The effects of strength training among persons with hand osteoarthritis: a two-year follow-up study.
Journal of Hand Therapy (2007)
Rogers MW, Wilder FV.
Hand exercise is recommended for hand osteoarthritis (OA) management, but few efficacy studies have been published.
The purpose of the study was to determine the effects of two years of whole body strength training and gripper
exercise on hand strength, pain, and function in adults with radiographic evidence of hand OA. Older adults
(N=55; 71.5+/-6.5 years; 80% female) participated in a two-year, three times per week strength training regimen.
Bilateral gripper exercise weight (i.e., isotonic grip strength), isometric grip strength, pain, and self-reported hand,
and finger function were recorded at baseline and 24 months. Isotonic grip strength increased 1.94 kg (20.14 kg
baseline, 22.09 kg follow-up; p <0.0003). Right and left isometric grip increased 3.62 kg (25.83 kg baseline,
29.45 kg follow-up; p<0.002) and 2.95 kg (22.73 kg baseline, 25.65 kg follow-up; p<0.0005), respectively.
Hand pain decreased from 4.77 to 2.62 (p<0.006). Hand and finger function scores showed minimal dysfunction
at baseline and follow-up. Results suggest strength training safely increases dynamic and static grip strength
and reduces pain in older persons with hand OA.
Joint-specific prevalence of osteoarthritis of the hand.
Osteoarthritis Cartilage (2006)
Wilder FV, Barrett JP, Farina EJ.
To quantify the prevalence of radiographic hand osteoarthritis (OA) among a group of community-dwelling individuals.
Joint-specific prevalence rates/100 of radiographic OA of the hand were quantified and reported by age, gender, and
dominant hand. Data from a community-based, longitudinal study designed to follow the natural history of OA were used.
Participants were ambulatory men and women, ages 40 years and older, with and without radiographic hand OA (N = 3327).
Bilateral hand OA was examined at three joints: second distal interphalangeal joints (DIP), third proximal
interphalangeal joints (PIP), and first carpometacarpal joint of the thumb (CMC). The ordinal scale of Kellgren and
Lawrence (0-4) was used to determine OA status (grades 2+). Radiographic hand OA status was determined for all persons
in the study group comprised of 2302 women (69%) and 1025 men (31%). The sample sizes for the age groups (years) were
532 (40-49), 905 (50-59), 998 (60-69), 749 (70-79), and 143 (80+). Overall, the DIP joint demonstrated the highest
OA prevalence, while the PIP joint showed the lowest prevalence. Joint-specific hand OA prevalence rates for second
DIP, third PIP, and first CMC were 35%, 18%, and 21%, respectively. Expectedly, hand OA prevalence for all joints
increased with age. With exceptions, women demonstrated higher hand OA prevalence rates for the three sites examined.
However, among men aged 40-49, the second DIP joint OA rate was higher (13%) compared with women (8%). Additionally,
men in that age group demonstrated an elevated first CMC joint OA rate (9%) compared with women (5%).
Gender-specific hand dominance analyses demonstrated that the majority of individuals with unilateral second DIP
or third PIP OA presented in their dominant hand. However, among those with unilateral first CMC OA, both genders
displayed a tendency to present in their nondominant hand. These findings suggest the need for further investigation
of the role gender can play in the development of hand OA in populations under 60 years of age. Additional
epidemiological studies addressing hand OA will serve to bridge the gap between the current levels of knowledge
about the knee and the hand. The disease burden of hand OA affects a large percentage of the population.
Research efforts that more exhaustively characterize the prevalence of hand OA may contribute toward interventions
that, ultimately, impact a rapidly growing segment of our population.
Positive hindfoot valgus and osteoarthritis of the first metatarsophalangeal joint.
Foot and Ankle International (2006)
Mahiquez MY, Wilder FV, and Stephens HM.
The aim of this retrospective cohort study was to evaluate the association between increased hindfoot valgus and
the subsequent development of osteoarthritis of the first metatarsophalangeal (MTP) joint. Specifically, our
hypothesis was that among individuals free from first MTP joint osteoarthritis, those who have positive hindfoot
valgus are more likely to develop first MTP joint osteoarthritis than are those individuals with normal hindfoot
alignment. Our sample consisted of 1592 men and women, 40 years of age or older, participating in the Clearwater
Osteoarthritis Study (1988 to 2001). Biennial physical examinations, including serial radiographs, were conducted.
