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Regenerative Medicine in Pain Management
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Sharon McQuillan, Rafael Gonzalez
In a phase II randomized placebo-controlled study by Lee et al.,75 the safety and efficacy of a single intra-articular injection of autologous adipose-derived MSCs in 12 patients with OA of the knee were assessed. Patients were evaluated over a 6-month time frame. Outcome measures included WOMAC score, safety, and MRI. The results showed a significant improvement in WOMAC score at 6 months. There was no change in cartilage defect shown on MRI at 6 months. No serious adverse events were reported.
Perioperative Metabolic Therapies in Orthopedics
Published in Kohlstadt Ingrid, Cintron Kenneth, Metabolic Therapies in Orthopedics, Second Edition, 2018
29-year-old Caucasian female presented on September 27 with a 3–4-month exacerbation of RA which was initially diagnosed in 2006 and treated until 2013 with a wide variety of DMARDs and BAs to include methotrexate and Plaquenil over 7 years. The patient chose to discontinue medications due to a wide variety of unacceptable side effects, although the medications were significantly helpful. She had not seen her rheumatologist in over 3 years. In the interim, she had done very well using a wide variety of integrated and lifestyle approaches and had done reasonably well until that summer when some increased stress around her daily activities at work exacerbated her pain. She presented with severely swollen joints, right greater than left knee, right great toe, volar left index finger, and diffuse morning stiffness lasting about 3 hours. She has a family history of cancer and her mother has elevated cholesterol but no autoimmune disease. Initial subjective WOMAC score: Pain 7/20; stiffness 6/8; difficulty with ADLs 38/68. Other PMH is non-contributory.
Osteoarthritis
Published in Gill Wakley, Ruth Chambers, Paul Dieppe, Musculoskeletal Matters in Primary Care, 2018
Gill Wakley, Ruth Chambers, Paul Dieppe
The Western Ontario and McMaster Osteoarthritis Index (WOMAC) is a validated instrument for measuring disease-specific outcomes, and it is sensitive to change.28Clinical Evidence (Issue 5)15 found one systematic review from 1997 that identified 11 randomised controlled trials (RCTs) of exercise in patients with osteoarthritis of the knee or hip. The review concluded that exercise regimes were beneficial but that ‘more evidence was needed’. One study looked at the effects of a structured exercise programme on self-reported disability. The participants, who all had knee osteoarthritis, were randomised to one of three programmes, namely an aerobic exercise programme, a resistance exercise programme or a health education programme. The two exercise groups did better than the education group and showed significant but modest reductions in disability and pain. Clinical Evidence15 also reported one systematic review from 1993 and three subsequent RCTs, and concluded that there was limited evidence to suggest that both exercise and education reduce pain and disability in patients with knee or hip osteoarthritis.
The Western Ontario and McMaster Universities Osteoarthritis, Lequesne Algofunctional index, Arthritis Impact Measurement Scale-short form, and Visual Analogue Scale in patients with knee osteoarthritis: responsiveness and minimal clinically important differences
Published in Disability and Rehabilitation, 2023
Reza Salehi, Leila Valizadeh, Hossein Negahban, Mehrnoosh Karimi, Shahin Goharpey, Shadab Shahali
Bellamy et al. developed the WOMAC questionnaire in 1988 as a multidimensional, patient-specific, self-administered health-related quality of life questionnaire for the evaluation of patients with hip or knee osteoarthritis. Filling takes about 5 min. It is made up of 24 questions divided into three categories: pain (5 questions), stiffness (2 questions), and physical function (17 questions). For each question, the scoring system is normally based on a 5-point Likert scale, indicating different degrees of difficulty (0 = none, 1 = mild, 2 = moderate, 3 = severe, 4 = very severe). Total score range for the WOMAC is from 0 to 96 that is calculated by adding the scores from each of the three dimensions. the higher score reflects the worst effects of knee osteoarthritis [5,12,19].
Cost-effectiveness analysis of arthroscopic injection of a bioadhesive hydrogel implant in conjunction with microfracture for the treatment of focal chondral defects of the knee – an Australian perspective
Published in Journal of Medical Economics, 2022
George Papadopoulos, Sarah Griffin, Hemant Rathi, Amit Gupta, Bhavna Sharma, Dirk van Bavel
The key benefit of JointRep is that it improves the quality of life of patients by improving the quality of the articular cartilage and hence the function of the knee joint, reducing the symptoms associated with cartilage defects. Several generic, as well as disease-specific instruments, have been developed to measure the QoL of knee patients. Of these, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is one of the most widely used instruments. It is a patient-reported, 24-item questionnaire encompassing three key disease areas- pain (5 items), joint stiffness (2 items) and physical function (17 items)24. Hence, WOMAC scores constituted the key effectiveness inputs in our model. Our model included the patient-level WOMAC scores9,25.
A prospective study of patients with knee pain and mechanical diagnosis and therapy (MDT) classification
Published in Physiotherapy Theory and Practice, 2022
Patient-reported and clinical examination responses were collected by the clinicians at intake, regularly throughout the care episode, and at discharge. The treating clinicians were responsible for determining and reporting inclusion, exclusion, and discharge status. Two primary patient-reported outcomes were assessed: pain intensity and patient self-reported disability via the Numeric Pain Rating Scale (NPRS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. Pain intensity reported by the patient within ‘the last few days’ was assessed using an 11-point NPRS ranging from 0 (‘No pain’) to 10 (‘Worst Pain Imaginable’). There has been some variation in the literature regarding the minimal clinically important difference (MCID) for the NPRS and it has been estimated at or slightly less than two points of change for patients with various musculoskeletal disorders (Childs, Piva, and Fritz, 2005; Piva, Gil, Moore, and Fitzgerald, 2009; Pool et al., 2007). Two points of change were determined to be the MCID for the NPRS in this study. The WOMAC is a patient self-report disability questionnaire for patients with knee and hip pain. The WOMAC measures five items for pain (score range 0–20), two for stiffness (score range 0–8), and 17 for functional limitation (score range 0–68) (McConnell, Kolopack, and Davis, 2001). The score ranges from 0 to 96 with greater scores indicating higher levels of disability. An MCID in WOMAC score change of 7.9 points has been reported (Angst, Aeschlimann, Steiner, and Stucki, 2001; Tubach et al., 2005).