Introduction - University of Pittsburgh



righttopRELATING NEUROPATHIC SYMPTOMS AND IMPAIRED MONOFILAMENT DETECTION TO KNEE OSTEOARTHRITIS PATIENTS FOLLOWING TOTAL KNEE REPLACEMENTbyGeorge M. KimmelBS, Slippery Rock University, 2013Submitted to the Graduate Faculty ofEpidemiologyGraduate School of Public Health in partial fulfillment of the requirements for the degree ofMaster of Public HealthUniversity of Pittsburgh201700RELATING NEUROPATHIC SYMPTOMS AND IMPAIRED MONOFILAMENT DETECTION TO KNEE OSTEOARTHRITIS PATIENTS FOLLOWING TOTAL KNEE REPLACEMENTbyGeorge M. KimmelBS, Slippery Rock University, 2013Submitted to the Graduate Faculty ofEpidemiologyGraduate School of Public Health in partial fulfillment of the requirements for the degree ofMaster of Public HealthUniversity of Pittsburgh2017right-285750UNIVERSITY OF PITTSBURGHGRADUATE SCHOOL OF PUBLIC HEALTHThis essay is submittedbyGeorge M. KimmelonAugust 11, 2017and approved byEssay Advisor:Nancy W. Glynn, PhD______________________________________Assistant Professor Department of EpidemiologyGraduate School of Public HealthUniversity of PittsburghEssay Reader:Elsa Strotmeyer, PhD, MPH ______________________________________Associate ProfessorCenter for Aging and Population HealthDepartment of EpidemiologyGraduate School of Public HealthUniversity of PittsburghEssay Reader:______________________________________Sara Piva, PhD, PTAssociate ProfessorDepartment of Physical TherapySchool of Health and Rehabilitation SciencesUniversity of Pittsburgh00UNIVERSITY OF PITTSBURGHGRADUATE SCHOOL OF PUBLIC HEALTHThis essay is submittedbyGeorge M. KimmelonAugust 11, 2017and approved byEssay Advisor:Nancy W. Glynn, PhD______________________________________Assistant Professor Department of EpidemiologyGraduate School of Public HealthUniversity of PittsburghEssay Reader:Elsa Strotmeyer, PhD, MPH ______________________________________Associate ProfessorCenter for Aging and Population HealthDepartment of EpidemiologyGraduate School of Public HealthUniversity of PittsburghEssay Reader:______________________________________Sara Piva, PhD, PTAssociate ProfessorDepartment of Physical TherapySchool of Health and Rehabilitation SciencesUniversity of Pittsburgh9144004333875Copyright ? by George Kimmel201700Copyright ? by George Kimmel2017righttopNancy W. Glynn, PhDRELATING NEUROPATHIC SYMPTOMS AND IMPAIRED MONOFILAMENT DETECTION TO KNEE OSTEOARTHRITIS IN TOTAL KNEE REPLACEMENT PATIENTSGeorge Kimmel, MPHUniversity of Pittsburgh, 2017 [MPH or MHA]University of Pittsburgh, [year]00Nancy W. Glynn, PhDRELATING NEUROPATHIC SYMPTOMS AND IMPAIRED MONOFILAMENT DETECTION TO KNEE OSTEOARTHRITIS IN TOTAL KNEE REPLACEMENT PATIENTSGeorge Kimmel, MPHUniversity of Pittsburgh, 2017 [MPH or MHA]University of Pittsburgh, [year]ABSTRACTKnee osteoarthritis (OA), the most common form of arthritis in the US, carries a lifetime risk of 45% in older adults. Knee OA has been associated with neuropathic symptoms, such as pain and loss of sensation, and reduced sensory peripheral nerve function (PNF). However, the relationship between knee OA and peripheral nerves remains poorly understood. We examined PNF using monofilament detection (insensitivity: unable to detect 3/4 touches of 1.4-g, 4-g and 10-g at dorsum of right and left big toe) in patients aged ≥60 years with knee OA who had unilateral total knee replacement (TKR). Patients (N=126) were 63.5% women; age 69.8±6.5 years; 2-4 months post-surgery, and had a mean Western Ontario and McMaster Universities Arthritis Index (WOMAC) score: 20.1±7.8. Conditional logistic regression was used to compare between knee differences of patients’ TKR and non-surgical knee (NSK) in separate models for 1.4-g, 4-g and 10-g monofilament insensitivity. Monofilament insensitivity was similar in the TKR knee compared to NSK: 1.4-g (31.8% vs. 29.4%), 4-g (15.9% vs. 15.1%), and 10-g (8.7% vs. 10.3%), all NS. In conditional logistic regression models, monofilament insensitivity was not different for 1.4-g (OR=1.3; 95% CI: 0.57-3.0), 4-g (OR=1.2; 95% CI: 0.39-3.5) or 10-g (OR=0.50; 95% CI: 0.09-2.7) in patients’ TKR vs. NSK. Although light touch monofilament insensitivity was highly prevalent in TKR patients, lack of differences for TKR vs. NSK suggests that knee OA rather than surgery may be responsible for PNF impairments. Future studies should include more sensitive tests of PNF in TKR patients to further elucidate the public health importance of PNF and knee OA.TABLE OF CONTENTS TOC \o "2-4" \h \z \t "Heading 1,1,Appendix,1,Heading,1" preface PAGEREF _Toc498962352 \h ix1.0Introduction PAGEREF _Toc498962353 \h 11.1knee OSTEOARTHRITIS PAGEREF _Toc498962354 \h 11.2Total knee replacement PAGEREF _Toc498962355 \h 41.3peripheral nerve function PAGEREF _Toc498962356 \h 51.4Gaps in literature PAGEREF _Toc498962357 \h 101.5public health significance PAGEREF _Toc498962358 \h 112.0objectives PAGEREF _Toc498962359 \h 123.0Methods PAGEREF _Toc498962360 \h 133.1ReCruitment PAGEREF _Toc498962361 \h 133.2Study population PAGEREF _Toc498962362 \h 143.3Study measures PAGEREF _Toc498962363 \h 163.3.1Monofilament testing PAGEREF _Toc498962364 \h 163.3.2Demographic Characteristics PAGEREF _Toc498962365 \h 173.4statistical analysis PAGEREF _Toc498962366 \h 174.0Results PAGEREF _Toc498962367 \h 185.0Discussion PAGEREF _Toc498962368 \h 20Appendix A – WOMAC OSTEOARTHRITIS INDEX PAGEREF _Toc498962369 \h 27bibliography PAGEREF _Toc498962370 \h 31List of tables TOC \h \z \c "Table" Table 1. Results of Studies Used in Literature Review Examining PN Function in Older Adults (N=9) PAGEREF _Toc498962371 \h 23List of figures TOC \h \z \c "Figure" Figure 1. Peripheral Nerve and Knee OA Conceptual Model PAGEREF _Toc498962698 \h 3Figure 2. Monofilament Testing Procedure PAGEREF _Toc498962699 \h 16Figure 3. Monofilament Insensitivity Comparison for TKR vs NSK PAGEREF _Toc498962700 \h 24Figure 4. Conditional Logistic Regression for Monofilament Insensitivity between Discordant Knees TKR vs. NSK PAGEREF _Toc498962701 \h 24Figure 5. Conditional Logistic Regression for Monofilament Insensitivity between Discordant Knees TKR vs. NSK (Females) PAGEREF _Toc498962702 \h 25Figure 6. Conditional Logistic Regression for Monofilament Insensitivity between Discordant Knees TKR vs. NSK (Males) PAGEREF _Toc498962703 \h 25Figure 7. Conditional Logistic Regression for Monofilament Insensitivity between Discordant Knees TKR vs. NSK (≤70) PAGEREF _Toc498962704 \h 26Figure 8. Conditional Logistic Regression for Monofilament Insensitivity between Discordant Knees TKR vs. NSK (>70) PAGEREF _Toc498962705 \h 26prefaceI would like to thank my committee for assisting me with my essay and the completion of the program. Thank you Dr. Glynn for helping me map out my journey through the program and getting me from the beginning to the end. Thank you Dr. Strotmeyer for your firm but insightful guidance and for introducing me to the world of academic research. I appreciate your patience and I believe the work I did will prepare me for future endeavors. Thank you Dr. Piva for showing me this research topic from the patient and clinical standpoint in a way that I may not have looked at before. I would also like to thank the coordinators and students that helped me throughout this internship process. Introductionknee OSTEOARTHRITISOsteoarthritis (OA), the most common form of arthritis, is a significant health burden on the US population. Knee OA is the most common form of lower-body arthritis in the USADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Centers for Disease Control and Prevention (CDC)", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "MMWR", "id" : "ITEM-1", "issue" : "16", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "421-6", "title" : "Prevalence and Most Common Causes of Disability Among Adults - United States, 2005", "type" : "article-journal", "volume" : "58" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹", "plainTextFormattedCitation" : "1", "previouslyFormattedCitation" : "¹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1. Under normal circumstances, the cartilage and surrounding articular tissue in the knee allows the bone surfaces to glide along their articular surfaces without friction and pain. Knee OA develops when cartilage between the bones of the lower leg starts to wear down causing inflammationADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Heidari", "given" : "Behazd", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Caspian J Intern Med", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "205-212", "title" : "prevalence, risk factors, pathogenesis and features: Part I", "type" : "article-journal", "volume" : "2" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²", "plainTextFormattedCitation" : "2", "previouslyFormattedCitation" : "²" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }2. This wearing down of cartilage and subchondral bone can cause structural changes to occur in the joint causing pain and mobility impairmentADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1093/rheumatology/keu332", "ISBN" : "1462-0324", "ISSN" : "14620332", "PMID" : "25150513", "abstract" : "OBJECTIVE: To estimate the prevalence of inadequate pain relief (IPR) among patients with symptomatic knee OA prescribed analgesic therapy and to characterize patients with IPR. METHODS: Patients \u226550 years old with physician-diagnosed knee OA who had taken topical or oral pain medication for at least 14 days were recruited for this prospective non-interventional study in six European countries. Pain and function were assessed using the Brief Pain Inventory (BPI) and the WOMAC; quality of life (QoL) was assessed using the 12-item short form. IPR was defined as an average pain score of >4 out of 10 on BPI question 5. RESULTS: Of 1187 patients enrolled, 68% were female and the mean age was 68 years (s.d. 9); 639 (54%) met the definition of IPR. Patient responses for the BPI average pain question were well correlated with responses on the WOMAC pain subscale (Spearman r = 0.64, P < 0.001). In multivariate logistic regression, patients with IPR had greater odds of being female [adjusted odds ratio (adjOR) 1.90 (95% CI 1.46, 2.48)] and having OA in both knees [adjOR 1.48 (95% CI 1.15, 1.90)], higher BMI, longer OA duration, depression or diabetes. Patients with IPR (vs non-IPR) were more likely to have worse QoL, greater function loss and greater pain interference. CONCLUSION: IPR is common among patients with knee OA requiring analgesics and is associated with large functional loss and impaired QoL. Patients at particular risk of IPR, as characterized in this study, may require greater attention towards their analgesic treatment options. Trial registration: (NCT01294696).", "author" : [ { "dropping-particle" : "", "family" : "Conaghan", "given" : "Philip G.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Peloso", "given" : "Paul M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V.", "family" : "Everett", "given" : "Sharlette", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rajagopalan", "given" : "Srinivasan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Black", "given" : "Christopher M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mavros", "given" : "Panagiotis", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arden", "given" : "Nigel K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Phillips", "given" : "Ceri J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rannou", "given" : "Fran\u00e7ois", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Laar", "given" : "Mart A F J", "non-dropping-particle" : "van de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moore", "given" : "R. Andrew", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Taylor", "given" : "Stephanie D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Rheumatology (Oxford, England)", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "270-277", "title" : "Inadequate pain relief and large functional loss among patients with knee osteoarthritis: evidence from a prospective multinational longitudinal study of osteoarthritis real-world therapies", "type" : "article-journal", "volume" : "54" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1002/art.24120", "ISBN" : "0004-3591 (Print)\\r0004-3591 (Linking)", "ISSN" : "21514658", "PMID" : "18821657", "abstract" : "OBJECTIVE: Refractory, disabling pain associated with knee osteoarthritis (OA) is usually treated with total knee replacement. However, pain in these patients might be associated with central nervous sensitization rather than peripheral inflammation and injury. We evaluated the presence of hyperalgesia in patients scheduled for a total knee replacement due to knee osteoarthritis with refractory pain, and we assessed the impact of pressure pain threshold measurements (PPT) on pain, disability, and quality of life of these patients. METHODS: Sixty-two female patients were compared with 22 age-matched healthy controls without reported pain for the last year. PPT was measured at the lower extremities subcutaneous dermatomes, over the vastus medialis, adductor longus, rectus femoris, vastus lateralis, tibialis anterior, peroneus longus, iliacus, quadratus lumborum and popliteus muscles and at the supraspinous ligaments from L1-L5, over the L5-S1 and S1-S2 sacral areas and at the pes anserinus bursae and patellar tendon. RESULTS: Patients with knee OA had significantly lower PPT over all evaluated structures versus healthy control subjects (P<0.001). Lower PPT values were correlated with higher pain intensity, higher disability scores, and with poorer quality of life, except for the role-emotional and general health status. Combined PPT values over the patellar tendon, at the S2 subcutaneous dermatome and at the adductor longus muscle were the best predictors for visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index pain scores. CONCLUSION: Patients with pain due to osteoarthritis who were scheduled for total knee replacement showed hyperalgesia of nervous system origin that negatively impacted pain, knee functional capacity, and most aspects of quality of life.", "author" : [ { "dropping-particle" : "", "family" : "Imamura", "given" : "Marta", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Imamura", "given" : "Satiko Tomikawa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kaziyama", "given" : "Helena H S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Targino", "given" : "Rosa Alves", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wu", "given" : "Tu Hsing", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Souza", "given" : "Luiz Paulo Marques", "non-dropping-particle" : "De", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cutait", "given" : "Martin Mendon\u00e7a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fregni", "given" : "Felipe", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Camanho", "given" : "Gilberto Luis", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arthritis Care and Research", "id" : "ITEM-2", "issue" : "10", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "1424-1431", "title" : "Impact of nervous system hyperalgesia on pain, disability, and quality of life in patients with knee osteoarthritis: A controlled analysis", "type" : "article-journal", "volume" : "59" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^3,4", "plainTextFormattedCitation" : "3,4", "previouslyFormattedCitation" : "^3,4" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3,4. Severe cases of prolonged knee OA can eventually lead to painful bone on bone contact. Other symptoms of knee OA include decreased range of motion, bony enlargements around the knee joint, and elevated sensitivity to cold temperatures as well as humidity in the airADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0972-3560", "ISSN" : "0972-3560", "PMID" : "2013432559", "abstract" : "Knee osteoarthritis (OA) is a disorder of cartilage and periarticular bone. It is a most frequent chronic musculoskeletal disorder and the leading cause of disability in the elderly. The risk factors include genetics, female sex, past trauma, advancing age, and obesity. A plain radiograph may help in the diagnosis of knee OA. The management of OA primarily comprises pharmacological therapy and various non-pharmacological interventions. Total joint replacement of the knee OA is recommended for patients with chronic pain and disability despite maximal medical therapy. This review focuses on the diagnosis, pathogenesis, and treatment based on recent studies.", "author" : [ { "dropping-particle" : "", "family" : "Arya", "given" : "R K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jain", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal, Indian Academy of Clinical Medicine", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "154-162", "title" : "Osteoarthritis of the knee joint: An overview", "type" : "article-journal", "volume" : "14" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁵", "plainTextFormattedCitation" : "5", "previouslyFormattedCitation" : "⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }5. Knee OA is attributed to 19% of disability among US adultsADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Centers for Disease Control and Prevention (CDC)", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "MMWR", "id" : "ITEM-1", "issue" : "16", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "421-6", "title" : "Prevalence and Most Common Causes of Disability Among Adults - United States, 2005", "type" : "article-journal", "volume" : "58" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹", "plainTextFormattedCitation" : "1", "previouslyFormattedCitation" : "¹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1, of which pain associated with movement is the most likely contributing factorADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Guccione", "given" : "Andrew A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Anderson", "given" : "Jennifer J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Anthony", "given" : "John M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zhang", "given" : "Yuqing", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wilson", "given" : "Peter W F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kelly-hayes", "given" : "Margaret", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wolf", "given" : "Philip A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kreger", "given" : "Bernard E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kannel", "given" : "William B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American Journal of Public Health", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "1993" ] ] }, "page" : "351-358", "title" : "The Effects of Specific Medical Conditions on the Functional Limitations of Elders in the Framingham Study", "type" : "article-journal", "volume" : "84" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁶", "plainTextFormattedCitation" : "6", "previouslyFormattedCitation" : "⁶" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }6. While no single test to diagnose knee OA exists, most doctors diagnose the condition through a combination of physical exams and clinical historyADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "author" : [ { "dropping-particle" : "", "family" : "Hyman", "given" : "Garrett", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arthritis-Health", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2011" ] ] }, "title" : "Knee Osteoarthritis Diagnosis", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁷", "plainTextFormattedCitation" : "7", "previouslyFormattedCitation" : "⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }7. The primary symptom doctors consider when diagnosing arthritis is pain that increases during activity and recovers during restADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Swagerty", "given" : "Daniel L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hellinger", "given" : "Deborah", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "RADIOLOGIC DECISION-MAKING", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2001" ] ] }, "page" : "279-286", "title" : "Radiographic