Joint Injury in Young Adults and Risk for Subsequent Knee and Hip Osteoarthritis Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee. Activity Increase Despite Arthritis (AÏDA): phase II randomised controlled trial of an active management booklet for hip and knee osteoarthritis in primary care. Moving to maintain function in knee osteoarthritis: evidence from the osteoarthritis initiative.
Osteoarthritis is a major contributor to functional impairment and reduced independence in older adults ( 1 - 4 ) . It is the leading cause of arthritis in the United States , affecting an estimated 21 million persons ( 5 ) , and has substantial economic impact ( 6 , 7 ) . History of an injury to a joint , particularly at the knee and hip , is associated with an increased risk for osteoarthritis in cross-sectional and casecontrol studies ( 8 - 11 ) . Such studies , however , may overestimate this relation because persons with symptomatic osteoarthritis may be more likely to recall a past injury or to interpret early symptoms of osteoarthritis as indicative of joint injury . A prospect i ve cohort study can address this weakness by determining exposure status before the outcome develops . To date , prospect i ve studies have examined the relation between history of joint injury and osteoarthritis in middle-aged persons and senior citizens ( 12 , 13 ) , but not in young adults . However , many athletic injuries occur in high school and college . In addition , joint trauma may be a more common cause of osteoarthritis than has been previously recognized ( 14 ) . We performed a prospect i ve cohort study of 1321 young adults to examine the risk for knee and hip osteoarthritis associated with joint injury during young adult life . Methods Study Participants The Johns Hopkins Precursors Study was design ed by the late Caroline Bedell Thomas , MD , to identify precursors of the aging process ( 15 ) . A total of 1337 medical students , members of the graduating classes of 1948 through 1964 at the Johns Hopkins University School of Medicine in Baltimore , Maryl and , enrolled in the study . The cohort was 91 % male and 97 % white ; the mean age was 22 years . At entry , participants underwent a st and ard history and examination , including  assessment of musculoskeletal disorders , history of trauma , level of physical activity , and measurement of weight and height . Body mass index was calculated as weight in kilograms divided by height in meters squared . In addition , participants were asked to categorize their level of physical training during the past month as none , little , moderate , or much , as described elsewhere ( 16 ) . Since graduation , participants have been followed prospect ively with annual self-administered question naires to detect incident disease and to up date risk factor status over time . At the time that baseline data were collected , it was not customary to obtain informed consent . After establishment of the Joint Committee on Clinical Investigation at Johns Hopkins , the follow-up protocol was review ed and approved . Assessment of Injury Injury was defined as a report of trauma to the knee or hip joint , including internal derangement and fracture . During the baseline assessment , knee and hip injuries that occurred before graduation from medical school and the year of their occurrence were recorded . Postgraduation injuries were assessed by annual morbidity question naires . During every 5-year follow-up period , at least 86 % of the living participants responded at least once to the question naires . Injuries were assigned diagnosis codes according to the International Classification of Diseases , Ninth Revision , Clinical Modification ( ICD-9-CM ) ( 17 ) . Diagnoses included torn meniscus ( code 836.2 ) ; torn knee ligament ( code 844.9 ) ; tibial fracture ( code 823.8 ) ; femoral fracture ( code 821.01 ) ; fibular fracture ( code 823.81 ) ; patellar fracture ( code 822 ) ; broken leg , site not otherwise specified ( code 827.0 ) ; knee injury , not otherwise specified ( code 959.7 ) ; gunshot wound ( code 891 ) ; hemarthrosis ( code 844.9 ) ; shin splints ( code 844.9 ) ; and hip dislocation ( code 836.5 ) . Incidence of Osteoarthritis The methods used to determine osteoarthritis incidence in this cohort have been described elsewhere ( 18 ) . Briefly , all participants were mailed annual morbidity question naires . Before 1985 , respondents were queried about the development of physical and musculoskeletal disorders . Since 1985 , follow-up morbidity question naires have contained the specific question , Have you ever had arthritis ? and have asked those who respond affirmatively to provide the type of arthritis , year of onset , and treatment received . An event of osteoarthritis was defined as the self-report of osteoarthritis or degenerative arthritis in response to the question naire . The incidence date was determined by the reported year of osteoarthritis onset . Two rheumatologists review ed each report of osteoarthritis , assigned ICD-9-CM codes ( 17 ) to the most specific arthritis site reported by the respondent , and excluded inflammatory arthritides . For this analysis , only osteoarthritis at the knee ( code 715.96 ) and hip ( code 715.95 ) were included as outcomes . In 1995 , all surviving participants who had previously reported osteoarthritis were mailed a more detailed question naire . They were asked , Have you had pain in or around the knee , including back of the knee , on most days for at least 