Background Osteoarthritis (OA) is the most prevalent chronic joint disorder worldwide and is associated with significant pain and disability. Objectives To assess the effects of viscosupplementation in the treatment of OA of the knee. The products were hyaluronan and hylan derivatives (Adant, Arthrum H, Artz (Artzal, Supartz), BioHy (Arthrease, Euflexxa, Nuflexxa), Durolane, Fermathron, Go-On, Hyalgan, Hylan G-F 20 (Synvisc Hylan G-F 20), Hyruan, NRD-101 (Suvenyl), Orthovisc, Ostenil, Replasyn, SLM-10, Suplasyn, Synject and Zeel compositum). Search strategy MEDLINE (up to January (week 1) 2006 for update), EMBASE, PREMEDLINE, Current Contents up to July 2003, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched. Specialised journals and reference lists of identified randomised controlled trials (RCTs) and pertinent review articles up to December 2005 were handsearched. Selection criteria RCTs of viscosupplementation for the treatment of people with a diagnosis of OA of the knee were eligible. Single and double-blinded studies, placebo-based and comparative studies were eligible. At least one of the four OMERACT III core set outcome measures had to be reported (Bellamy 1997). Data collection and analysis Each trial was assessed independently by two reviewers for its methodological quality using a validated tool. All data were extracted by one reviewer and verified by a second reviewer. Continuous outcome measures were analysed as weighted mean differences (WMD) with 95% confidence intervals (CI). However, where different scales were used to measure the same outcome, standardized mean differences (SMD) were used. Dichotomous outcomes were analyzed by relative risk (RR). Main results Seventy-six trials with a median quality score of 3 (range 1 to 5) were identified. Follow-up periods varied between day of last injection and eighteen months. Forty trials included comparisons of hyaluronan/hylan and placebo (saline or arthrocentesis), ten trials included comparisons of intra-articular (IA) corticosteroids, six trials included comparisons of nonsteroidal anti-inflammatory drugs (NSAIDs), three trials included comparisons of physical therapy, two trials included comparisons of exercise, two trials included comparisons of arthroscopy, two trials included comparisons of conventional treatment, and fifteen trials included comparisons of other hyaluronans/hylan. The pooled analyses of the effects of viscosupplements against 'placebo' controls generally supported the efficacy of this class of intervention. In these same analyses, differential efficacy effects were observed for different products on different variables and at different timepoints. Of note is the 5 to 13 week post injection period which showed a percent improvement from baseline of 28 to 54% for pain and 9 to 32% for function. In general, comparable efficacy was noted against NSAIDs and longer-term benefits were noted in comparisons against IA corticosteroids. In general, few adverse events were reported in the hyaluronan/hylan trials included in these analyses. Authors' conclusions Based on the aforementioned analyses, viscosupplementation is an effective treatment for OA of the knee with beneficial effects: on pain, function and patient global assessment; and at different post injection periods but especially at the 5 to 13 week post injection period. It is of note that the magnitude of the clinical effect, as expressed by the WMD and standardised mean difference (SMD) from the RevMan 4.2 output, is different for different products, comparisons, timepoints, variables and trial designs. However, there are few randomised head-to-head comparisons of different viscosupplements and readers should be cautious, therefore, in drawing conclusions regarding the relative value of different products. The clinical effect for some products, against placebo, on some variables at some timepoints is in the moderate to large effect-size range. Readers should refer to relevant tables to review specific detail given the heterogeneity in effects across the product class and some discrepancies observed between the RevMan 4.2 analyses and the original publications. Overall, the analyses performed are positive for the HA class and particularly positive for some products with respect to certain variables and timepoints, such as pain on weight bearing at 5 to 13 weeks postinjection. In general, sample-size restrictions preclude any definitive comment on the safety of the HA class of products; however, within the constraints of the trial designs employed no major safety issues were detected. In some analyses viscosupplements were comparable in efficacy to systemic forms of active intervention, with more local reactions but fewer systemic adverse events. In other analyses HA products had more prolonged effects than IA corticosteroids. Overall, the aforementioned analyses support the use of the HA class of products in the treatment of knee OA.

/pdf/viscosupplementation-for-the-treatment-of-osteoarthritis-of-3irfb0d2h5.pdf

Viscosupplementation for the treatment of osteoarthritis of the knee

A review of standing balance recovery from stroke.

Background
Knee osteoarthritis (OA) is one of the leading causes of disability within the adult population. Current treatment options for OA of the knee include intra-articular (IA) hyaluronic acid (HA), a molecule found intrinsically within the knee joint that provides viscoelastic properties to the synovial fluid. A variety of mechanisms in which HA is thought to combat knee OA are reported in the current basic literature.