Assessment of Osteoarthritis", "type" : "article-journal", "volume" : "64" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁸", "plainTextFormattedCitation" : "8", "previouslyFormattedCitation" : "⁸" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }8. The two different classifications of knee OA are symptomatic and radiographic. Symptomatic knee OA refers to indicators that a patient may feel and include pain, stiffness, and loss of motionADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Heidari", "given" : "Behazd", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Caspian J Intern Med", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "205-212", "title" : "prevalence, risk factors, pathogenesis and features: Part I", "type" : "article-journal", "volume" : "2" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²", "plainTextFormattedCitation" : "2", "previouslyFormattedCitation" : "²" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }2. Radiographic OA refers to a diagnosis by x-ray and involves the following criteria: narrowing of the joint space of the knee, the presence of osteophytes and/cysts, and subchondral sclerosisADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "author" : [ { "dropping-particle" : "", "family" : "Eustice", "given" : "Carol", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "VeryWell", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2017" ] ] }, "title" : "Symptomatic Osteoarthritis Versus Radiographic Osteoarthritis", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁹", "plainTextFormattedCitation" : "9", "previouslyFormattedCitation" : "⁹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }9. The most common radiological classification criteria comes from the Kellgren-Lawerence (K/L) radiographic grading schemeADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Kellgren", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lawrence", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Blackwell Scientific Publications", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "1963" ] ] }, "title" : "Atlas of standard radiographs. The epidemiology of chronic rheumatism. Vol. 2", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁰", "plainTextFormattedCitation" : "10", "previouslyFormattedCitation" : "¹⁰" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }10. Developed in the 1957, this scale judges knee OA according to a five point scale ranging from 0-4ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Hayes", "given" : "Bethany", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kittelson", "given" : "Andrew", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Loyd", "given" : "Brian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wellsandt", "given" : "Elizabeth", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Flug", "given" : "Jonathan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stevens-lapsley", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Association of American Medical Colleges", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "18-21", "title" : "Assessing Radiographic Knee Osteoarthritis : An Online Training Tutorial for the Kellgren-Lawrence Grading Scale", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹¹", "plainTextFormattedCitation" : "11", "previouslyFormattedCitation" : "¹¹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }11. The scale classifies the severity of knee OA by the presence of narrowed joint space, sclerosis, cysts and/osteophytes, and malformationADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Hayes", "given" : "Bethany", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kittelson", "given" : "Andrew", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Loyd", "given" : "Brian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wellsandt", "given" : "Elizabeth", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Flug", "given" : "Jonathan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stevens-lapsley", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Association of American Medical Colleges", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "18-21", "title" : "Assessing Radiographic Knee Osteoarthritis : An Online Training Tutorial for the Kellgren-Lawrence Grading Scale", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹¹", "plainTextFormattedCitation" : "11", "previouslyFormattedCitation" : "¹¹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }11. A classification of two or higher indicates the presence of arthritis in the knee and requires the incidence of osteophytes and distinct joint space narrowingADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Hayes", "given" : "Bethany", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kittelson", "given" : "Andrew", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Loyd", "given" : "Brian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wellsandt", "given" : "Elizabeth", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Flug", "given" : "Jonathan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stevens-lapsley", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Association of American Medical Colleges", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "18-21", "title" : "Assessing Radiographic Knee Osteoarthritis : An Online Training Tutorial for the Kellgren-Lawrence Grading Scale", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹¹", "plainTextFormattedCitation" : "11", "previouslyFormattedCitation" : "¹¹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }11. Further classifications require more than one osteophytes in the knee along with further joint space narrowingADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Hayes", "given" : "Bethany", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kittelson", "given" : "Andrew", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Loyd", "given" : "Brian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wellsandt", "given" : "Elizabeth", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Flug", "given" : "Jonathan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stevens-lapsley", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Association of American Medical Colleges", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "18-21", "title" : "Assessing Radiographic Knee Osteoarthritis : An Online Training Tutorial for the Kellgren-Lawrence Grading Scale", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹¹", "plainTextFormattedCitation" : "11", "previouslyFormattedCitation" : "¹¹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }11. Knee OA affects all ages and ethnic backgrounds but predominately occurs in older populations. Murphy et. al. calculated the lifetime risk of developing knee OA by applying logistic regression and general estimation equations to a cohort of 3,068 participating in the Johnston County Osteoarthritis Project, a longitudinal study of men and women ages 45 and older living in rural North CarolinaADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/art.24021.Lifetime", "ISBN" : "0004-3591 (Print)\\r0004-3591 (Linking)", "ISSN" : "00043591", "PMID" : "18759314", "abstract" : "OBJECTIVE: To estimate the lifetime risk of symptomatic knee osteoarthritis (OA), overall and stratified by sex, race, education, history of knee injury, and body mass index (BMI).\\n\\nMETHODS: The lifetime risk of symptomatic OA in at least 1 knee was estimated from logistic regression models with generalized estimating equations among 3,068 participants of the Johnston County Osteoarthritis Project, a longitudinal study of black and white women and men age >or=45 years living in rural North Carolina. Radiographic, sociodemographic, and symptomatic knee data measured at baseline (1990-1997) and first followup (1999-2003) were analyzed.\\n\\nRESULTS: The lifetime risk of symptomatic knee OA was 44.7% (95% confidence interval [95% CI] 40.0-49.3%). Cohort members with history of a knee injury had a lifetime risk of 56.8% (95% CI 48.4-65.2%). Lifetime risk rose with increasing BMI, with a risk of 2 in 3 among those who were obese.\\n\\nCONCLUSION: Nearly half of the adults in Johnston County will develop symptomatic knee OA by age 85 years, with lifetime risk highest among obese persons. These current high risks in Johnston County may suggest similar risks in the general US population, especially given the increase in 2 major risk factors for knee OA, aging, and obesity. This underscores the immediate need for greater use of clinical and public health interventions, especially those that address weight loss and self-management, to reduce the impact of having knee OA.", "author" : [ { "dropping-particle" : "", "family" : "Murphy", "given" : "Louise", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schwartz", "given" : "Todd A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Helmick", "given" : "Charles G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Renner", "given" : "Jordan B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tudor", "given" : "Gail", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Koch", "given" : "Gary", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dragomir", "given" : "Anca", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kalsbeek", "given" : "William D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Luta", "given" : "Gheorghe", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jordan", "given" : "Joanne M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arthritis Rheum.", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "1207-1213", "title" : "Lifetime Risk of Symptomatic Knee Osteoarthritis", "type" : "article-journal", "volume" : "59" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹²", "plainTextFormattedCitation" : "12", "previouslyFormattedCitation" : "¹²" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }12. Findings showed a lifetime risk of developing knee OA of approximately 45%ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/art.24021.Lifetime", "ISBN" : "0004-3591 (Print)\\r0004-3591 (Linking)", "ISSN" : "00043591", "PMID" : "18759314", "abstract" : "OBJECTIVE: To estimate the lifetime risk of symptomatic knee osteoarthritis (OA), overall and stratified by sex, race, education, history of knee injury, and body mass index (BMI).\\n\\nMETHODS: The lifetime risk of symptomatic OA in at least 1 knee was estimated from logistic regression models with generalized estimating equations among 3,068 participants of the Johnston County Osteoarthritis Project, a longitudinal study of black and white women and men age >or=45 years living in rural North Carolina. Radiographic, sociodemographic, and symptomatic knee data measured at baseline (1990-1997) and first followup (1999-2003) were analyzed.\\n\\nRESULTS: The lifetime risk of symptomatic knee OA was 44.7% (95% confidence interval [95% CI] 40.0-49.3%). Cohort members with history of a knee injury had a lifetime risk of 56.8% (95% CI 48.4-65.2%). Lifetime risk rose with increasing BMI, with a risk of 2 in 3 among those who were obese.\\n\\nCONCLUSION: Nearly half of the adults in Johnston County will develop symptomatic knee OA by age 85 years, with lifetime risk highest among obese persons. These current high risks in Johnston County may suggest similar risks in the general US population, especially given the increase in 2 major risk factors for knee OA, aging, and obesity. This underscores the immediate need for greater use of clinical and public health interventions, especially those that address weight loss and self-management, to reduce the impact of having knee OA.", "author" : [ { "dropping-particle" : "", "family" : "Murphy", "given" : "Louise", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schwartz", "given" : "Todd A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Helmick", "given" : "Charles G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Renner", "given" : "Jordan B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tudor", "given" : "Gail", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Koch", "given" : "Gary", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dragomir", "given" : "Anca", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kalsbeek", "given" : "William D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Luta", "given" : "Gheorghe", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jordan", "given" : "Joanne M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arthritis Rheum.", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "1207-1213", "title" : "Lifetime Risk of Symptomatic Knee Osteoarthritis", "type" : "article-journal", "volume" : "59" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹²", "plainTextFormattedCitation" : "12", "previouslyFormattedCitation" : "¹²" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }12. This study also showed that for those who had previous knee injuries, lifetime risk rose to 56.8% and, for those who with a BMI in the obese category, about two out of every three were at risk for knee OA. According to the National Health and Examination Survey (NHANES III), approximately 37% of those who participated in a representative U.S. survey reported doctor diagnosed radiographic OAADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/art.23176.Estimates", "author" : [ { "dropping-particle" : "", "family" : "Lawrence", "given" : "Reva C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Felson", "given" : "David T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Helmick", "given" : "Charles G.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arnold", "given" : "Lesley M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Choi", "given" : "Hyon", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Deyo", "given" : "Richard A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gabriel", "given" : "Sherine", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arthritis Rheum", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "26-35", "title" : "Estimates of the Prevalence of Arthritis and Other Rheumatic Conditions in the United States, Part II", "type" : "article-journal", "volume" : "58" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹³", "plainTextFormattedCitation" : "13", "previouslyFormattedCitation" : "¹³" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }13. A large meta-analysis that included 85 studies related to risk factors of developing knee OA showed that obesity was the leading contributor to knee OA (pooled OR 2.63, 95% CI: 2.28-3.05) followed by previous knee trauma (pooled OR 3.86, 95% CI: 2.61-5.70) including prolonged squattingADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/art.20127", "ISBN" : "0004-3591", "ISSN" : "00043591", "PMID" : "15077301", "abstract" : "OBJECTIVE: To examine the association between squatting, a common daily posture in China, and the prevalence of radiographic osteoarthritis (OA) in different knee compartments among Chinese subjects from Beijing, and to estimate how much of the difference in prevalence of knee OA between Chinese subjects in Beijing and white subjects in Framingham, Massachusetts is accounted for by the impact of squatting. METHODS: We recruited a random sample of Beijing residents age > or =60 years. Subjects answered questions on joint symptoms, and knee radiographs were obtained. Subjects were also asked to recall the average amount of time spent squatting each day at age 25 years. Radiographic films (weight-bearing anteroposterior and skyline views) were read for Kellgren/Lawrence (K/L) grade and individual radiographic features. Medial disease was defined when radiographs showed a K/L grade of > or =2 at the tibiofemoral joint and a medial joint space narrowing score of > or =1, and lateral disease was assessed in a comparable manner in the lateral compartments. We examined the association of squatting with the prevalence of tibiofemoral OA as well as with the prevalence of patellofemoral knee OA, while adjusting for age and other potential confounding factors. We used the same approach to assess the relationship between squatting and tibiofemoral OA in the medial compartment and in the lateral compartment. Finally, we estimated the impact of squatting at age 25 on the difference in prevalence of knee OA between Chinese subjects in Beijing and white subjects in the Framingham OA Study. RESULTS: Squatting was very common among the Chinese subjects: approximately 40% of men and approximately 68% of women reported squatting > or =1 hour per day at age 25. The prevalence of tibiofemoral OA increased as the time spent squatting at age 25 increased in both the men and the women. Compared with subjects who squatted <30 minutes per day at age 25, the multivariable-adjusted prevalence odds ratios of tibiofemoral OA were 1.1 for time spent squatting of 30-59 minutes/day, 1.0 for 60-119 minutes/day, 1.7 for 120-179 minutes/day, and 2.0 for > or =120 minutes/day among the men (P for trend = 0.074), and the respective odds ratios among the women were 1.4, 1.3, 1.2, and 2.4 (P for trend = 0.077). A weaker association with patellofemoral OA was found. Prolonged squatting in daily life was more strongly associated with medial knee OA than with lateral disease in the men, but had a \u2026", "author" : [ { "dropping-particle" : "", "family" : "Zhang", "given" : "Yuqing", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hunter", "given" : "David J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nevitt", "given" : "Michael C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Xu", "given" : "Ling", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Niu", "given" : "Jingbo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lui", "given" : "Li Yung", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yu", "given" : "Wei", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Aliabadi", "given" : "Piran", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Felson", "given" : "David T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arthritis and Rheumatism", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2004" ] ] }, "page" : "1187-1192", "title" : "Association of Squatting With Increased Prevalence of Radiographic Tibiofemoral Knee Osteoarthritis: The Beijing Osteoarthritis Study", "type" : "article-journal", "volume" : "50" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁴", "plainTextFormattedCitation" : "14", "previouslyFormattedCitation" : "¹⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }14 and the presence of hand OA (pooled OR 1.49, 95% CI: 1.05-2.10)ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.joca.2009.08.010", "ISBN" : "4491782733", "ISSN" : "10634584", "PMID" : "19751691", "abstract" : "Objective: Knee osteoarthritis (OA) is common in older adults. Determination of risk factors for onset of knee OA may help in its prevention. The objective of this systematic review, and meta-analysis, was to determine the current evidence on risk factors for knee OA. Design: A systematic literature search was carried out for cohort and case-control studies evaluating the association of demographic, comorbid, and other patient-determined factors with onset of knee OA. A scoring tool was developed to assess the quality of studies. Heterogeneity of studies was examined. Where possible studies were pooled to give an overall estimate of the association of factors with onset of knee OA. Results: Of the 2233 studies screened, 85 were eventually included in the review. Study quality tended to be moderate. The main factors consistently associated with knee OA were obesity (pooled OR 2.63, 95% CI 2.28-3.05), previous knee trauma (pooled OR 3.86, 95% CI 2.61-5.70), hand OA (pooled OR 1.49, 95% CI 1.05-2.10), female gender (pooled OR 1.84 95% CI 1.32-2.55) and older age. Smoking appeared to have a moderate protective effect, however this was not evident once the analysis was restricted to cohort studies only. Conclusions: Whilst certain factors have been extensively reviewed (for example, body mass index), more longitudinal studies are needed to investigate the association of physical occupational and other patient-determined factors with future knee OA. The quality of such studies also needs to be improved. However, there are identifiable factors which can be targeted for prevention of disabling knee pain. ?? 