1 month ? and Have you had pain in or around either hip joint , including the buttock , groin , and side of upper thigh , on most days for at least 1 month ? These symptom-related questions were used to screen for knee and hip osteoarthritis , respectively , in the National Health and Nutrition Examination Survey ( NHANES ) ( 19 ) . Respondents were also asked whether they had undergone  radiographic evaluation of their knees and hips  and whether radiography revealed osteophytes , joint space narrowing , subchondral cysts , or bony sclerosis ( the radiographic hallmarks of osteoarthritis ) ( 20 ) . Statistical Analysis The association between baseline characteristics and injury status was assessed by using the Student t-test for continuous variables and the chi-square test for categorical variables . These data are presented both for the entire cohort and separately by sex . Injury was the independent variable in the survival analysis ; age was the time variable . Knee and hip osteoarthritis were examined as separate outcomes . The relation of a joint injury at baseline to the incidence of osteoarthritis was examined by using KaplanMeier analysis ( 21 ) . The log-rank statistic was used to test whether the cumulative incidence of osteoarthritis differed according to injury status at cohort entry ( 22 ) . In addition , Cox proportional-hazards analysis was used to estimate the independent risk for osteoarthritis associated with a joint injury . Cox models were constructed for injury status at cohort entry and over follow-up , modeled as a time-dependent covariate . We adjusted for age at graduation , sex , body mass index , and level of physical activity , each of which was determined at baseline , to evaluate for possible confounding . In this cohort , body mass index at enrollment was more predictive of future osteoarthritis than average or most recent body mass index during follow-up ( 18 ) . These analyses were performed for all reported events of knee and hip osteoarthritis and for cases confirmed by both characteristic symptoms and radiographic findings . Hazard ratios are reported as relative risks with 95 % CIs . Statistical significance was defined as an level equal to 0.05 using a two-tailed test . We conducted a sensitivity analysis to assess the potential effect of an omitted covariate on the association between joint injury and subsequent osteoarthritis . Role of the Funding Sources The funding sources did not have a role in the collection , analysis , or interpretation of the data or in the decision to su bmi t the study for publication . Results At graduation from medical school , the average age of the 1216 men and 121 women in the cohort was 26 years . Our analysis is based on events reported through 30 November 1995 and represents a median follow-up of 36 years . Information at baseline or during follow-up was available for 1321 participants , who form the basis of our longitudinal analysis . At the end of follow-up in 1995 , the mean age of the cohort SD was 61.4 8.9 years . Overall , 141 participants had a joint injury ( knee alone [ n = 111 ] , hip alone [ n = 16 ] , or injuries at both sites [ n = 14 ] ) before or after graduation . Table 1 shows the baseline characteristics of the cohort according to injury status at the end of follow-up . Proportions of men and women with joint injury were similar ( P > 0.2 , chi-square test ) . Participants were generally lean , 49 % were physically active , and 54 % smoked cigarettes . Men who had a joint injury were heavier at baseline than men who were injury-free , but both groups of men were similar in age , level of physical activity , and smoking status . Women with injury were , on average , 2 years older at baseline than those without injury . Table 1 . Baseline Characteristics of 1321 Men and Women according to Joint Injury at Cohort Entry or during Follow-up At baseline , 47 men ( 3.9 % ) reported a knee injury and 12 men ( 1.0 % ) reported a hip injury . The mean age at which the injuries occurred was 16 years . Knee injuries included 10 tibial fractures , 3 fibular fractures , 4 femoral fractures , 2 patellar fractures , and 9 otherwise unspecified leg fractures . In addition , 8 men incurred trauma result ing in torn knee cartilage , 2 had torn knee ligaments , 2 had knee injuries result ing from gunshot wounds , 1 had traumatic hemarthrosis , 1 had joint dislocation , 1 had shin splints , and 4 had otherwise unspecified knee injuries . Of men with a knee injury , 4 reported that they were injured while playing football , 2 each reported that they were injured while playing basketball or participating in athletics , and 1 each reported that he was injured while horseback riding , bicycling , skiing , playing volleyball , wrestling , playing baseball , or playing tennis . Knee trauma also result ed from motor vehicle accidents ( n =3 ) and falls ( n = 2 ) . At baseline , 4 of the 121 women ( 3.3 % ) had a history of knee injuries and 1 ( 0.8 % ) had a history of hip injuries . Sixty-two men and 7 women developed knee osteoarthritis , and 27 men and 5 women developed hip osteoarthritis . The mean SD ages at onset of AIM This paper reports a study of the effects of aquatic exercise on physical fitness ( flexibility , strength and aerobic fitness ) , self-reported physical functioning and pain in adults with osteoarthritis of the hip or knee . BACKGROUND Osteoarthritis is a common cause of disability and a primary reason for hip and knee joint replacement . Exercise