/pdf/the-mechanism-of-action-for-hyaluronic-acid-treatment-in-the-3denzfr9os.pdf

The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review

https://www.archives-pmr.org/article/S0003-9993(09)00934-4/pdf

5-Repetition Sit-to-Stand Test in Subjects With Chronic Stroke: Reliability and Validity

Muscle Strength and Weight-Bearing Symmetry Relate to Sit-to-Stand Performance in Individuals with Stroke

Chou SW, Wong AMK, Leong CP, Hong WS, Tang FT, Lin TH: Postural control during sit-to-stand and gait in stroke patients Am J Phys Med Rehabil 2003;82:42–47ObjectiveTo investigate the relationship of sit-to-stand and gait performance in hemiplegic stroke patientsDesignA total of 40 chronic

Postural control during sit-to stand and gait in stroke patients.

Background Body sway increases with age. The purpose of this study was to obtain baseline data and the characteristics of balance performance in different age groups for balance strategy management. Methods Healthy individuals (n = 107) were divided into young, middle-aged, and elderly groups, and assessed by computerized dynamic posturography (CDP) on a Smart Balance Master. The 6 subtests in the sensory organization tests (SOT) for the CDP were as follows: subtest 1, eyes open, fixed support platform; subtest 2, eyes closed, fixed platform; subtest 3, eyes open, fixed platform; subtest 4, eyes open, swaying platform; subtest 5, eyes closed, swaying platform; subtest 6, swaying visual surround, swaying platform. Motor balance control tests included the limit of stability (LOS) test at 75% of LOS in 8 directions and the left/right and forward/backward rhythmic weight shift (RWS) test. Results In the SOT, the elderly group demonstrated significantly lower average stability and maximal stability scores in subtests 4-6. This group also demonstrated a relatively lower average percentage of ankle strategy in subtests 4-6. In the motor control tests, the elderly group demonstrated a significantly higher overall reactive time and lower overall directional control in the LOS test, lower on-axis velocity during the forward/backward and left/right motor control test and a lower average percentage of forward/backward directional control in the RWS test. Conclusion The elderly had a higher degree of postural imbalance and used hip strategy to a greater extent to maintain their balance, especially when standing on a swaying support surface in the absence of visual surround or with conflicted visual surround. The elderly required a longer reaction time and demonstrated lower directional control in balance performance.

Comparison of the static and dynamic balance performance in young, middle-aged, and elderly healthy people.

Wong AMK, Leong CP, Su TY, Yu SW, Tsai WC, Chen CPC: Clinical trial of acupuncture for patients with spinal cord injuries. Am J Phys Med Rehabil 2003;82:21–27.ObjectiveTo examine whether electrical acupuncture therapy through adhesive surface electrodes and concomitant auricular acupuncture

Clinical trial of acupuncture for patients with spinal cord injuries.

The effects of a new foot-toe orthosis in treating painful hallux valgus.

Objective: To investigate the correlation between hemiplegic shoulder pain factors during the acute and chronic stages of stroke recovery. Design: A prospective longitudinal study. Subjects: Seventy-six stroke patients with hemiplegic shoulders. Methods: Hemiplegic shoulder pain and clinical, physical, and sonography results were recorded at admission and during both acute (before discharge) and chronic stages (6 months after discharge). Results: During the acute stage, hemiplegic shoulder pain correlated significantly with shoulder motor function level and range of motion limitations. During the chronic stage, hemiplegic shoulder pain correlated significantly with shoulder motor function level, range of motion limitations, spasticity and abnormal sonographic findings. Higher incidence (p = 0.014) of hemiplegic shoulder pain and pain scores (p < 0.01) were noted and abnormal sonographic findings of the biceps tendon long head (p = 0.01) and subscapularis tendon (p = 0.01) were higher during the chronic stage. Effusion, tenosynovitis or tendinopathy of the biceps tendon long head, and supraspinatus tendinopathy were notable during both stages. Conclusion: Hemiplegic shoulder pain was correlated with lower motor function level and shoulder range of motion limitation in both stages. Shoulder spasticity and abnormal sonographic findings were correlated with hemiplegic shoulder pain during the chronic stage.

/pdf/sonography-and-physical-findings-in-stroke-patients-with-olkh9ezejy.pdf

Chau-Peng Leong

Papers

Postural control during sit-to stand and gait in stroke patients.

Comparison of the static and dynamic balance performance in young, middle-aged, and elderly healthy people.

Clinical trial of acupuncture for patients with spinal cord injuries.

The effects of a new foot-toe orthosis in treating painful hallux valgus.

Sonography and physical findings in stroke patients with hemiplegic shoulders: a longitudinal study.