2009 Osteoarthritis Research Society International.", "author" : [ { "dropping-particle" : "", "family" : "Blagojevic", "given" : "M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jinks", "given" : "C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jeffery", "given" : "A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jordan", "given" : "K. P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Osteoarthritis and Cartilage", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "24-33", "publisher" : "Elsevier Ltd", "title" : "Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis", "type" : "article-journal", "volume" : "18" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁵", "plainTextFormattedCitation" : "15", "previouslyFormattedCitation" : "¹⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }15. Studies have also shown female sex to be a risk factor in the incidence of knee OAADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.joca.2005.04.014", "ISBN" : "1063-4584 (Print)\\r1063-4584 (Linking)", "ISSN" : "10634584", "PMID" : "15978850", "abstract" : "Objective: To resolve uncertainty regarding sex differences in osteoarthritis (OA) by performing a meta-analysis of sex differences in OA prevalence, incidence and severity. Methods: Standard search strategies for population-based studies of OA providing sex-specific data. Random effects meta-analysis to provide pooled male vs female risk and rate ratios for prevalent and incident OA, and standardized mean differences (SMD) for OA severity. Meta-regression was used to investigate sources of heterogeneity. Results: Males had a significantly reduced risk for prevalent OA in the knee [Risk Ratio (RR) 0.63, 95% CI 0.53-0.75] and hand [RR 0.81, 95% CI 0.73-0.90] but not for other sites. Males aged <55 years had a greater risk of prevalent cervical spine OA [RR 1.29, 95% CI 1.18-1.41]. Males also had significantly reduced rates of incident OA in the knee [Incidence Rate Ratio (IRR) 0.55, 95% CI 0.32-0.94] and hip [IRR 0.64, 95% CI 0.48-0.86], with a trend for hand [IRR 0.65, 95% confidence interval (CI) 0.35-1.20]. Females, particularly those ???55 years, tended to have more severe OA in the knee but not other sites. Heterogeneity in the estimates of sex differences in prevalence was substantially explained by age and other study design factors including method of OA definition. Conclusions: The results demonstrate the presence of sex differences in OA prevalence and incidence, with females generally at a higher risk. Females also tend to have more severe knee OA, particularly after menopausal age. The site differences indicate the need for further studies to explore mechanisms underlying OA. ?? 2005 OsteoArthritis Research Society International. Published by Elsevier Ltd. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Srikanth", "given" : "Velandai K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fryer", "given" : "Jayne L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zhai", "given" : "Guangju", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Winzenberg", "given" : "Tania M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hosmer", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jones", "given" : "Graeme", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Osteoarthritis and Cartilage", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2005" ] ] }, "page" : "769-781", "title" : "A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis", "type" : "article-journal", "volume" : "13" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁶", "plainTextFormattedCitation" : "16", "previouslyFormattedCitation" : "¹⁶" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }16. In addition to age, several modifiable and non-modifiable risk factors for knee OA exist. Diabetes and obesity are large contributors to both peripheral nerve (PN) decline and knee OA. Obesity, defined as a BMI >30 kg/m2, contributes largely to the progression of knee OA by placing mechanical stress on the joints which leads to the formation of lesions and cartilage damage (Figure 1)ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.joca.2015.01.013", "ISBN" : "1063-4584", "ISSN" : "15229653", "PMID" : "25655678", "abstract" : "Purpose: Recent studies have suggested that metabolic factors (obesity, diabetes, hypertension and dyslipidemia) and their clustering in metabolic syndrome (MetS) might be involved in the pathophysiology of knee osteoarthritis (OA). We investigated their impact on radiographic progression by an annualised measure of the joint space narrowing (JSN) of the medial tibiofemoral compartment. Methods: 559 patients older than 50 years with symptomatic knee OA were recruited for the placebo arm of the SEKOIA trial. The presence of diabetes, hypertension and dyslipidemia was determined at baseline interview. Body mass index (BMI) was calculated, obesity was considered >30kg/m². MetS was defined by the sum of metabolic factors ???3. Minimal medial tibiofemoral joint space on plain radiographs was measured by an automated method at baseline and then annually for up to 3 years. Results: The mean age of patients was 62.8 [62.2-63.4] years; 392 were women. A total of 43.8% was obese, 6.6% had type 2 diabetes, 45.1% hypertension, 27.6% dyslipidemia and 13.6% MetS. Mean annualised JSN was greater for patients with type 2 diabetes than without diabetes (0.26 [-0.35 to-0.17] vs 0.14 [-0.16 to-0.12] mm; P=0.001). This association remained significant after adjustment for sex, age, BMI, hypertension and dyslipidemia (P=0.018). In subgroup analysis, type 2 diabetes was a significant predictor of JSN in males but not females. The other metabolic factors and MetS were not associated with annualised JSN. Conclusion: Type 2 diabetes was a predictor of joint space reduction in men with established knee OA. No relationships were found between MetS or other metabolic factors and radiographic progression.", "author" : [ { "dropping-particle" : "", "family" : "Eymard", "given" : "F.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Parsons", "given" : "C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Edwards", "given" : "M. 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Y.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bruy??re", "given" : "O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Richette", "given" : "P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cooper", "given" : "C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chevalier", "given" : "X.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Osteoarthritis and Cartilage", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "851-859", "title" : "Diabetes is a risk factor for knee osteoarthritis progression", "type" : "article-journal", "volume" : "23" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁷", "plainTextFormattedCitation" : "17", "previouslyFormattedCitation" : "¹⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }17. This added stress encourages the proliferation of osteophytes within the joints that creates a pathway to knee OA. Diabetes and other metabolic factors have also been shown to contribute to the progression of knee OAADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.mehy.2012.01.008", "ISBN" : "1532-2777 (Electronic) 0306-9877 (Linking)", "ISSN" : "03069877", "PMID" : "22305707", "abstract" : "Clinical practice and research efforts related to the highly prevalent and disabling disease, osteoarthritis (OA), have long been hampered by an inadequate case definition. Much of the difficulty is due to a lack of agreement between X-rays evidence of OA and a patient's report of pain at that site. Such discordance between reported pain and radiographic evidence of OA has been attributed to several factors. This paper proposes another possible explanation, for at least a portion of such patients. It is hypothesized that an insidiously increasing diabetic neuropathy, particularly in the lower extremity, while first causing some pain, may gradually inhibit the ability to feel pain which might have otherwise been reported by those patients without neuropathy. Many of these patients with early stage glucose dysmetabolism will proceed to develop overt type 2 diabetes; however, the pain-inhibiting neuropathy caused by glucose metabolism dysfunction may manifest long before such a diagnosis. The high prevalence of diabetes and pre-diabetic conditions, especially among the aged population, could mean that a substantial number of individuals with osteoarthritis will have both diseases to varying degrees over time. Validating and quantifying this hypothesized association would be useful to millions of persons and would significantly impact both research and clinical practice dealing with these major diseases of older persons. \u00a9 2012 Elsevier Ltd.", "author" : [ { "dropping-particle" : "", "family" : "Leaverton", "given" : "Paul E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Peregoy", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fahlman", "given" : "Lissa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sangeorzan", "given" : "Emmeline", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barrett", "given" : "John P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medical Hypotheses", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "471-474", "publisher" : "Elsevier Ltd", "title" : "Does diabetes hide osteoarthritis pain?", "type" : "article-journal", "volume" : "78" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁸", "plainTextFormattedCitation" : "18", "previouslyFormattedCitation" : "¹⁸" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }18. Both diabetes and knee OA are chronic conditions, have subclinical presentations that often are undiagnosed clinically during their onset, and increase as populations ageADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.mehy.2012.01.008", "ISBN" : "1532-2777 (Electronic) 0306-9877 (Linking)", "ISSN" : "03069877", "PMID" : "22305707", "abstract" : "Clinical practice and research efforts related to the highly prevalent and disabling disease, osteoarthritis (OA), have long been hampered by an inadequate case definition. Much of the difficulty is due to a lack of agreement between X-rays evidence of OA and a patient's report of pain at that site. Such discordance between reported pain and radiographic evidence of OA has been attributed to several factors. This paper proposes another possible explanation, for at least a portion of such patients. It is hypothesized that an insidiously increasing diabetic neuropathy, particularly in the lower extremity, while first causing some pain, may gradually inhibit the ability to feel pain which might have otherwise been reported by those patients without neuropathy. Many of these patients with early stage glucose dysmetabolism will proceed to develop overt type 2 diabetes; however, the pain-inhibiting neuropathy caused by glucose metabolism dysfunction may manifest long before such a diagnosis. The high prevalence of diabetes and pre-diabetic conditions, especially among the aged population, could mean that a substantial number of individuals with osteoarthritis will have both diseases to varying degrees over time. Validating and quantifying this hypothesized association would be useful to millions of persons and would significantly impact both research and clinical practice dealing with these major diseases of older persons. \u00a9 2012 Elsevier Ltd.", "author" : [ { "dropping-particle" : "", "family" : "Leaverton", "given" : "Paul E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Peregoy", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fahlman", "given" : "Lissa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sangeorzan", "given" : "Emmeline", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barrett", "given" : "John P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medical Hypotheses", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "471-474", "publisher" : "Elsevier Ltd", "title" : "Does diabetes hide osteoarthritis pain?", "type" : "article-journal", "volume" : "78" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁸", "plainTextFormattedCitation" : "18", "previouslyFormattedCitation" : "¹⁸" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }18. Decreased PN function is also a common complication of 11855452120900010852151871980Figure SEQ Figure \* ARABIC 1. Peripheral Nerve and Knee OA Conceptual Model00Figure SEQ Figure \* ARABIC 1. Peripheral Nerve and Knee OA Conceptual Modeldiabetes, with approximately 45-50% of diabetes patients having a diagnosis of peripheral neuropathyADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/9780470779750.ch34", "ISBN" : "9780470017272", "ISSN" : "00471852", "PMID" : "21661190", "abstract" : "Awareness of neuropathy as a chronic complication of diabetes is constantly increasing. Diabetes centers adopt methods to diagnose neuropathy without neurological training. This trend calls for instructions on how to use and interpret diagnostic methods. This book includes recent research and covers clinical, technical, and public health aspects of neuropathy, bringing together the top experts in the field.", "author" : [ { "dropping-particle" : "", "family" : "Boulton", "given" : "Andrew J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Epidemiology of Diabetes Mellitus: Second Edition", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "565-576", "title" : "Epidemiology of Diabetic Neuropathy", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁹", "plainTextFormattedCitation" : "19", "previouslyFormattedCitation" : "¹⁹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }19. Diabetic neuropathy may have similar symptoms and presentation to knee OA, including sensory axonal degeneration and loss of proprioception in the lower extremities.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Zochodne", "given" : "DW", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Muscle Nerve", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "144-166", "title" : "Diabetes mellitus and the peripheral nervous system: manifestations and mechanisms", "type" : "article-journal", "volume" : "36" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁰", "plainTextFormattedCitation" : "20", "previouslyFormattedCitation" : "²⁰" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }20 Leaverton et. al. hypothesized that the symptomatic pain in knee OA may possibly be explained in diabetes by neuropathy, as patients with diabetes-associated neuropathy suffered knee OA at an earlier age as well as with greater severity compared to study participants without diabetesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.mehy.2012.01.008", "ISBN" : "1532-2777 (Electronic) 0306-9877 (Linking)", "ISSN" : "03069877", "PMID" : "22305707", "abstract" : "Clinical practice and research efforts related to the highly prevalent and disabling disease, osteoarthritis (OA), have long been hampered by an inadequate case definition. Much of the difficulty is due to a lack of agreement between X-rays evidence of OA and a patient's report of pain at that site. Such discordance between reported pain and radiographic evidence of OA has been attributed to several factors. This paper proposes another possible explanation, for at least a portion of such patients. It is hypothesized that an insidiously increasing diabetic neuropathy, particularly in the lower extremity, while first causing some pain, may gradually inhibit the ability to feel pain which might have otherwise been reported by those patients without neuropathy. Many of these patients with early stage glucose dysmetabolism will proceed to develop overt type 2 diabetes; however, the pain-inhibiting neuropathy caused by glucose metabolism dysfunction may manifest long before such a diagnosis. The high prevalence of diabetes and pre-diabetic conditions, especially among the aged population, could mean that a substantial number of individuals with osteoarthritis will have both diseases to varying degrees over time. Validating and quantifying this hypothesized association would be useful to millions of persons and would significantly impact both research and clinical practice dealing with these major diseases of older persons. \u00a9 2012 Elsevier Ltd.", "author" : [ { "dropping-particle" : "", "family" : "Leaverton", "given" : "Paul E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Peregoy", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fahlman", "given" : "Lissa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sangeorzan", "given" : "Emmeline", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barrett", "given" : "John P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medical Hypotheses", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "471-474", "publisher" : "Elsevier Ltd", "title" : "Does diabetes hide osteoarthritis pain?", "type" : "article-journal", "volume" : "78" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "¹⁸", "plainTextFormattedCitation" : "18", "previouslyFormattedCitation" : "¹⁸" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }18. Consideration of comorbid conditions such as diabetes and obesity may prove valuable to treating the pain and functional limitations that are associated with knee OA and PN decline. Total knee replacement Total knee replacement (TKR), also known as a total knee arthroplasty, are common procedures performed on Americans each year. Annually, more than 700,000 TKRs are performed in the U.S., corresponding to a prevalence rate of 1.52%ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2106/JBJS.N.01141", "ISSN" : "1535-1386", "PMID" : "26333733", "abstract" : "BACKGROUND Descriptive epidemiology of total joint replacement procedures is limited to annual procedure volumes (incidence). The prevalence of the growing number of individuals living with a total hip or total knee replacement is currently unknown. Our objective was to estimate the prevalence of total hip and total knee replacement in the United States. METHODS Prevalence was estimated using the counting method by combining historical incidence data from the National Hospital Discharge Survey and the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases from 1969 to 2010 with general population census and mortality counts. We accounted for relative differences in mortality rates between those who have had total hip or knee replacement and the general population. RESULTS The 2010 prevalence of total hip and total knee replacement in the total U.S. population was 0.83% and 1.52%, respectively. Prevalence was higher among women than among men and increased with age, reaching 5.26% for total hip replacement and 10.38% for total knee replacement at eighty years. These estimates corresponded to 2.5 million individuals (1.4 million women and 1.1 million men) with total hip replacement and 4.7 million individuals (3.0 million women and 1.7 million men) with total knee replacement in 2010. Secular trends indicated a substantial rise in prevalence over time and a shift to younger ages. CONCLUSIONS Around 7 million Americans are living with a hip or knee replacement, and consequently, in most cases, are mobile, despite advanced arthritis. These numbers underscore the substantial public health impact of total hip and knee arthroplasties.", "author" : [ { "dropping-particle" : "", "family" : "Maradit Kremers", "given" : "Hilal", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Larson", "given" : "Dirk R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Crowson", "given" : "Cynthia S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kremers", "given" : "Walter K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Washington", "given" : "Raynard E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Steiner", "given" : "Claudia