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Ben R Metcalf

Bio: Ben R Metcalf is an academic researcher from University of Melbourne. The author has contributed to research in topics: Osteoarthritis & Knee pain. The author has an hindex of 29, co-authored 91 publications receiving 2949 citations. Previous affiliations of Ben R Metcalf include Murdoch University & Monash University.


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Journal ArticleDOI
TL;DR: Balance deficits can be identified in the osteoarthritic population using simple, inexpensive measures, however, the clinical relevance of the small deficits identified remains unknown and warrants further investigation.
Abstract: Objectives. To compare balance in individuals with symptomatic knee osteoarthritis (OA) and in age-, gender- and body-mass-matched controls using simple clinical measures. Methods. Thirty-three people with OA and 33 controls participated. Static postural sway wantero-posterior (AP), lateral and totalx was measured using a swaymeter on two different surfaces and under two visual conditions. Dynamic standing balance was assessed using the ‘step test’. Results. Both groups displayed similar postural sway on most variables measured. Significantly greater sway was noted in the OA group on a firm surface in both lateral (eyes open) and AP directions (eyes closed), as well as total sway (eyes closed) (P < 0.05). Poorer dynamic standing balance was observed in the OA group as evidenced by the step test (P < 0.0001). Conclusions. Balance deficits can be identified in the osteoarthritic population using simple, inexpensive measures. However, the clinical relevance of the small deficits identified remains unknown and warrants further investigation.

251 citations

Journal ArticleDOI
TL;DR: The physiotherapy programme tested in this trial was no more effective than regular contact with a therapist at reducing pain and disability.
Abstract: Objective: To determine whether a multimodal physiotherapy programme including taping, exercises, and massage is effective for knee osteoarthritis, and if benefits can be maintained with self management. Methods: Randomised, double blind, placebo controlled trial; 140 community volunteers with knee osteoarthritis participated and 119 completed the trial. Physiotherapy and placebo interventions were applied by 10 physiotherapists in private practices for 12 weeks. Physiotherapy included exercise, massage, taping, and mobilisation, followed by 12 weeks of self management. Placebo was sham ultrasound and light application of a non-therapeutic gel, followed by no treatment. Primary outcomes were pain measured by visual analogue scale and patient global change. Secondary measures included WOMAC, knee pain scale, SF-36, assessment of quality of life index, quadriceps strength, and balance test. Results: Using an intention to treat analysis, physiotherapy and placebo groups showed similar pain reductions at 12 weeks: –2.2 cm (95% CI, –2.6 to –1.7) and –2.0 cm (–2.5 to –1.5), respectively. At 24 weeks, pain remained reduced from baseline in both groups: –2.1 (–2.6 to –1.6) and –1.6 (–2.2 to –1.0), respectively. Global improvement was reported by 70% of physiotherapy participants (51/73) at 12 weeks and by 59% (43/73) at 24 weeks. Similarly, global improvement was reported by 72% of placebo participants (48/67) at 12 weeks and by 49% (33/67) at 24 weeks (all p>0.05). Conclusions: The physiotherapy programme tested in this trial was no more effective than regular contact with a therapist at reducing pain and disability.

215 citations

Journal ArticleDOI
01 Oct 2014-JAMA
TL;DR: In patients older than 50 years with moderate or severe chronic knee pain, neither laser nor needle acupuncture conferred benefit over sham for pain or function, and the findings do not support acupuncture for these patients.
Abstract: RESULTS At 12 weeks and 1 year, 26 (9%) and 50 (18%) participants were lost to follow-up, respectively. Analyses showed neither needle nor laser acupuncture significantly improved pain (mean difference; −0.4 units; 95% CI, −1.2 to 0.4, and −0.1; 95% CI, −0.9 to 0.7, respectively) or function (−1.7; 95% CI, −6.1 to 2.6, and 0.5; 95% CI, −3.4 to 4.4, respectively) compared with sham at 12 weeks. Compared with control, needle and laser acupuncture resulted in modest improvements in pain (−1.1; 95% CI, −1.8 to −0.4, and −0.8; 95% CI, −1.5 to −0.1, respectively) at 12 weeks, but not at 1 year. Needle acupuncture resulted in modest improvement in function compared with control at 12 weeks (−3.9; 95% CI, −7.7 to −0.2) but was not significantly different from sham (−1.7; 95% CI, −6.1 to 2.6) and was not maintained at 1 year. There were no differences for most secondary outcomes and no serious adverse events.

212 citations

Journal ArticleDOI
TL;DR: Regression analyses demonstrated that disease severity, baseline functioning, and magnitude of immediate change in walking pain and the first peak adduction moment with insoles were predictive of clinical outcome at 3 months.
Abstract: Objective To assess immediate effects of laterally wedged insoles on walking pain, external knee adduction moment, and static alignment, and whether these immediate effects together with age, body mass index, and disease severity predict clinical outcome after 3 months of wearing insoles in medial knee osteoarthritis. Methods Forty volunteers (mean age 64.7 years, 16 men) were tested in random order with and without a pair of 5° full-length lateral wedges. Immediate changes in static alignment were measured via radiographic mechanical axis and changes in adduction moment via 3-dimensional gait analysis. After 3 months of treatment with insoles, changes in pain and physical functioning were assessed via the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and patient-perceived global change scores. Results Reductions in the adduction moment occurred with insoles (first peak mean [95% confidence intervals (95% CI)] −0.22 [−0.28, −0.15] Nm/body weight × height %), accompanied by a reduction in walking pain of ∼24% (mean [95% CI] −1.0 [−4.0, 2.0]). Insoles had no mean effect on static alignment. Mean improvement in WOMAC pain (P = 0.004) and physical functioning (mean [95% CI] −6 [−11, −1]) was observed at 3 months, with 25 (69%) and 26 (72%) of 36 individuals reporting global improvement in pain and functioning, respectively. Regression analyses demonstrated that disease severity, baseline functioning, and magnitude of immediate change in walking pain and the first peak adduction moment with insoles were predictive of clinical outcome at 3 months. Conclusion Lateral wedges immediately reduced knee adduction moment and walking pain but had no effect on static alignment. Although some parameters predicted clinical outcome, these explained only one-third of the variance, suggesting that other unknown factors are also important.

