F. ; Esch, M. van der ; Vliet Vlieland, T.P. ; Ostelo, R.W.J.G. et al. sine al.
2020, Article / Letter to editor (Physiotherapy Research International, vol. 25, iss. 2, (2020), pp. e1819)OBJECTIVES: Knee osteoarthritis (OA) is characterized by its heterogeneity, with large differences in clinical characteristics between patients. Therefore, a stratified approach to exercise therapy, whereby patients are allocated to homogeneous subgroups and receive a stratified, subgroup-specific intervention, can be expected to optimize current clinical effects. Recently, we developed and pilot tested a model of stratified exercise therapy based on clinically relevant subgroups of knee OA patients that we previously identified. Based on the promising results, it is timely to evaluate the (cost-)effectiveness of stratified exercise therapy compared with usual, "nonstratified" exercise therapy. METHODS: A pragmatic cluster randomized controlled trial including economic and process evaluation, comparing stratified exercise therapy with usual care by physical therapists (PTs) in primary care, in a total of 408 patients with clinically diagnosed knee OA. Eligible physical therapy practices are randomized in a 1:2 ratio to provide the experimental (in 204 patients) or control intervention (in 204 patients), respectively. The experimental intervention is a model of stratified exercise therapy consisting of (a) a stratification algorithm that allocates patients to a "high muscle strength subgroup," "low muscle strength subgroup," or "obesity subgroup" and (b) subgroup-specific, protocolized exercise therapy (with an additional dietary intervention from a dietician for the obesity subgroup only). The control intervention will be usual best practice by PTs (i.e., nonstratified exercise therapy). Our primary outcome measures are knee pain severity (Numeric Rating Scale) and physical functioning (Knee Injury and Osteoarthritis Outcome Score subscale daily living). Measurements will be performed at baseline, 3-month (primary endpoint), 6-month (questionnaires only), and 12-month follow-up, with an additional cost questionnaire at 9 months. Intention-to-treat, multilevel, regression analysis comparing stratified versus usual care will be performed. CONCLUSION: This study will demonstrate whether stratified care provided by primary care PTs is effective and cost-effective compared with usual best practice from PTs.
Author Response.
Bier, J.D. ; Scholten-Peeters, W.G.M. ; Staal, J.B. ; Pool, J. ; Tulder, M.W. van ; Beekman, E. ; Knoop, J. ; Meerhoff, G. ; Verhagen, A.P.
2019, Article / Letter to editor (Physical Therapy, vol. 99, iss. 1, (2019), pp. 120)
Clinical Practice Guideline for PhysicalTherapy Assessment and Treatment in Patients With Nonspecific Neck Pain.
Bier, J.D. ; Scholten-Peeters, W.G.M. ; Staal, J.B. ; Pool, J. ; Tulder, M.W. van ; Beekman, E. ; Knoop, J. ; Meerhoff, G. ; Verhagen, A.P.
2018, Article / Letter to editor (Physical Therapy, vol. 98, iss. 3, (2018), pp. 162-171)
Subgrouping and TargetEd Exercise pRogrammes for knee and hip OsteoArthritis (STEER OA): a systematic review update and individual participant data meta-analysis protocol.
Holden, M.A. ; Burke, D.L. ; Runhaar, J. ; Windt, D. van Der ; Riley, R.D. ; Dziedzic, K. ; Legha, A. ; Evans, A.L. ; Abbott, J.H. ; Baker, K. ; Brown, J. ; Bennell, K.L. ; Bossen, D. ; Brosseau, L. ; Chaipinyo, K. ; Christensen, R. ; Cochrane, T. ; Rooij, M. de ; Doherty, M. ; French, H.P. ; Hickson, S. ; Hinman, R.S. ; Hopman-Rock, M. ; Hurley, M.V. ; Ingram, C. ; Knoop, J. ; Krauss, I. ; McCarthy, C. ; Messier, S.P. ; Patrick, D.L. ; Sahin, N. ; Talbot, L.A. ; Taylor, R. ; Teirlinck, C.H. ; Middelkoop, M. van ; Walker, C. ; Foster, N.E. et al. sine al.
2017, Article / Letter to editor (BMJ Open, vol. 7, iss. 12, (2017), pp. e018971)INTRODUCTION: Knee and hip osteoarthritis (OA) is a leading cause of disability worldwide. Therapeutic exercise is a recommended core treatment for people with knee and hip OA, however, the observed effect sizes for reducing pain and improving physical function are small to moderate. This may be due to insufficient targeting of exercise to subgroups of people who are most likely to respond and/or suboptimal content of exercise programmes. This study aims to identify: (1) subgroups of people with knee and hip OA that do/donnot respond to therapeutic exercise and to different types of exercise and (2) mediators of the effect of therapeutic exercise for reducing pain and improving physical function. This will enable optimal targeting and refining the content of future exercise interventions. METHODS AND ANALYSIS: Systematic review and individual participant data meta-analyses. A previous comprehensive systematic review will be updated to identify randomised controlled trials that compare the effects of therapeutic exercise for people with knee and hip OA on pain and physical function to a non-exercise control. Lead authors of eligible trials will be invited to share individual participant data. Trial-level and participant-level characteristics (for baseline variables and outcomes) of included studies will be summarised. Meta-analyses will use a two-stage approach, where effect estimates are obtained for each trial and then synthesised using a random effects model (to account for heterogeneity). All analyses will be on an intention-to-treat principle and all summary meta-analysis estimates will be reported as standardised mean differences with 95% CI. ETHICS AND DISSEMINATION: Research ethical or governance approval is exempt as no new data are being collected and no identifiable participant information will be shared. Findings will be disseminated via national and international conferences, publication in peer-reviewed journals and summaries posted on websites accessed by the public and clinicians. PROSPERO REGISTRATION NUMBER: CRD42017054049.

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