A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jiranek", "given" : "William A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Berry", "given" : "Daniel J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of bone and joint surgery. American volume", "id" : "ITEM-1", "issue" : "17", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "1386-97", "title" : "Prevalence of Total Hip and Knee Replacement in the United States.", "type" : "article-journal", "volume" : "97" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.2106/JBJS.F.00222", "ISBN" : "0021-9355 (Print)\\n0021-9355 (Linking)", "ISSN" : "0021-9355", "PMID" : "17403800", "abstract" : "BACKGROUND: Over the past decade, there has been an increase in the number of revision total hip and knee arthroplasties performed in the United States. The purpose of this study was to formulate projections for the number of primary and revision total hip and knee arthroplasties that will be performed in the United States through 2030. METHODS: The Nationwide Inpatient Sample (1990 to 2003) was used in conjunction with United States Census Bureau data to quantify primary and revision arthroplasty rates as a function of age, gender, race and/or ethnicity, and census region. Projections were performed with use of Poisson regression on historical procedure rates in combination with population projections from 2005 to 2030. RESULTS: By 2030, the demand for primary total hip arthroplasties is estimated to grow by 174% to 572,000. The demand for primary total knee arthroplasties is projected to grow by 673% to 3.48 million procedures. The demand for hip revision procedures is projected to double by the year 2026, while the demand for knee revisions is expected to double by 2015. Although hip revisions are currently more frequently performed than knee revisions, the demand for knee revisions is expected to surpass the demand for hip revisions after 2007. Overall, total hip and total knee revisions are projected to grow by 137% and 601%, respectively, between 2005 and 2030. CONCLUSIONS: These large projected increases in demand for total hip and knee arthroplasties provide a quantitative basis for future policy decisions related to the numbers of orthopaedic surgeons needed to perform these procedures and the deployment of appropriate resources to serve this need.", "author" : [ { "dropping-particle" : "", "family" : "Kurtz", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ong", "given" : "K\\", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lau", "given" : "Edmund", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mowat", "given" : "Fionna", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Halpern", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of bone and joint surgery. American volume", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "780-785", "title" : "Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030.", "type" : "article-journal", "volume" : "89" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^21,22", "plainTextFormattedCitation" : "21,22", "previouslyFormattedCitation" : "^21,22" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }21,22. These numbers are expected to rise with the increase in baby boomers entering older adulthood as well as others medical advances that improve quality of life into old age. Over the past decade the amount of TKR surgeries has doubledADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s00330-015-3977-8", "ISBN" : "0938-7994", "ISSN" : "14321084", "PMID" : "26376884", "abstract" : "OBJECTIVE: To evaluate whether change in fixed-location measures of radiographic joint space width (JSW) and cartilage thickness by MRI predict knee replacement. METHODS: Knees replaced between 36 and 60 months' follow-up in the Osteoarthritis Initiative were each matched with one control by age, sex and radiographic status. Radiographic JSW was determined from fixed flexion radiographs and subregional femorotibial cartilage thickness from 3 T MRI. Changes between the annual visit before replacement (T0) and 2 years before T0 (T-2) were compared using conditional logistic regression. RESULTS: One hundred and nineteen knees from 102 participants (55.5 % women; age 64.2 +/- 8.7 [mean +/- SD] years) were studied. Fixed-location JSW change at 22.5 % from medial to lateral differed more between replaced and control knees (case-control [cc] OR = 1.57; 95 % CI: 1.23-2.01) than minimum medial JSW change (ccOR = 1.38; 95 % CI: 1.11-1.71). Medial femorotibial cartilage loss displayed discrimination similar to minimum JSW, and central tibial cartilage loss similar to fixed-location JSW. Location-independent thinning and thickening scores were elevated prior to knee replacement. CONCLUSIONS: Discrimination of structural progression between knee pre-placement cases versus controls was stronger for fixed-location than minimum radiographic JSW. MRI displayed similar discrimination to radiography and suggested greater simultaneous cartilage thickening and loss prior to knee replacement. KEY POINTS: * Fixed-location JSW predicts surgical knee replacement more strongly than minimum JSW. * MRI predicts knee replacement with similar accuracy to radiographic JSW. * MRI reveals greater cartilage thinning and thickening prior to knee replacement", "author" : [ { "dropping-particle" : "", "family" : "Eckstein", "given" : "Felix", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boudreau", "given" : "Robert", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wang", "given" : "Zhijie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hannon", "given" : "Michael J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Duryea", "given" : "Jeff", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wirth", "given" : "Wolfgang", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cotofana", "given" : "Sebastian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guermazi", "given" : "Ali", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roemer", "given" : "Frank", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nevitt", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "John", "given" : "Markus R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ladel", "given" : "Christoph", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sharma", "given" : "Leena", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hunter", "given" : "David J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kwoh", "given" : "C. Kent", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "European Radiology", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "1942-1951", "title" : "Comparison of radiographic joint space width and magnetic resonance imaging for prediction of knee replacement: A longitudinal case-control study from the Osteoarthritis Initiative", "type" : "article-journal", "volume" : "26" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²³", "plainTextFormattedCitation" : "23", "previouslyFormattedCitation" : "²³" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }23. By 2030, it is projected that the demand for TKRs will increase 673% to 3.48 million proceduresADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s00330-015-3977-8", "ISBN" : "0938-7994", "ISSN" : "14321084", "PMID" : "26376884", "abstract" : "OBJECTIVE: To evaluate whether change in fixed-location measures of radiographic joint space width (JSW) and cartilage thickness by MRI predict knee replacement. METHODS: Knees replaced between 36 and 60 months' follow-up in the Osteoarthritis Initiative were each matched with one control by age, sex and radiographic status. Radiographic JSW was determined from fixed flexion radiographs and subregional femorotibial cartilage thickness from 3 T MRI. Changes between the annual visit before replacement (T0) and 2 years before T0 (T-2) were compared using conditional logistic regression. RESULTS: One hundred and nineteen knees from 102 participants (55.5 % women; age 64.2 +/- 8.7 [mean +/- SD] years) were studied. Fixed-location JSW change at 22.5 % from medial to lateral differed more between replaced and control knees (case-control [cc] OR = 1.57; 95 % CI: 1.23-2.01) than minimum medial JSW change (ccOR = 1.38; 95 % CI: 1.11-1.71). Medial femorotibial cartilage loss displayed discrimination similar to minimum JSW, and central tibial cartilage loss similar to fixed-location JSW. Location-independent thinning and thickening scores were elevated prior to knee replacement. CONCLUSIONS: Discrimination of structural progression between knee pre-placement cases versus controls was stronger for fixed-location than minimum radiographic JSW. MRI displayed similar discrimination to radiography and suggested greater simultaneous cartilage thickening and loss prior to knee replacement. KEY POINTS: * Fixed-location JSW predicts surgical knee replacement more strongly than minimum JSW. * MRI predicts knee replacement with similar accuracy to radiographic JSW. * MRI reveals greater cartilage thinning and thickening prior to knee replacement", "author" : [ { "dropping-particle" : "", "family" : "Eckstein", "given" : "Felix", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boudreau", "given" : "Robert", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wang", "given" : "Zhijie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hannon", "given" : "Michael J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Duryea", "given" : "Jeff", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wirth", "given" : "Wolfgang", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cotofana", "given" : "Sebastian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guermazi", "given" : "Ali", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roemer", "given" : "Frank", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nevitt", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "John", "given" : "Markus R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ladel", "given" : "Christoph", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sharma", "given" : "Leena", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hunter", "given" : "David J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kwoh", "given" : "C. Kent", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "European Radiology", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "1942-1951", "title" : "Comparison of radiographic joint space width and magnetic resonance imaging for prediction of knee replacement: A longitudinal case-control study from the Osteoarthritis Initiative", "type" : "article-journal", "volume" : "26" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²³", "plainTextFormattedCitation" : "23", "previouslyFormattedCitation" : "²³" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }23. End-stage arthritis is the most common reason for TKR procedures. Over half of all people who have been diagnosed with knee OA will have a TKR surgery in their lifetimeADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s00330-015-3977-8", "ISBN" : "0938-7994", "ISSN" : "14321084", "PMID" : "26376884", "abstract" : "OBJECTIVE: To evaluate whether change in fixed-location measures of radiographic joint space width (JSW) and cartilage thickness by MRI predict knee replacement. METHODS: Knees replaced between 36 and 60 months' follow-up in the Osteoarthritis Initiative were each matched with one control by age, sex and radiographic status. Radiographic JSW was determined from fixed flexion radiographs and subregional femorotibial cartilage thickness from 3 T MRI. Changes between the annual visit before replacement (T0) and 2 years before T0 (T-2) were compared using conditional logistic regression. RESULTS: One hundred and nineteen knees from 102 participants (55.5 % women; age 64.2 +/- 8.7 [mean +/- SD] years) were studied. Fixed-location JSW change at 22.5 % from medial to lateral differed more between replaced and control knees (case-control [cc] OR = 1.57; 95 % CI: 1.23-2.01) than minimum medial JSW change (ccOR = 1.38; 95 % CI: 1.11-1.71). Medial femorotibial cartilage loss displayed discrimination similar to minimum JSW, and central tibial cartilage loss similar to fixed-location JSW. Location-independent thinning and thickening scores were elevated prior to knee replacement. CONCLUSIONS: Discrimination of structural progression between knee pre-placement cases versus controls was stronger for fixed-location than minimum radiographic JSW. MRI displayed similar discrimination to radiography and suggested greater simultaneous cartilage thickening and loss prior to knee replacement. KEY POINTS: * Fixed-location JSW predicts surgical knee replacement more strongly than minimum JSW. * MRI predicts knee replacement with similar accuracy to radiographic JSW. * MRI reveals greater cartilage thinning and thickening prior to knee replacement", "author" : [ { "dropping-particle" : "", "family" : "Eckstein", "given" : "Felix", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boudreau", "given" : "Robert", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wang", "given" : "Zhijie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hannon", "given" : "Michael J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Duryea", "given" : "Jeff", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wirth", "given" : "Wolfgang", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cotofana", "given" : "Sebastian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guermazi", "given" : "Ali", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roemer", "given" : "Frank", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nevitt", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "John", "given" : "Markus R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ladel", "given" : "Christoph", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sharma", "given" : "Leena", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hunter", "given" : "David J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kwoh", "given" : "C. Kent", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "European Radiology", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "1942-1951", "title" : "Comparison of radiographic joint space width and magnetic resonance imaging for prediction of knee replacement: A longitudinal case-control study from the Osteoarthritis Initiative", "type" : "article-journal", "volume" : "26" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²³", "plainTextFormattedCitation" : "23", "previouslyFormattedCitation" : "²³" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }23. Many of the adults who opt for TKR have significant functional limitations and activity restrictions due to the pain associated with knee OAADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/acr.20384", "ISBN" : "0004-3591", "ISSN" : "00043591", "PMID" : "20981812", "abstract" : "Objective: Despite its impact on the overall outcome and health-related quality of life (HRQOL) after knee surgery, physical activity has not been investigated directly using accelerometry or step monitoring during the first year after total knee arthroplasty (TKA) due to osteoarthritis (OA). Therefore, the present study aimed to evaluate the development of physical activity over 12 months after surgery and its relationship to clinical outcome and HRQOL.; Methods: Fifty-three patients scheduled for primary TKA due to OA were measured with the DynaPort ADL monitor and a step activity monitor preoperatively and at 2, 6, and 12 months of followup. Clinical outcome and HRQOL were investigated using the American Knee Society Score (KSS) and Short Form 36 (SF-36) health survey.; Results: Physical activity increased significantly within 12 months of followup (from mean \u00b1 SD 4,993 \u00b1 2,170 gait cycles preoperatively to 5,932 \u00b1 2,111 gait cycles; P = 0.003). Clinical outcome and HRQOL improved from baseline (mean \u00b1 SD KSS 88.9 \u00b1 21.4, mean \u00b1 SD SF-36 43.1 \u00b1 18.4) to 12 months of followup (mean \u00b1 SD KSS 188.6 \u00b1 10.9; P = 0.001 and mean \u00b1 SD SF-36 82.5 \u00b1 15.9; P = 0.001). Physical activity parameters did not correlate with clinical outcome.; Conclusion: TKA offers profound improvements of physical activity for the majority of patients. Despite these improvements and the excellent clinical outcome, most patients do not reach the level of physical activity reported for healthy subjects. The activity level after treatment seems to be influenced by physical activity behavior prior to surgery rather than by the treatment itself.; Copyright \u00a9 2011 by the American College of Rheumatology.", "author" : [ { "dropping-particle" : "", "family" : "Brandes", "given" : "Mirko", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ringling", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Winter", "given" : "Corinna", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hillmann", "given" : "Axel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rosenbaum", "given" : "Dieter", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arthritis Care and Research", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "328-334", "title" : "Changes in physical activity and health-related quality of life during the first year after total knee arthroplasty", "type" : "article-journal", "volume" : "63" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.joca.2007.08.010", "ISBN" : "1063-4584 (Print)", "ISSN" : "10634584", "PMID" : "17900934", "abstract" : "Objective: Few data are available on the level of actual physical activity in patients with osteoarthritis (OA) of the hip and knee. The aim of this study was to measure the level of actual physical activity of patients with end-stage OA of the hip and the knee, to compare this with that of matched healthy controls, and to analyze the data in order to ascertain the factors of influence. Method: The actual physical activity was measured with an activity monitor (AM) in 40 hip and 44 knee OA patients, and compared with measurements obtained from healthy controls. Data were also collected on pain and psychological aspects as anxiety, depression and mental functioning. The primary outcome parameter of the actual physical activity was the percentage of movement-related activity. Results: The percentage of movement-related activity did not differ between the two OA groups. It was 8.8 (4.2)% for the hip and 8.1 (3.8)% for the knee OA patients. The matched controls were significantly higher movement-related active than OA patients (about 11.0 (2.9)%). Increasing age and body mass index were negatively associated with the percentage of movement-related activity (\u03b2 = -0.29 and \u03b2 = -0.25, respectively), whereas mental functioning was positively related (\u03b2 = 0.30). Conclusion: The impact of end-stage OA on the level of actual physical activity is equal for hip and knee OA patients. The actual physical activity for both of the OA groups was significantly and clinically relevantly lower compared to controls. However, this difference was smaller than expected and less dominant than patients' perception of limitations in daily life. Clinicians must be aware that the patients' perception of physical functioning in daily life does not always correspond to the actual physical activity. \u00a9 2007 Osteoarthritis Research Society International.", "author" : [ { "dropping-particle" : "", "family" : "Groot", "given" : "I. B.", "non-dropping-particle" : "de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bussmann", "given" : "J. B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stam", "given" : "H. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Verhaar", "given" : "J. A N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Osteoarthritis and Cartilage", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "436-442", "title" : "Actual everyday physical activity in patients with end-stage hip or knee osteoarthritis compared with healthy controls", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Holsgaard", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roos", "given" : "E M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "This", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-3", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "577-585", "title" : "Objectively measured physical activity in patients with end stage knee or hip osteoarthritis", "type" : "article-journal", "volume" : "48" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^24\u201326", "plainTextFormattedCitation" : "24\u201326", "previouslyFormattedCitation" : "^24\u201326" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }24–26. TKR surgeries involve removing the damaged tissue and articular cartilage from the end of the femur and the top of the tibia that become damaged due to arthritisADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2017", "1", "6" ] ] }, "container-title" : "Arthritis Research UK", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2017" ] ] }, "title" : "Total knee replacement", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁷", "plainTextFormattedCitation" : "27", "previouslyFormattedCitation" : "²⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }27. A TKR may also involve removing parts of the patella, depending on the severity of the knee joint degeneration and at the surgeon’s discretionADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2017", "1", "6" ] ] }, "container-title" : "Arthritis Research UK", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2017" ] ] }, "title" : "Total knee replacement", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁷", "plainTextFormattedCitation" : "27", "previouslyFormattedCitation" : "²⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }27. After removing the damaged tissue of the knee, prosthetic pieces (usually made of metal or plastic) are cemented into the knee and held in placeADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2017", "1", "6" ] ] }, "container-title" : "Arthritis Research UK", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2017" ] ] }, "title" : "Total knee replacement", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁷", "plainTextFormattedCitation" : "27", "previouslyFormattedCitation" : "²⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }27. These synthetic implants allow the joint to move around more freely and without risk of friction or inflammation. Although patients often find relief from the persistent pain of knee OA following TKR surgery, 37% of patients still have persistent functional limitations one year after their surgeriesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2519/jospt.2010.3317", "ISBN" : "0190-6011", "ISSN" : "0190-6011", "PMID" : "20710093", "abstract" : "STUDY DESIGN: Prospective cohort study. OBJECTIVES: To measure changes in muscle strength, range of motion, and function from 2 weeks before to 6 months after total knee arthroplasty (TKA) and compare outcomes with data from a control group consisting of healthy adults. BACKGROUND : Total knee arthroplasty successfully alleviates pain from knee osteoarthritis, but deficits in function can persist long term. How impairments and functional limitations change over the first 6 months after TKA, compared to data from healthy adults, has not been well reported in the literature. METHODS: Twenty-four patients who underwent a primary unilateral TKA were compared to healthy adults (n = 17). All patients participated in a standardized rehabilitation program following surgery. Isometric quadriceps torque was assessed using an electromechanical dynamometer. Range of motion was measured actively and passively. Functional performance was assessed using the stair-climbing test, timed up-and-go test, 6-minute walk test, and single-limb stance time. Patients underwent testing at 2 weeks preoperatively and at 1, 3, and 6 months postoperatively. RESULTS: Compared to healthy older adults, patients performed significantly worse at all times for all measures (P-\ufffdl.05), except for single-limb stance time at 6 months (P-\ufffdn.05). One month postoperatively, patients experienced significant losses from preoperative levels in all outcomes. Patients recovered to preoperative levels by 6 months postoperatively on all measures, except knee flexion range of motion, but still exhibited the same extent of limitation they did prior to surgery. CONCLUSION : The persistent impairments and functional limitations 6 months after TKA with standard rehabilitation suggest that more intensive therapeutic approaches may be necessary to restore function of patients following TKA to the levels of healthy adults. LEVEL OF EVIDENCE: Therapy, level 2b", "author" : [ { "dropping-particle" : "", "family" : "Bade", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kohrt", "given" : "W M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stevens-Lapsley", "given" : "J E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Orthopaedic and Sports Physical Therapy", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "559-567", "title" : "Outcomes before and after total knee arthroplasty compared to healthy adults", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁸", "plainTextFormattedCitation" : "28", "previouslyFormattedCitation" : "²⁸" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }28. Patients who undergo TKR have significantly decreased range of motion, decreased quadriceps strength, and slower walk time-tests compared to their healthy counterparts up to six months after surgeryADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2519/jospt.2010.3317", "ISBN" : "0190-6011", "ISSN" : "0190-6011", "PMID" : "20710093", "abstract" : "STUDY DESIGN: Prospective cohort study. OBJECTIVES: To measure changes in muscle strength, range of motion, and function from 2 weeks before to 6 months after total knee arthroplasty (TKA) and compare outcomes with data from a control group consisting of healthy adults. BACKGROUND : Total knee arthroplasty successfully alleviates pain from knee osteoarthritis, but deficits in function can persist long term. How impairments and functional limitations change over the first 6 months after TKA, compared to data from healthy adults, has not been well reported in the literature. METHODS: Twenty-four patients who underwent a primary unilateral TKA were compared to healthy adults (n = 17). All patients participated in a standardized rehabilitation program following surgery. Isometric quadriceps torque was assessed using an electromechanical dynamometer. Range of motion was measured actively and passively. Functional performance was assessed using the stair-climbing test, timed up-and-go test, 6-minute walk test, and single-limb stance time. Patients underwent testing at 2 weeks preoperatively and at 1, 3, and 6 months postoperatively. RESULTS: Compared to healthy older adults, patients performed significantly worse at all times for all measures (P-\ufffdl.05), except for single-limb stance time at 6 months (P-\ufffdn.05). One month postoperatively, patients experienced significant losses from preoperative levels in all outcomes. Patients recovered to preoperative levels by 6 months postoperatively on all measures, except knee flexion range of motion, but still exhibited the same extent of limitation they did prior to surgery. CONCLUSION : The persistent impairments and functional limitations 6 months after TKA with standard rehabilitation suggest that more intensive therapeutic approaches may be necessary to restore function of patients following TKA to the levels of healthy adults. LEVEL OF EVIDENCE: Therapy, level 2b", "author" : [ { "dropping-particle" : "", "family" : "Bade", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kohrt", "given" : "W M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stevens-Lapsley", "given" : "J E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Orthopaedic and Sports Physical Therapy", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "559-567", "title" : "Outcomes before and after total knee arthroplasty compared to healthy adults", "type" : "article-journal", "volume" : "40" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁸", "plainTextFormattedCitation" : "28", "previouslyFormattedCitation" : "²⁸" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }28. In addition, patients who undergo unilateral TKR often have additional surgeries in the contralateral knee to relieve knee OA symptoms. The surgery may also damage nerves within the knee, with consequences being decreased function of the mechanoreceptors which can impair movement and controlADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0301-620X (Print)\\n0301-620X (Linking)", "ISSN" : "0301-620X", "PMID" : "8682816", "abstract" : "Decreasing proprioception of the knee is multifactorial and is a function of age and degenerative joint disease. Soft-tissue release during total knee replacement may have an influence. We have quantified soft-tissue imbalance at the time of knee replacement and attempted to eliminate it at full extension, using established methods. We studied the influence of residual soft-tissue imbalance on postoperative proprioception, assessing this in 38 patients before total knee replacement and at three and six months postoperatively. We found that proprioception improved in varus knees at three and six months after soft-tissue balancing procedures. Knees balanced in full extension and in flexion (< +/- 2 degrees) showed a significant improvement in proprioception (p < 0.0005) whereas those which were not balanced in flexion but fully balanced in extension had no significant improvement. We conclude that soft-tissue balance in both flexion and extension is important to allow satisfactory postoperative proprioception of the knee.", "author" : [ { "dropping-particle" : "", "family" : "Attfield", "given" : "S F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wilton", "given" : "T J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pratt", "given" : "D J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sambatakakis", "given" : "a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of bone and joint surgery. British volume", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "1996" ] ] }, "page" : "540-545", "title" : "Soft-tissue balance and recovery of proprioception after total knee replacement.", "type" : "article-journal", "volume" : "78" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "²⁹", "plainTextFormattedCitation" : "29", "previouslyFormattedCitation" : "²⁹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }29. With the changes that occur in TKR surgery, it is important to examine how they affect PN function in older populations with knee OA following TKR. peripheral nerve functionThe peripheral nerve (PN) system of the body connects the brain and spinal cord to the rest of the body, acting as a transmission with the nervous system to the outer limbs of the body. Within the knee joint, nerves are classified by the nature with which they innervate the knee: articular branches that innervate the knee joint directly and minor articular branches that pass through the knee jointADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s002640050001", "ISSN" : "0341-2695", "PMID" : "10774852", "abstract" : "The nerve distribution to the knee joints was analyzed in 5 cadavers and 10 joint capsules specimens were resected during total knee arthroplasty. We found nerve fibers immunoreactive for anti-substance P antibody in the articular capsule. By confocal laser scanning microscopy, we evaluated the three-dimensional structures of the Ruffini's corpuscles and the free nerve endings, both of which were immunoreactive for anti-protein gene product 9.5.", "author" : [ { "dropping-particle" : "", "family" : "Hirasawa", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Okajima", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ohta", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tokioka", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "International orthopaedics", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2000" ] ] }, "page" : "1-4", "title" : "Nerve distribution to the human knee joint: anatomical and immunohistochemical study.", "type" : "article-journal", "volume" : "24" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁰", "plainTextFormattedCitation" : "30", "previouslyFormattedCitation" : "³⁰" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }30. The knee joint has several major nerves that supply the knee: the posterior articular nerve which is the largest nerve supply to the knee and a terminal branch of the obturator nerve along with the sural nerve which supply the posterior afferent sectionADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/036354658201000601", "ISBN" : "0363-5465 (Print)\\n0363-5465 (Linking)", "ISSN" : "0363-5465", "PMID" : "6897495", "abstract" : "This investigation utilized gross dissections, histological preparations, and neurophysiologic experiments to gain an improved understanding of the innervation of the human knee. Anatomical illustrations represent the findings of dissections of 15 fresh amputation specimens. Neurohistologic preparations using silver staining techniques demonstrate the rich innervation of the soft tissues of the knee, and a variety of specialized receptors are identified. In 10 subjects with normal knees, and experimentally produced knee effusion of 60 cc was found to result in profound inhibition of reflexly evoked quadriceps contraction. Clinical implications of the anatomical and physiologic data are discussed.", "author" : [ { "dropping-particle" : "", "family" : "Kennedy", "given" : "John C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Alexander", "given" : "Ian J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hayes", "given" : "Keith C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The American Journal of Sports Medicine", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "1982" ] ] }, "page" : "329-335", "title" : "Nerve supply of the human knee and its functional importance", "type" : "article-journal", "volume" : "10" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³¹", "plainTextFormattedCitation" : "31", "previouslyFormattedCitation" : "³¹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }31. The common peroneal, saphenous, and femoral nerves supply the anterior afferent section of the kneeADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/036354658201000601", "ISBN" : "0363-5465 (Print)\\n0363-5465 (Linking)", "ISSN" : "0363-5465", "PMID" : "6897495", "abstract" : "This investigation utilized gross dissections, histological preparations, and neurophysiologic experiments to gain an improved understanding of the innervation of the human knee. Anatomical illustrations represent the findings of dissections of 15 fresh amputation specimens. Neurohistologic preparations using silver staining techniques demonstrate the rich innervation of the soft tissues of the knee, and a variety of specialized receptors are identified. In 10 subjects with normal knees, and experimentally produced knee effusion of 60 cc was found to result in profound inhibition of reflexly evoked quadriceps contraction. Clinical implications of the anatomical and physiologic data are discussed.", "author" : [ { "dropping-particle" : "", "family" : "Kennedy", "given" : "John C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Alexander", "given" : "Ian J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hayes", "given" : "Keith C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The American Journal of Sports Medicine", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "1982" ] ] }, "page" : "329-335", "title" : "Nerve supply of the human knee and its functional importance", "type" : "article-journal", "volume" : "10" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³¹", "plainTextFormattedCitation" : "31", "previouslyFormattedCitation" : "³¹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }31. There are two types of peripheral neurons. Motor neurons carry neural impulses from the central nervous system (CNS) to muscles and glands and sensory nerves that carry neural impulses to the CNS via afferent nerve fibersADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2017", "1", "1" ] ] }, "author" : [ { "dropping-particle" : "", "family" : "Chawla", "given" : "Jasvinder", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medscape", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2016" ] ] }, "title" : "Peripheral Nervous System Anatomy", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³²", "plainTextFormattedCitation" : "32", "previouslyFormattedCitation" : "³²" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }32. Several different fibers and receptors aid in the transmission of signals to the CNS. Mechanoreceptors located in the ligaments, muscles, and bone that detect pressure and distortion which helps maintain balance and to perform normal daily activitiesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s11556-007-0026-x", "ISBN" : "1813-7253", "ISSN" : "18137253", "abstract" : "Abstract&nbsp;&nbsp;Throughout the human life span the functions of several physiological systems dramatically change, including proprioception. Impaired proprioception leads to less accurate detection of body position changes increasing the risk of fall, and to abnormal joint biomechanics during functional activities so, over a period of time, degenerative joint disease may result. Altered neuromuscular control of the lower limb and consequently poor balance resulting from changes in the proprioceptive function could be related to the high incidence of harmful falls that occur in old age subjects. There is evidence of proprioception deterioration with aging. Regular physical activity seems to be a beneficial strategy to preserve proprioception and prevent falls among older subjects. Some studies have demonstrated that the regular physical activity can attenuate age-related decline in proprioception. This paper reviews the evidence of age effects on joint proprioception. We will discuss the possible mechanisms behind these effects and the role of regular physical activity in the attenuation of age-related decline in proprioception.", "author" : [ { "dropping-particle" : "", "family" : "Ribeiro", "given" : "Fernando", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Oliveira", "given" : "Jos\u00e9", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "European Review of Aging and Physical Activity", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "71-76", "title" : "Aging effects on joint proprioception: The role of physical activity in proprioception preservation", "type" : "article-journal", "volume" : "4" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³³", "plainTextFormattedCitation" : "33", "previouslyFormattedCitation" : "³³" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }33. Polypeptides also aid the PN system by detecting sensations such as painADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s002640050001", "ISSN" : "0341-2695", "PMID" : "10774852", "abstract" : "The nerve distribution to the knee joints was analyzed in 5 cadavers and 10 joint capsules specimens were resected during total knee arthroplasty. We found nerve fibers immunoreactive for anti-substance P antibody in the articular capsule. By confocal laser scanning microscopy, we evaluated the three-dimensional structures of the Ruffini's corpuscles and the free nerve endings, both of which were immunoreactive for anti-protein gene product 9.5.", "author" : [ { "dropping-particle" : "", "family" : "Hirasawa", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Okajima", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ohta", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tokioka", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "International orthopaedics", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2000" ] ] }, "page" : "1-4", "title" : "Nerve distribution to the human knee joint: anatomical and immunohistochemical study.", "type" : "article-journal", "volume" : "24" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁰", "plainTextFormattedCitation" : "30", "previouslyFormattedCitation" : "³⁰" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }30. Calcitonin and substance P among other neuropeptides have been localized as transmitters of pain sensations in the body. These neuropeptides may contribute to some of the discomfort experienced by people with knee OAADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s002640050001", "ISSN" : "0341-2695", "PMID" : "10774852", "abstract" : "The nerve distribution to the knee joints was analyzed in 5 cadavers and 10 joint capsules specimens were resected during total knee arthroplasty. We found nerve fibers immunoreactive for anti-substance P antibody in the articular capsule. 