is important for preventing and /or managing the functional limitations associated with joint disease . Aquatic exercise is thought to be beneficial and is often recommended for people with osteoarthritis ; however , few studies have examined the effects on people with osteoarthritis , and these have yielded inconsistent results . METHODS A two-group r and omized controlled trial with a convenience sample was used . Participants were recruited from community sources and r and omly assigned to a 12-week aquatic programme or a non-exercise control condition . Data for 38 participants were collected at baseline , week 6 , and week 12 during 2003 and 2004 . Instruments were a st and ard plastic goniometer , a h and held dynamometer , the 6-minute walk test , the multidimensional Health Assessment Question naire , and a visual analogue scale for pain . RESULTS Repeated measures analysis of variance showed that aquatic exercise statistically significantly improved knee and hip flexibility , strength and aerobic fitness , but had no effect on self-reported physical functioning and pain . The exercise adherence rate was 81.7 % , and no exercise-related adverse effect was observed or reported . CONCLUSIONS Beneficial short-term effects of aquatic exercise were found in adults with osteoarthritis of the hip or knee . Although the programme may not offer pain relief or self-reported improvements in physical functioning , results suggest that aquatic exercise does not worsen the joint condition or result in injury . Nurses engaging in disease management and health promotion for these patients should consider recommending or implementing aquatic classes for patients BACKGROUND The Hip & Knee Book : Helping you cope with osteoarthritis was developed to change disadvantageous beliefs and encourage physical activity in people with hip or knee osteoarthritis . AIM To assess the feasibility of conducting a definitive r and omised controlled trial ( RCT ) of this evidence -based booklet in people with hip or knee osteoarthritis . DESIGN Phase II feasibility r and omised controlled trial ( RCT ) . METHOD Computerised search es of patients ' record data bases identified people with osteoarthritis of the hip or knee , who were invited to participate in the RCT comparing the new booklet with a control booklet . Outcomes were measured at baseline , 1 month , and 3 months , and included : beliefs about hip and knee pain , exercise , and fear avoidance ; level of physical activity ; and health service use . RESULTS The trial methods were feasible in terms of recruitment , r and omisation , and follow-up , but most participants recruited had longst and ing established symptoms . After one and 3 months , there was a small relative improvement in illness , exercise , and fear-avoidance beliefs and physical activity level in The Hip & Knee Book group ( n = 59 ) compared with the control group ( n = 60 ) , which provides some proof of principle for using these outcomes in future trials . CONCLUSION This feasibility study provided proof of principle for testing The Hip & Knee Book in a larger definitive RCT OBJECTIVES To investigate the association between baseline physical activity and 1-year functional performance in adults with knee osteoarthritis ( OA ) . DESIGN Prospect i ve cohort study of knee OA development and progression with 1-year follow-up . SETTING Community . PARTICIPANTS Osteoarthritis Initiative public data on adults with knee OA ( n=2274 ; age , 45 - 79y ) who participated in functional performance assessment s ( timed 20-m walk and chair st and test ) at baseline and 1-year follow-up . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURE A good 1-year performance outcome ( separately defined for walk time and chair st and measures ) was improvement from baseline quintile or maintenance in the best quintile . RESULTS Almost 2 in 5 persons with radiographic knee OA improved or maintained high performance at 1 year .  Physical activity  measured by the  Physical Activity Scale for the Elderly  ( PASE ) was significantly associated with good walk rate and chair st and outcomes ( odds ratio per 40 units PASE [ 95 % confidence interval]=1.13 [ 1.13 , 1.17 ] and 1.10 [ 1.05 , 1.15 ] , respectively ) , as were participation in sports/recreational activities ( 1.45 [ 1.23 , 1.71 ] and 1.29 [ 1.09 , 1.51 ] , respectively ) and lifestyle activities ( 1.11 [ 1.06 , 1.16 ] and 1.09 [ 1.04 , 1.14 ] , respectively ) . An independent protective relationship for these physical activity measures approached significance after adjusting for sociodemographic and health factors . Older adults reported the least baseline physical activity and least frequent good 1-year outcomes . CONCLUSIONS These findings support public health recommendations to be physically active in order to preserve function for persons with knee OA .  Physical activity messages should specifically target older adults whose low activity levels may jeopardize their ability to maintain functional performance
Social ( e.g. support from spouse ( n = 141 ) ) and environment ( outdoor temperature ( n = 38 ) ) factors were identified as possible factors that influence physical activity .
Conclusion : Demographic , physical , social , psychological and environmental factors are all important correlates for physical activity for people with knee or hip osteoarthritis .
Objective : To determine the factors associated with physical activity participation in adults with hip or knee osteoarthritis .