165 citations

Journal ArticleDOI
TL;DR: An individualized clinical Pilates program produced similar beneficial effects on self-reported disability, pain, function and health-related quality of life as a general exercise program in community volunteers with chronic low back pain.
Abstract: This single-assessor-blinded randomized controlled trial aimed to compare the efficacy of physiotherapy-delivered clinical Pilates and general exercise for chronic low back pain. Methods: Eighty-seven community volunteers with low back pain for >=3 months and age 18-70 were randomized to either the Pilates (n = 44) or general exercise (n = 43) group. The primary outcome was pain/disability measured with the Quebec scale. Secondary outcomes included pain on a numeric rating scale, Patient-Specific Functional Scale, Pain Self-efficacy Questionnaire, quality of life, and global perceived effect of treatment. All participants attended 60-min exercise sessions twice weekly for 6 wk supervised by a physiotherapist and performed daily home exercises that were continued during the follow-up. Participants from the clinical Pilates group received an individualized direction-specific exercise program prescribed by the physiotherapist after a clinical examination. The general exercise group received a generic set of exercises that were multidirectional and nonspecific. Outcomes were assessed after 6 wk (primary time point) and at 12 and 24 wk. Differences in mean change were compared between groups using ANCOVA adjusted for baseline values of the outcome. Results: Eighty-three participants (96%) completed the 6-wk intervention and 60 (69%) completed the 24-wk follow-up. At 6 wk, no difference was found between groups for change in the Quebec scale (3.5, 95% confidence interval = -7.3 to 0.3, P = 0.07); both groups showed significant improvements. Similar results were found at the 12- and 24-wk follow-up and for the secondary outcome measures. Conclusions: An individualized clinical Pilates program produced similar beneficial effects on self-reported disability, pain, function and health-related quality of life as a general exercise program in community volunteers with chronic low back pain. (C)2012The American College of Sports Medicine

163 citations


Cited by
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Journal ArticleDOI
06 Jun 1986-JAMA
TL;DR: The editors have done a masterful job of weaving together the biologic, the behavioral, and the clinical sciences into a single tapestry in which everyone from the molecular biologist to the practicing psychiatrist can find and appreciate his or her own research.
Abstract: I have developed "tennis elbow" from lugging this book around the past four weeks, but it is worth the pain, the effort, and the aspirin. It is also worth the (relatively speaking) bargain price. Including appendixes, this book contains 894 pages of text. The entire panorama of the neural sciences is surveyed and examined, and it is comprehensive in its scope, from genomes to social behaviors. The editors explicitly state that the book is designed as "an introductory text for students of biology, behavior, and medicine," but it is hard to imagine any audience, interested in any fragment of neuroscience at any level of sophistication, that would not enjoy this book. The editors have done a masterful job of weaving together the biologic, the behavioral, and the clinical sciences into a single tapestry in which everyone from the molecular biologist to the practicing psychiatrist can find and appreciate his or

7,563 citations

Journal ArticleDOI
TL;DR: Twenty-five carefully worded recommendations have been generated based on a critical appraisal of existing guidelines, a systematic review of research evidence and the consensus opinions of an international, multidisciplinary group of experts for the management of hip and knee osteoarthritis.

2,616 citations

Journal ArticleDOI
TL;DR: Clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients.
Abstract: This guideline from the ACP provides clinical recommendations about noninvasive pharmacologic and nonpharmacologic treatment of low back pain.

1,848 citations

Journal ArticleDOI
TL;DR: The evidence for prescribing exercise therapy in the treatment of metabolic syndrome‐related disorders (insulin resistance, type 2 diabetes, dyslipidemia, hypertension, obesity), heart and pulmonary diseases, muscle, bone and joint diseases, and cancer, depression, asthma and type 1 diabetes is presented.
Abstract: Considerable knowledge has accumulated in recent decades concerning the significance of physical activity in the treatment of a number of diseases, including diseases that do not primarily manifest as disorders of the locomotive apparatus. In this review we present the evidence for prescribing exercise therapy in the treatment of metabolic syndrome-related disorders (insulin resistance, type 2 diabetes, dyslipidemia, hypertension, obesity), heart and pulmonary diseases (chronic obstructive pulmonary disease, coronary heart disease, chronic heart failure, intermittent claudication), muscle, bone and joint diseases (osteoarthritis, rheumatoid arthritis, osteoporosis, fibromyalgia, chronic fatigue syndrome) and cancer, depression, asthma and type 1 diabetes. For each disease, we review the effect of exercise therapy on disease pathogenesis, on symptoms specific to the diagnosis, on physical fitness or strength and on quality of life. The possible mechanisms of action are briefly examined and the principles for prescribing exercise therapy are discussed, focusing on the type and amount of exercise and possible contraindications.

1,317 citations