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The Health, Aging and Body Composition (Health ABC) study, a longitudinal observational study of 3,075 community-dwelling white and black cohort ages 70-79 with and without diabetes from Pittsburgh, PA and Memphis, TN, showed that half of the mobile adults in the cohort experienced some PN impairmentADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/jgs.13152", "abstract" : "\u00a9 2014, Copyright the Authors Journal compilation \u00a9 2014, The American Geriatrics Society.", "author" : [ { "dropping-particle" : "", "family" : "Ward", "given" : "Rachel E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boudreau", "given" : "Robert M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caserotti", "given" : "Paolo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "Tamara B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zivkovic", "given" : "Sasa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodpaster", "given" : "Bret H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Satterfield", "given" : "Suzanne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kritchevsky", "given" : "Stephen B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cauley", "given" : "Jane A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Simonsick", "given" : "Eleanor M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Health", "given" : "Aging and Body Composition Study", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the American Geriatrics Society", "id" : "ITEM-1", "issue" : "12", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "2273-2279", "title" : "Sensory and motor peripheral nerve function and incident mobility disability", "type" : "article-journal", "volume" : "62" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁴", "plainTextFormattedCitation" : "34", "previouslyFormattedCitation" : "³⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }34. Further work from this study has also linked decreased PN function to important late-life health outcomes such as worse physical performanceADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2337/dc08-0433.A.I.V.", "author" : [ { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rekeneire", "given" : "Schwartz", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V.", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Faulkner", "given" : "Kimberly A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Resnick", "given" : "Helaine E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodpaster", "given" : "Bret H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shorr", "given" : "Ronald I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "Tamara B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Diabetes Care", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "1767-1772", "title" : "The Relationship of Reduced Peripheral Nerve Function and Diabetes With Physical Performance in Older White and Black", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁵", "plainTextFormattedCitation" : "35", "previouslyFormattedCitation" : "³⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }35, walking enduranceADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.exger.2017.04.007", "ISSN" : "1873-6815 (Electronic)", "PMID" : "28442382", "abstract" : "BACKGROUND: Age-related peripheral nervous system (PNS) impairments are highly prevalent in older adults. Although sensorimotor and cardiovascular autonomic function have been shown to be related in persons with diabetes, the nature of the relationship in general community-dwelling older adult populations is unknown. METHODS: Health, Aging and Body Composition participants (n=2399, age=76.5+/-2.9years, 52% women, 38% black) underwent peripheral nerve testing at the 2000/01 clinic visit. Nerve conduction amplitude and velocity were measured at the peroneal motor nerve. Sensory nerve function was assessed with vibration detection threshold and monofilament (1.4-g/10-g) testing at the big toe. Symptoms of lower-extremity peripheral neuropathy were collected by self-report. Cardiovascular autonomic function indicators included postural hypotension, resting heart rate (HR), as well as HR response to and recovery from submaximal exercise testing (400m walk). Multivariable modeling adjusted for demographic/lifestyle factors, medication use and comorbid conditions. RESULTS: In fully adjusted models, poor motor nerve conduction velocity (<40m/s) was associated with greater odds of postural hypotension, (OR=1.6, 95% CI: 1.0-2.5), while poor motor amplitude (<1mV) was associated with 2.3beats/min (p=0.003) higher resting HR. No associations were observed between sensory nerve function or symptoms of peripheral neuropathy and indicators of cardiovascular autonomic function. CONCLUSIONS: Motor nerve function and indicators cardiovascular autonomic function remained significantly related even after considering many potentially shared risk factors. Future studies should investigate common underlying processes for developing multiple PNS impairments in older adults.", "author" : [ { "dropping-particle" : "", "family" : "Lange-Maia", "given" : "Brittney S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jakicic", "given" : "John M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cauley", "given" : "Jane A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boudreau", "given" : "Robert M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Simonsick", "given" : "Eleanor M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Satterfield", "given" : "Suzanne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zivkovic", "given" : "Sasa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "Tamara B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Experimental gerontology", "id" : "ITEM-1", "issue" : "2016", "issued" : { "date-parts" : [ [ "2017" ] ] }, "publisher" : "Elsevier Inc", "title" : "Relationship between sensorimotor peripheral nerve function and indicators of cardiovascular autonomic function in older adults from the Health, Aging and Body composition Study.", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁶", "plainTextFormattedCitation" : "36", "previouslyFormattedCitation" : "³⁶" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }36, increased likelihood of fallsADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.amjmed.2004.01.010", "ISBN" : "0002-9343 (Print) 0002-9343 (Linking)", "ISSN" : "00029343", "PMID" : "15178496", "abstract" : "Purpose To estimate the prevalence of neurological signs and their association with limitations in mobility and falls in a sample of older persons without known neurological disease. Methods A neurologist examined 818 participants from the InCHIANTI study who were aged \u226565 years and who did not have cognitive impairment, treatment with neuroleptics, and a history of neurological disease. Mobility was assessed as walking speed and self-reported ability to walk at least 1 km without difficulty. Participants were asked to report falls that had occurred in the previous 12 months. Results Less than 20% (160/818) of participants had no neurological signs. Neurological signs were more prevalent in older participants and those with impaired mobility. When all neurological signs were included in sex-and age-adjusted multivariate models, 10 were mutually independent correlates of poor mobility. After adjusting for age and sex, the number of neurological signs was associated with progressively slower walking speed (P <0.001), a higher probability of reported inability to walk 1 km (P <0.001), and a history of falls (P <0.05). Conclusion Neurological signs are independent correlates of limitations in mobility and falls in older persons who have no clear history of neurological disease. \u00a9 2004 by Excerpta Medica Inc.", "author" : [ { "dropping-particle" : "", "family" : "Ferrucci", "given" : "Luigi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bandinelli", "given" : "Stefania", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cavazzini", "given" : "Chiara", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lauretani", "given" : "Fulvio", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Corsi", "given" : "Annamaria", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bartali", "given" : "Benedetta", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cherubini", "given" : "Antonio", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Launer", "given" : "Lenore", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guralnik", "given" : "Jack M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American Journal of Medicine", "id" : "ITEM-1", "issue" : "12", "issued" : { "date-parts" : [ [ "2004" ] ] }, "page" : "807-815", "title" : "Neurological examination findings to predict limitations in mobility and falls in older persons without a history of neurological disease", "type" : "article-journal", "volume" : "116" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁷", "plainTextFormattedCitation" : "37", "previouslyFormattedCitation" : "³⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }37, and an onset of mobility limitationsADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/jgs.13152", "abstract" : "\u00a9 2014, Copyright the Authors Journal compilation \u00a9 2014, The American Geriatrics Society.", "author" : [ { "dropping-particle" : "", "family" : "Ward", "given" : "Rachel E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boudreau", "given" : "Robert M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caserotti", "given" : "Paolo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "Tamara B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zivkovic", "given" : "Sasa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodpaster", "given" : "Bret H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Satterfield", "given" : "Suzanne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kritchevsky", "given" : "Stephen B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cauley", "given" : "Jane A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Simonsick", "given" : "Eleanor M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Health", "given" : "Aging and Body Composition Study", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the American Geriatrics Society", "id" : "ITEM-1", "issue" : "12", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "2273-2279", "title" : "Sensory and motor peripheral nerve function and incident mobility disability", "type" : "article-journal", "volume" : "62" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁴", "plainTextFormattedCitation" : "34", "previouslyFormattedCitation" : "³⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }34. PN impairment has been shown to increase with age. Gregg et. al. estimated the prevalence of PN impairment from the NHANES surveyADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Gregg", "given" : "Edward W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sorlie", "given" : "Paul", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Paulose-Ram", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gu", "given" : "Q", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Eberhardt", "given" : "MS", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wolz", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Burt", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Curtin", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Engelgau", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Geiss", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Diabetes Care", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2004" ] ] }, "page" : "1591-1597", "title" : "Prevalence of Lower-Extremity Disease in the U . S . Adult Population \u2265 40 Years of Age with and without diabetes: 1999-2000 National Health and Nutrition Examination Survey", "type" : "article-journal", "volume" : "27" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁸", "plainTextFormattedCitation" : "38", "previouslyFormattedCitation" : "³⁸" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }38. The analysis, which included those with and without diabetes, found that 28% of adults 70-79 and 35% of adults ≥80 showing loss of 10-g monofilament detection in the USADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Gregg", "given" : "Edward W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sorlie", "given" : "Paul", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Paulose-Ram", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gu", "given" : "Q", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Eberhardt", "given" : "MS", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wolz", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Burt", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Curtin", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Engelgau", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Geiss", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Diabetes Care", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2004" ] ] }, "page" : "1591-1597", "title" : "Prevalence of Lower-Extremity Disease in the U . S . Adult Population \u2265 40 Years of Age with and without diabetes: 1999-2000 National Health and Nutrition Examination Survey", "type" : "article-journal", "volume" : "27" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁸", "plainTextFormattedCitation" : "38", "previouslyFormattedCitation" : "³⁸" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }38. The findings of this study indicate an age gradient in PN impairment that should be studied further.Sex may also be a contributing factor to PN impairment in the aging process. Older men tend to have slower nerve conduction compared to women due to greater height and potential hormonal effects and the nervous systemADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0003-9993", "PMID" : "8239949", "abstract" : "Our purpose was to examine the effects of gender on nerve conduction results in healthy subjects. Fifty-four men, mean age 60.2 years and mean height 167cm, were compared with 62 women, mean age 62.2 years and mean height 153cm. We studied median, ulnar, sural, peroneal, and tibial nerves. Analyzing the raw data, women had significantly faster conduction velocities than men for all nerves except median motor (p < 0.05) three of four sensory amplitudes were larger in women and two of four motor amplitudes were larger in men (p < 0.05). After adjustment of the data for height, most statistically significant differences in conduction velocity disappeared, although differences in amplitude persisted. We conclude that most gender differences in nerve conduction velocity can be largely explained by height, whereas amplitude differences persist despite correction for height, temperature, and age.", "author" : [ { "dropping-particle" : "", "family" : "Robinson", "given" : "L R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rubner", "given" : "D E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wahl", "given" : "P W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fujimoto", "given" : "W Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stolov", "given" : "W C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Archives of physical medicine and rehabilitation", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "1993" ] ] }, "page" : "1134-8", "title" : "Influences of height and gender on normal nerve conduction studies.", "type" : "article-journal", "volume" : "74" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "S0531556502001663 [pii]", "ISBN" : "0531-5565 (Print)\\r0531-5565 (Linking)", "ISSN" : "0531-5565", "PMID" : "12543268", "abstract" : "The population of the western world is ageing. This increase in the elderly population will inevitably mean a rise in the prevalence of age-related cognitive decline and late-onset neuropsychiatric disorder, such as Alzheimer's disease (AD). There are sex differences in the incidence and age of onset of these disorders. Sex steroids and sex chromosomes are therefore implicated in their pathophysiology. We have identified relevant past and current literature using a Medline search and from the references of relevant papers. These were then reviewed and relevant articles have been summarized and included in the review. Evidence is presented for the wide-ranging actions of estrogen in the brain at the cellular, metabolic and neurotransmitter levels as well as from the cognitive, AD, depression and cerebrovascular perspectives. The authors conclude that it is unlikely that estrogen will become a stand-alone treatment for any of these disorders, although there may still be a role as an adjunctive treatment and as a prophylactic measure.", "author" : [ { "dropping-particle" : "", "family" : "Norbury", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cutter", "given" : "W J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Compton", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Robertson", "given" : "D M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Craig", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Whitehead", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Murphy", "given" : "D G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Exp Gerontol", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2003" ] ] }, "page" : "109-117", "title" : "The neuroprotective effects of estrogen on the aging brain", "type" : "article-journal", "volume" : "38" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^39,40", "plainTextFormattedCitation" : "39,40", "previouslyFormattedCitation" : "^39,40" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }39,40. Baldereschi et al. examined the epidemiology of distal symmetrical neuropathy (DSN) in a cohort 2,845 older Italians. Results showed that although both men and women experienced higher peripheral neuropathy rates with age, males experienced a rate of 9.02 cases of DSN per 1,000 person-years compared to 7.91 per 1,000 person-years for women at the end of the three year follow-upADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1212/01.wnl.0000260606.36443.29", "ISBN" : "0000260606", "ISSN" : "00283878", "PMID" : "17470747", "abstract" : "OBJECTIVES: To estimate prevalence and incidence of distal symmetric neuropathies (DSN) in the Italian elderly, and to evaluate the accuracy of our procedure to screen for DSN.\\n\\nMETHODS: In eight Italian municipalities, a population-based sample was directly evaluated both at baseline (1992) and after a 3-year follow-up. Cohort members who had died were studied. DSN diagnosis and subtyping were made according to specified diagnostic criteria.\\n\\nRESULTS: Our screening procedure proved accurate (sensitivity 94.7%, specificity 70%, positive predictive value 18.9%), and provided an adjusted prevalence of 7.0 (95% CI, 6.9 to 7.0). Women outnumber men both in the oldest age groups and as a whole. Rates increase with increasing age in both genders. Among the 2,845 individuals re-screened at the follow-up and the 221 deceased subjects with reliable information, we identified 100 incident cases of DSN. Adjusted annual incidence rate (per 1,000 person-years) in the population 65 to 84 years of age is 7.9 (95% CI, 6.3 to 9.5), and for the nondiabetic DSN is 5.76 (95% CI, 4.3 to 7.3). Age significantly predicted the onset of DSN both in diabetic individuals (for every increasing year of age RR = 1.07; 95% CI, 1.01 to 1.14) and in the entire study population (RR = 1.05; 95% CI, 1.02 to 1.09).