The Kellgren and Lawrence ordinal scale was used to determine radiographic evidence (grades 2+) of the study outcomes
and incidence of first MTP joint osteoarthritis. Standing hindfoot valgus was assessed visually by a registered nurse,
with a hindfoot valgus measurement of more than 5 degrees classified as a positive hindfoot valgus. Individuals with
hindfoot valgus were 23% more likely to subsequently develop first MTP joint osteoarthritis than were those without
hindfoot malalignment (risk ratio = 1.23; p-value < 0.006). This risk estimate reflects the potential influence
of age, gender, and body mass index. Our data suggest that hindfoot valgus may increase the risk of developing foot
osteoarthritis. The association of hindfoot valgus with first MTP joint osteoarthritis in this epidemiological
assessment is supportive of the mechanical theory for the development of osteoarthritis. The authors speculate
that future, related studies may determine that osteoarthritis prevention strategies can be broadened to include
individuals with positive hindfoot valgus.
Exercise and Osteoarthritis: Are we stopping too early? Findings from the Clearwater Exercise Study
Journal of Aging and Physical Activity (2006)
Wilder, FV, Barrett, JP, and Farina, EJ
The value of exercise for persons with knee osteoarthritis (OA) receives continuing consideration.
The optimal length of study follow-up time remains unclear. A case-series of persons with knee OA participating
in an exercise intervention was followed for two years. We quantified the change in knee pain scores during Months
1-12 and during Months 13-24. Eleven individuals with radiographic knee OA, and knee pain scores of 2+, were
evaluated. Pain scores were collected weekly from participants who exercised three times weekly. Participants
demonstrated pain reduction during both time periods. Pain reduction during Months 13-24, -10.7%, was slightly
higher than pain reduction during Months 1-12, -7.8%. Among persons with knee OA who exercise, our findings
suggest that knee pain amelioration continues beyond twelve months. Clinicians should consider encouraging
longterm exercise programs for knee OA patients. To best characterize effect of exercise on knee pain,
researchers designing clinical trials may want to lengthen the study’s duration.
Effect of regular exercise on the radiographic progression of foot osteoarthritis.
Journal of the American Podiatric Medical Association (2005)
Wilder FV, Barrett JP Jr, Farina EJ.
Among the elderly, osteoarthritis often causes chronic pain and disability. Although research has addressed
the association between exercise and osteoarthritis, few studies have examined the effect of exercise on the
radiographic progression of osteoarthritis. We investigated the relationship between ongoing exercise and
radiographic progression of foot osteoarthritis. The first metatarsophalangeal and medial cuneiform-first
tarsometatarsal joints were assessed. Joint-specific osteoarthritis radiographic progression scores were determined
using four assessments: joint space narrowing, osteophytes, sclerosis, and a composite score. This cohort study
included a subset of 221 men and women aged 40 to 91 years participating in a community-based osteoarthritis study.
Adjusted risk estimates (95% confidence intervals) summarizing the relationship between ongoing exercise and
radiographic progression in the first metatarsophalangeal joint ranged from 0.34 (0.11-0.99) for osteophytes
to 0.66 (0.23-1.92) for sclerosis; because only eight individuals experienced medial cuneiform-first tarsometatarsal
joint progression, these estimates were less stable, ranging from 2.41 (0.49-11.83) for composite to 4.29
(0.11-166.52) for osteophytes. Overall, our findings do not suggest that regular exercise is a risk factor
for foot osteoarthritis progression. Future replication studies are warranted to confirm these findings.
The
association of radiographic foot osteoarthritis
and radiographic osteoarthritis at other
sites
Osteoarthritis and Cartilage (2005)
Wilder
FV, Barrett JP, Farina EJ.
Objective
To quantify the association between radiographic
foot osteoarthritis (OA) and radiographic
OA at four joints: second distal interphalangeal
(DIP), third proximal interphalangeal
(PIP), first carpometacarpal (CMC), and
the knee.