\\n\\nCONCLUSIONS: We provide the first population-based distal symmetric neuropathies incidence data, as well as prevalence rates from an unselected sample of Italian elderly. Distal symmetric neuropathies are an age-associated condition, but the frequency of diabetic distal symmetric neuropathies declines with age, coincident with an increase in nondiabetic cases.", "author" : [ { "dropping-particle" : "", "family" : "Baldereschi", "given" : "M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Inzitari", "given" : "M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Carlo", "given" : "A.", "non-dropping-particle" : "Di", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Farchi", "given" : "G.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scafato", "given" : "E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Inzitari", "given" : "D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Neurology", "id" : "ITEM-1", "issue" : "18", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "1460-1467", "title" : "Epidemiology of distal symmetrical neuropathies in the Italian elderly", "type" : "article-journal", "volume" : "68" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴¹", "plainTextFormattedCitation" : "41", "previouslyFormattedCitation" : "⁴¹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }41. Sex differences in PN impairment should be investigated to understand the physiologic and biological differences. The correlation between PN function and knee OA continues to be poorly understood. Previous studies have been cross-sectional and therefore have limitations in findingsADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/S0736-0266(03)00054-8", "ISBN" : "0736-0266", "ISSN" : "07360266", "PMID" : "12919865", "abstract" : "Proprioception plays an integral role in neuromotor control of the knee joint and deficits in knee joint proprioception are well documented in individuals with knee osteoarthritis (OA). However, the functional relevance of these deficits is not clear. This cross-sectional study evaluated the relationship between knee joint proprioception and pain and disability in a large cohort of individuals with knee OA. Two hundred and twenty participants (145 F, 75 M) with symptomatic knee OA were recruited from the community. Five non-weight bearing active tests with ipsilateral limb matching responses were performed at 20?? and 40?? flexion to measure knee joint position sense. Pain and disability were assessed by self-reported questionnaires and objective measures of balance and gait. Results showed little association between knee joint position sense variables and measures of pain and disability (r values <0.24, most p > 0.05). When comparing participants with the worst and best joint position sense, no significant differences in pain and disability could be found (p > 0.05). While our study design does not allow causality to be established, these results suggest that deficits in joint position sense may be due to factors other than pain and that deficits are not large enough to impact upon disability. ?? 2003 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Bennell", "given" : "Kim L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hinman", "given" : "Rana S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Metcalf", "given" : "Ben R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Crossley", "given" : "Kay M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Buchbinder", "given" : "Rachelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smith", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McColl", "given" : "Geoffrey", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Orthopaedic Research", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2003" ] ] }, "page" : "792-797", "title" : "Relationship of knee joint proprioception to pain and disability in individuals with knee osteoarthritis", "type" : "article-journal", "volume" : "21" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1136/ard.2005.043653", "ISBN" : "0003-4967", "ISSN" : "0003-4967", "PMID" : "16308342", "abstract" : "OBJECTIVE: To investigate the relative impact of radiographic osteoarthritis (ROA) and current knee pain on lower limb physical function, quadriceps strength, knee joint proprioception, and postural sway.\\n\\nMETHODS: Using a 2x2 factorial design, 142 community derived subjects aged over 45 were divided into four subgroups based on the presence or absence of ROA (Kellgren & Lawrence>grade 2) and knee pain (as assessed by NHANES questions and a 100 mm visual analogue scale). Maximum isometric contraction of the quadriceps, knee joint proprioceptive acuity, static postural sway, and WOMAC index (both whole and function subscale) were assessed in all subjects.\\n\\nRESULTS: Compared with normal subjects, reported disability was greater for all other subgroups (p<0.01). Subjects with both ROA and knee pain reported the greatest disability, and those with knee pain only had greater disability than those with ROA only. Quadriceps weakness was observed in all groups compared with normal subjects (p<0.01), though they were no significant intergroup differences. Subjects with knee pain had a greater sway area than those without (p<0.05) but the presence of ROA was not associated with increased postural sway. No differences in proprioceptive acuity were observed between groups.\\n\\nCONCLUSIONS: The presence of knee pain has a negative association with quadriceps strength, postural sway, and disability compared with ROA. However, the presence of pain-free ROA has a significant negative influence on relative quadriceps strength and reported disability.", "author" : [ { "dropping-particle" : "", "family" : "Hall", "given" : "M C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Annals of the Rheumatic Diseases", "id" : "ITEM-2", "issue" : "7", "issued" : { "date-parts" : [ [ "2005" ] ] }, "page" : "865-870", "title" : "Relative impact of radiographic osteoarthritis and pain on quadriceps strength, proprioception, static postural sway and lower limb function", "type" : "article-journal", "volume" : "65" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^42,43", "plainTextFormattedCitation" : "42,43", "previouslyFormattedCitation" : "^42,43" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }42,43. Studies of mice models have found that as age-related joint deterioration and subsequent decreased joint innervation occurs, the deterioration risk of developing knee OA increasesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Salo", "given" : "PT", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Seeratten", "given" : "RA", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Erwin", "given" : "WM", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bray", "given" : "RC", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Acta Orthop Scand", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2002" ] ] }, "page" : "77-84", "title" : "Evidence for a neuropathic contribution to the development of spontaneous knee osteoarthrosis in a mouse model", "type" : "article-journal", "volume" : "73" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴⁴", "plainTextFormattedCitation" : "44", "previouslyFormattedCitation" : "⁴⁴" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }44. Under normal circumstances, the creation and destruction of extracellular components of PN tissue in sensory neurons maintains an equilibrium to ensure healthy function absent of painADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.joca.2010.09.013", "ISBN" : "1063-4584", "ISSN" : "10634584", "PMID" : "21396464", "abstract" : "Objective: To respond to a pre-specified set of questions posed by the United States Food and Drug Administration (FDA) on defining the disease state to inform the clinical development of drugs, biological products, and medical devices for the prevention and treatment of osteoarthritis (OA). Methods: An Osteoarthritis Research Society International (OARSI) Disease State working group was established, comprised of representatives from academia and industry. The Working Group met in person and by teleconference on several occasions from the Spring of 2008 through the Autumn of 2009 to develop consensus-based, evidence-informed responses to these questions. A report was presented at a public forum in December 2009 and accepted by the OARSI Board of Directors in the Summer of 2010. Results: An operational definition of OA was developed incorporating current understanding of the condition. The structural changes that characterize OA at the joint level were distinguished from the patients' experience of OA as the 'disease' and 'illness', respectively. Recommendations were made regarding the evaluation of both in future OA clinical trials. The current poor understanding of the phenotypes that characterize OA was identified as an important area for future research. Conclusions: The design and conduct of clinical trials for new OA treatments should address the heterogeneity of the disease, treatment-associated structural changes in target joints and patient-reported outcomes. \u00a9 2011 Osteoarthritis Research Society International.", "author" : [ { "dropping-particle" : "", "family" : "Lane", "given" : "N. E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brandt", "given" : "K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hawker", "given" : "G.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Peeva", "given" : "E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schreyer", "given" : "E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tsuji", "given" : "W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hochberg", "given" : "M. C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Osteoarthritis and Cartilage", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "478-482", "title" : "OARSI-FDA initiative: Defining the disease state of osteoarthritis", "type" : "article-journal", "volume" : "19" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴⁵", "plainTextFormattedCitation" : "45", "previouslyFormattedCitation" : "⁴⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }45. In patients who develop knee OA, the equilibrium is disrupted which leads to the destruction of cartilage. The body responds with an increased presence of chondrocytes, which eventually leads destruction of the cells and neural fibersADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.joca.2010.09.013", "ISBN" : "1063-4584", "ISSN" : "10634584", "PMID" : "21396464", "abstract" : "Objective: To respond to a pre-specified set of questions posed by the United States Food and Drug Administration (FDA) on defining the disease state to inform the clinical development of drugs, biological products, and medical devices for the prevention and treatment of osteoarthritis (OA). Methods: An Osteoarthritis Research Society International (OARSI) Disease State working group was established, comprised of representatives from academia and industry. The Working Group met in person and by teleconference on several occasions from the Spring of 2008 through the Autumn of 2009 to develop consensus-based, evidence-informed responses to these questions. A report was presented at a public forum in December 2009 and accepted by the OARSI Board of Directors in the Summer of 2010. Results: An operational definition of OA was developed incorporating current understanding of the condition. The structural changes that characterize OA at the joint level were distinguished from the patients' experience of OA as the 'disease' and 'illness', respectively. Recommendations were made regarding the evaluation of both in future OA clinical trials. The current poor understanding of the phenotypes that characterize OA was identified as an important area for future research. Conclusions: The design and conduct of clinical trials for new OA treatments should address the heterogeneity of the disease, treatment-associated structural changes in target joints and patient-reported outcomes. \u00a9 2011 Osteoarthritis Research Society International.", "author" : [ { "dropping-particle" : "", "family" : "Lane", "given" : "N. E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brandt", "given" : "K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hawker", "given" : "G.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Peeva", "given" : "E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schreyer", "given" : "E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tsuji", "given" : "W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hochberg", "given" : "M. C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Osteoarthritis and Cartilage", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "478-482", "title" : "OARSI-FDA initiative: Defining the disease state of osteoarthritis", "type" : "article-journal", "volume" : "19" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴⁵", "plainTextFormattedCitation" : "45", "previouslyFormattedCitation" : "⁴⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }45. These chondrocytes disrupt the sensory fibers found in the knee that further exacerbates the pain reception in the knees with OAADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/ar2762", "ISBN" : "1478-6362 (Electronic)\\r1478-6354 (Linking)", "ISSN" : "1478-6354", "PMID" : "19519925", "abstract" : "With the recognition that osteoarthritis is a disease of the whole joint, attention has focused increasingly on features in the joint environment which cause ongoing joint damage and are likely sources of pain. This article reviews current ways of assessing osteoarthritis progression and what factors potentiate it, structural abnormalities that probably produce pain, new understandings of the genetics of osteoarthritis, and evaluations of new and old treatments.", "author" : [ { "dropping-particle" : "", "family" : "Felson", "given" : "David T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arthritis Research & Therapy", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "245", "title" : "Developments in the clinical understanding of Osteoarthritis", "type" : "article-journal", "volume" : "11" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴⁶", "plainTextFormattedCitation" : "46", "previouslyFormattedCitation" : "⁴⁶" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }46. Examining these PN changes in relation to knee OA remains a topic that needs to be explored further.Several methods for testing PN function exist for older adults. A nerve conduction study (NCS) tests motor and sensory nerve function by sending electrical impulses that stimulate the nerves and assessing the responseADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.14336/AD.2015.1127", "ISSN" : "2152-5250", "abstract" : "The objective of this study is to systematically review the relationship between lower-extremity peripheral nerve function and mobility in older adults. The National Library of Medicine (PubMed) was searched on March 23, 2015 with no limits on publication dates. One reviewer selected original research studies of older adults (\u226565 years) that assessed the relationship between lower-extremity peripheral nerve function and mobility-related outcomes. Participants, study design and methods of assessing peripheral nerve impairment were evaluated and results were reported and synthesized. Eight articles were identified, including 6 cross-sectional and 2 longitudinal studies. These articles investigated 6 elderly cohorts (4 from the U.S. and 2 from Italy): 3 community-dwelling (including 1 with only disabled women and 1 without mobility limitations at baseline), 1 with both community-dwelling and institutionalized residents, 1 from a range of residential locations, and 1 of patients with peripheral arterial disease. Mean ages ranged from 71-82 years. Nerve function was assessed by vibration threshold (n=2); sensory measures and clinical signs and symptoms of neuropathy (n=2); motor nerve conduction (n=1); and a combination of both sensory measures and motor nerve conduction (n=3). Each study found that worse peripheral nerve function was related to poor mobility, although relationships varied based on the nerve function measure and mobility domain assessed. Six studies found that the association between nerve function and mobility persisted despite adjustment for diabetes. Evidence suggests that peripheral nerve function impairment at various levels of severity is related to poor mobility independent of diabetes. Relationships varied depending on peripheral nerve measure, which may be particularly important when investigating specific biological mechanisms. Future research needs to identify risk factors for peripheral nerve decline beyond diabetes, especially those common in late-life and modifiable. Interventions to preserve nerve function should be investigated with regard to their effect on postponing or preventing disability in older adults.;", "author" : [ { "dropping-particle" : "", "family" : "Ward", "given" : "Rachel E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caserotti", "given" : "Paolo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cauley", "given" : "Jane A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boudreau", "given" : "Robert M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodpaster", "given" : "Bret H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Aging and Disease", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "466", "title" : "Mobility-Related Consequences of Reduced Lower-Extremity Peripheral Nerve Function with Age: A Systematic Review", "type" : "article-journal", "volume" : "7" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴⁷", "plainTextFormattedCitation" : "47", "previouslyFormattedCitation" : "⁴⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }47. The results include the compound muscle action potential (CMAP) for motor nerves and the sensory nerve action potential amplitude (SNAP). This test evaluates both the amplitude of the response from the nerves and the speed at which the signal travels the length of the nerve being tested. Monofilament testing assesses sensory nerve function by applying a standard pressure via a nylon fiber to an extremity. The monofilament delivers different calibers of pressure when applied to skin surfaces and include 1.4-g, 2-g, 4-g, and 10-g levels of pressure. The monofilament test is used to test specific sensory nerve receptors, including the Pacinian corpuscle which perceives pressure in areas of the knee which can greatly affect mobility including balanceADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1210/jc.2010-0892", "ISSN" : "0021972X", "PMID" : "21051576", "abstract" : "Neuropathic pain occurs in about 6-7%of the general population and in 15-20% of people with diabetes. It is defined as a disease or disorder of the sensorimotor system and must be distinguished from nociceptive pain, which is a consequence of trauma, injury, or inflammation. A host of other conditions can masquerade as neuropathy including entrapments, fasciitis, and claudication. Pain can derive from damage to unmyelinated C-fibers, A\u03b4fibers in the periphery, or from mechanisms within the spinal cord, brainstem, and cerebral cortex. A variety of excitatory and inhibitory neurotransmitters are involved and form the basis for targeted drug therapy. More important, however, is the pathogenesis of damage to the pain mechanism, which is multifactorial and includes metabolic disturbances such as hyperglycemia, even impaired glucose tolerance, dyslipidemia, oxidative and nitrosative stress, growth factor deficiencies, microvascular insufficiency, and autoimmunedamageto nerve fibers. The approach to managing the patient with neuropathic pain is first to understand and recognize the cause of pain in a particular patient and to use monotherapies or drug combinations directed at the different typesandsources of pain. Ultimately, therapy directed at the underlying pathogenesis of neuropathy is needed. The case presented in this report illustrates the complexity of resolution of pain