Method
Data collected for the Clearwater Osteoarthritis
Study (COS) were analyzed (N=3436). The
study outcome was first metatarso-phalangeal
joint (first MTP) OA status. The predictor
variables were second DIP, third PIP,
first CMC, and knee OA. The Kellgren and
Lawrence scale determined OA status. The
strength of the association between foot
OA and other sites was further explored
by unilateral and bilateral categories.
Results
For both genders, we found a significant,
positive relationship between grade 2+
foot OA and second DIP, third PIP, first
CMC, and knee OA. This relationship maintained
its significance after adjustment for
age, body mass index, and occupational
history. Adjusted odds ratios ranged from
3.2 for the second DIP joint (P 0.0001)
to 3.7 for the knee joint (P 0.0001).
Relative to unilateral joint disease,
co-existing bilateral disease yielded
a significantly elevated risk for foot
OA for all joints examined. While other
studies have not specifically examined
co-occurrence with foot OA, our findings
are consistent with results from related
studies..
Conclusion
There is a dearth of studies exploring
foot OA. Our findings support the theory
of a systemic etiology involved in the
development of OA. Future epidemiological
studies that further distinguish the relationship
between OA at differing sites will provide
an enhanced ability to describe the respective
influences of mechanical and systemic
factors in the development of this disease.
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The association between medication usage
and dropout status among participants of
an exercise study for people with osteoarthritis
Physical Therapy
(2005)
Wilder
FV, Barrett JP, Farina EJ.
Background
and Purpose
Little is known about predictors of dropout
status in exercise studies for people
with osteoarthritis. Losses to follow-up
can pose serious threats to study validity.
The purpose of this study was to assess
the ability of arthritis medication usage
the month prior to enrollment to predict
dropout status among participants in an
exercise study for people with osteoarthritis.
Subject
and Method
Men and women who participated in an exercise
study for people with osteoarthritis (N=143)
were followed. Participants who completed
24+ months of the exercise program were
considered retained, whereas individuals
who withdrew prior to 24 months were considered
dropouts.
Results
Of the 143 participants analyzed, 78 (55%)
completed 24+ months of the exercise program
and 65 (45%) dropped out. Among those
who reported arthritis medication usage,
54% were lost to follow-up. The group
reporting no usage of arthritis medication
had a 20% dropout rate (odds ratio=3.5,
95% confidence interval=1.6-7.6). The
final adjusted model controlling for baseline
health status, body mass index, and the
interaction between baseline health status
and body mass index indicated that those
individuals who reported arthritis medication
usage were more than 4 times more likely
to drop out than were those who reported
no arthritis medication usage (odds ratio=4.5,
95% confidence interval=1.8-11.4).
Discussion
and Conclusion
The results showed that self-reported
arthritis medication usage the month prior
to study enrollment was associated with
subsequent dropout status among this group
of exercisers with osteoarthritis. Further
identification of baseline characteristics
predictive of participant dropout status
may benefit future exercise studies. A
priori knowledge of "at-risk" exercise
study participants will afford the opportunity
for the timely allocation of appropriate
resources aimed at reducing losses to
follow-up.
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Osteoarthritis
pain and weather
Rheumatology (2003)
Wilder FV, Hall BJ, Barrett JP
Objective
To evaluate the association between weather
(barometric pressure, precipitation and
temperature) and pain among individuals
with osteoarthritis (OA) (n=154) at the
following sites: neck, hand, shoulder,
knee and foot.
Method
This prospective study evaluated men and
women, aged 49-90 yr, participating in
a community-based, osteoarthritis exercise
study (June 1998-January 2002). Weekly
self-reported pain scores were collected
using a visual analogue scale. Statistical
tests, including regression and correlation
analyses, were conducted. P values < 0.001
were considered significant.
Results
The total number of pain recordings varied
by site, ranging from 2269 (feet) to 6061
(hands). The mean temperature was 23 degrees
C with a low of 0 degrees C and a high
of 36 degrees C. Precipitation levels
ranged from 0.00-21.08 cm, with a mean
of 0.36 cm. Most associations explored
produced non-significant findings. However,
among women with hand OA, higher pain
was significantly associated with days
of rising barometric pressure (P < 0.001).
Conclusion
Among a population of exercisers aged
49 yr and older, overall these findings
did not support the hypothesis that weather
is associated with pain. While some associations
were suggestive of a relationship, largely
these findings indicate that weather is
quite modestly, if at all, associated
with pain from OA.
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