in an individual and the need for a holistic approach to medicine, employing empathy, compassion, and understanding in the relationship between the doctor and the patient to succeed in alleviating pain. Copyright \u00a9 2010 by The Endocrine Society.", "author" : [ { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Clinical Endocrinology and Metabolism", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "4802-4811", "title" : "The Approach to the Management of the Patient with Neuropathic Pain", "type" : "article-journal", "volume" : "95" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴⁸", "plainTextFormattedCitation" : "48", "previouslyFormattedCitation" : "⁴⁸" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }48. The 10-g monofilament is a standard test used to detect peripheral neuropathy and can be used in both diabetic and non-diabetic populationsADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2337/dc08-0433.A.I.V.", "author" : [ { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rekeneire", "given" : "Schwartz", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V.", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Faulkner", "given" : "Kimberly A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Resnick", "given" : "Helaine E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodpaster", "given" : "Bret H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shorr", "given" : "Ronald I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "Tamara B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Diabetes Care", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "1767-1772", "title" : "The Relationship of Reduced Peripheral Nerve Function and Diabetes With Physical Performance in Older White and Black", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁵", "plainTextFormattedCitation" : "35", "previouslyFormattedCitation" : "³⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }35. In diabetic populations the 10-g monofilament test is also used to predict foot ulceration which can lead to skin infections and amputationADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2337/dc09-1835", "ISBN" : "1935-5548 (Electronic)\\r0149-5992 (Linking)", "ISSN" : "01495992", "PMID" : "20357373", "abstract" : "OBJECTIVE: To determine the specific monofilament examination score that predicts the subsequent 4-year incidence of diabetic neuropathy with the highest degree of diagnostic accuracy. RESEARCH DESIGN AND METHODS: Longitudinal follow-up of 175 of 197 (89%) participants in the Toronto Diabetic Neuropathy Cohort without baseline neuropathy for incident neuropathy. We examined the baseline monofilament examination score (and other simple sensory screening tests) by receiver operating characteristic (ROC) curve analysis. RESULTS: Incident diabetic neuropathy developed in 50 (29%) participants over a mean follow-up of 4.1 years (interquartile range 2.6-7.1 years). Although male sex, longer diabetes duration, taller height, and higher blood pressure at baseline were associated with incident neuropathy, the strongest association was with a lower baseline monofilament score (score out of 8 was 3.7 +/- 2.5 for incident neuropathy vs. 5.7 +/- 2.3 for those who did not develop neuropathy; P < 0.001). The optimal threshold score for risk of incident neuropathy was <or=5 sensate stimuli out of 8, with 72% sensitivity, 64% specificity, positive and negative likelihood ratios of 2.5 and 0.35, and positive and negative predictive values of 87 and 46%, respectively (chi(2) = 20.7, P < 0.001). Area under the ROC curve was significantly greater for the monofilament examination compared with that for other simple sensory tests. CONCLUSIONS: A simple threshold of <or=5 sensate stimuli out of 8 discriminates 4-year risk of diabetic neuropathy with acceptable operating characteristics. Although there are limitations in its specificity for prediction of future neuropathy onset, the monofilament examination is appropriate as a simple diabetic neuropathy screening instrument generalizable to the clinical setting.", "author" : [ { "dropping-particle" : "", "family" : "Perkins", "given" : "Bruce A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Orszag", "given" : "Andrej", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ngo", "given" : "Mylan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ng", "given" : "Eduardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "New", "given" : "Patti", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bril", "given" : "Vera", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Diabetes Care", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "1549-1554", "title" : "Prediction of incident diabetic neuropathy using the monofilament examination: A 4-year prospective study", "type" : "article-journal", "volume" : "33" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴⁹", "plainTextFormattedCitation" : "49", "previouslyFormattedCitation" : "⁴⁹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }49. The light 1.4-g monofilament is used to detect subclinical symptoms of peripheral neuropathy is both diabetic and non-diabetic populationsADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2337/dc08-0433.A.I.V.", "author" : [ { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rekeneire", "given" : "Schwartz", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V.", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Faulkner", "given" : "Kimberly A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Resnick", "given" : "Helaine E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodpaster", "given" : "Bret H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shorr", "given" : "Ronald I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "Tamara B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Diabetes Care", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "1767-1772", "title" : "The Relationship of Reduced Peripheral Nerve Function and Diabetes With Physical Performance in Older White and Black", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁵", "plainTextFormattedCitation" : "35", "previouslyFormattedCitation" : "³⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }35. The dorsum of the toe is usually tested due to the higher sensitivity at this site. The participant is asked to report when they feel the pressure from the monofilament being applied. The test is performed in multiple trials. Vibration detection threshold (VBT) is another measure that evaluates sensory nerve function. Participants begin the test by placing their large toe on a knob that is attached to a platformADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.14336/AD.2015.1127", "ISSN" : "2152-5250", "abstract" : "The objective of this study is to systematically review the relationship between lower-extremity peripheral nerve function and mobility in older adults. The National Library of Medicine (PubMed) was searched on March 23, 2015 with no limits on publication dates. 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The platform begins to vibrate at a low intensity and is gradually increased until the participant reports detectionADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.14336/AD.2015.1127", "ISSN" : "2152-5250", "abstract" : "The objective of this study is to systematically review the relationship between lower-extremity peripheral nerve function and mobility in older adults. The National Library of Medicine (PubMed) was searched on March 23, 2015 with no limits on publication dates. One reviewer selected original research studies of older adults (\u226565 years) that assessed the relationship between lower-extremity peripheral nerve function and mobility-related outcomes. Participants, study design and methods of assessing peripheral nerve impairment were evaluated and results were reported and synthesized. Eight articles were identified, including 6 cross-sectional and 2 longitudinal studies. 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Another example, the quantitative tuning fork, involves placing adjusted weights to a fork-like instrument that changes the vibration on a 0-8 scaleADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.14336/AD.2015.1127", "ISSN" : "2152-5250", "abstract" : "The objective of this study is to systematically review the relationship between lower-extremity peripheral nerve function and mobility in older adults. The National Library of Medicine (PubMed) was searched on March 23, 2015 with no limits on publication dates. One reviewer selected original research studies of older adults (\u226565 years) that assessed the relationship between lower-extremity peripheral nerve function and mobility-related outcomes. Participants, study design and methods of assessing peripheral nerve impairment were evaluated and results were reported and synthesized. Eight articles were identified, including 6 cross-sectional and 2 longitudinal studies. 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The vibration decreases the longer it is placed on a skin surface until the participants reports when they can no longer feel itADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.14336/AD.2015.1127", "ISSN" : "2152-5250", "abstract" : "The objective of this study is to systematically review the relationship between lower-extremity peripheral nerve function and mobility in older adults. The National Library of Medicine (PubMed) was searched on March 23, 2015 with no limits on publication dates. One reviewer selected original research studies of older adults (\u226565 years) that assessed the relationship between lower-extremity peripheral nerve function and mobility-related outcomes. Participants, study design and methods of assessing peripheral nerve impairment were evaluated and results were reported and synthesized. Eight articles were identified, including 6 cross-sectional and 2 longitudinal studies. 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Together, these testing methods provide different information on PN impairment in older populations. Several studies have evaluated the relationship between PN function and OA using these various testing methods (Table 1). 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Both studies also found that after adjusting for diabetes, the relationship between poor sensory motor performance and these mobility outcomes remained significant. Resnick et al. found that diabetes was not found to be linked to any of the mobility measures after adjusting for sensory impairment in the Women’s Health and Aging StudyADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Resnick", "given" : "Helaine E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V.", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Leveille", "given" : "Suzanne G.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brancati", "given" : "Frederick L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Balfour", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Diabetes Care", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2000" ] ] }, "title" : "Independent Effects of Peripheral Nerve Dysfunction on Lower-Extremity Physical Function in Old Age The Women \u2019 s Health and Aging Study", "type" : "article-journal", "volume" : "23" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁵⁰", "plainTextFormattedCitation" : "50", "previouslyFormattedCitation" : "⁵⁰" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }50. While results from this study were promising, the study had limited generalizability due to the cohort being only disabled womenADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Resnick", "given" : "Helaine E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V.", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Leveille", "given" : "Suzanne G.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brancati", "given" : "Frederick L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Balfour", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Diabetes Care", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2000" ] ] }, "title" : "Independent Effects of Peripheral Nerve Dysfunction on Lower-Extremity Physical Function in Old Age The Women \u2019 s Health and Aging Study", "type" : "article-journal", "volume" : "23" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁵⁰", "plainTextFormattedCitation" : "50", "previouslyFormattedCitation" : "⁵⁰" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }50. In the Health ABC study, adjusting for PN function measurements attenuated only a portion of mobility outcomes (20.8% for usual walking speed, 26.5% for standing balance, and 25.1% for SPPB score)ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2337/dc08-0433.A.I.V.", "author" : [ { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rekeneire", "given" : "Schwartz", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V.", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Faulkner", "given" : "Kimberly A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Resnick", "given" : "Helaine E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodpaster", "given" : "Bret H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shorr", "given" : "Ronald I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "Tamara B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Diabetes Care", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "1767-1772", "title" : "The Relationship of Reduced Peripheral Nerve Function and Diabetes With Physical Performance in Older White and Black", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁵", "plainTextFormattedCitation" : "35", "previouslyFormattedCitation" : "³⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }35. The implications of vibration and tuning fork testing can be used for future implications of sensory nerve impairment in older populations. Using monofilament testing has also been used in previous studies of sensory nerve impairment. Ferrucci et al. tested a cohort of 818 Italian elders in the for PN impairment relating to mobility outcomes and fallsADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.amjmed.2004.01.010", "ISBN" : "0002-9343 (Print) 0002-9343 (Linking)", "ISSN" : "00029343", "PMID" : "15178496", "abstract" : "Purpose To estimate the prevalence of neurological signs and their association with limitations in mobility and falls in a sample of older persons without known neurological disease. Methods A neurologist examined 818 participants from the InCHIANTI study who were aged \u226565 years and who did not have cognitive impairment, treatment with neuroleptics, and a history of neurological disease. Mobility was assessed as walking speed and self-reported ability to walk at least 1 km without difficulty. Participants were asked to report falls that had occurred in the previous 12 months. Results Less than 20% (160/818) of participants had no neurological signs. Neurological signs were more prevalent in older participants and those with impaired mobility. When all neurological signs were included in sex-and age-adjusted multivariate models, 10 were mutually independent correlates of poor mobility. After adjusting for age and sex, the number of neurological signs was associated with progressively slower walking speed (P <0.001), a higher probability of reported inability to walk 1 km (P <0.001), and a history of falls (P <0.05). Conclusion Neurological signs are independent correlates of limitations in mobility and falls in older persons who have no clear history of neurological disease. \u00a9 2004 by Excerpta Medica Inc.", "author" : [ { "dropping-particle" : "", "family" : "Ferrucci", "given" : "Luigi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bandinelli", "given" : "Stefania", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cavazzini", "given" : "Chiara", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lauretani", "given" : "Fulvio", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Corsi", "given" : "Annamaria", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bartali", "given" : "Benedetta", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cherubini", "given" : "Antonio", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Launer", "given" : "Lenore", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guralnik", "given" : "Jack M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American Journal of Medicine", "id" : "ITEM-1", "issue" : "12", "issued" : { "date-parts" : [ [ "2004" ] ] }, "page" : "807-815", "title" : "Neurological examination findings to predict limitations in mobility and falls in older persons without a history of neurological disease", "type" : "article-journal", "volume" : "116" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁷", "plainTextFormattedCitation" : "37", "previouslyFormattedCitation" : "³⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }37. From the cross-sectional study, results showed that after adjustment for sex and age, inability to detect 2-g and 4-g monofilament was related to slower walking speed (% difference (95% CI: -12% (-6% - -19%) and increased odds of not being able to walk 1 km OR=2.90 (95% CI: 1.40 – 5.90) when compared to the average of the cohortADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.amjmed.2004.01.010", "ISBN" : "0002-9343 (Print) 0002-9343 (Linking)", "ISSN" : "00029343", "PMID" : "15178496", "abstract" : "Purpose To estimate the prevalence of neurological signs and their association with limitations in mobility and falls in a sample of older persons without known neurological disease. Methods A neurologist examined 818 participants from the InCHIANTI study who were aged \u226565 years and who did not have cognitive impairment, treatment with neuroleptics, and a history of neurological disease. Mobility was assessed as walking speed and self-reported ability to walk at least 1 km without difficulty. Participants were asked to report falls that had occurred in the previous 12 months. Results Less than 20% (160/818) of participants had no neurological signs. Neurological signs were more prevalent in older participants and those with impaired mobility. When all neurological signs were included in sex-and age-adjusted multivariate models, 10 were mutually independent correlates of poor mobility. After adjusting for age and sex, the number of neurological signs was associated with progressively slower walking speed (P <0.001), a higher probability of reported inability to walk 1 km (P <0.001), and a history of falls (P <0.05). Conclusion Neurological signs are independent correlates of limitations in mobility and falls in older persons who have no clear history of neurological disease. \u00a9 2004 by Excerpta Medica Inc.", "author" : [ { "dropping-particle" : "", "family" : "Ferrucci", "given" : "Luigi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bandinelli", "given" : "Stefania", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cavazzini", "given" : "Chiara", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lauretani", "given" : "Fulvio", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Corsi", "given" : "Annamaria", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bartali", "given" : "Benedetta", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cherubini", "given" : "Antonio", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Launer", "given" : "Lenore", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guralnik", "given" : "Jack M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American Journal of Medicine", "id" : "ITEM-1", "issue" : "12", "issued" : { "date-parts" : [ [ "2004" ] ] }, "page" : "807-815", "title" : "Neurological examination findings to predict limitations in mobility and falls in older persons without a history of neurological disease", "type" : "article-journal", "volume" : "116" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁷", "plainTextFormattedCitation" : "37", "previouslyFormattedCitation" : "³⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }37. Using the 1.4-g and 10-g monofilament, Strotmeyer et al. found that greater monofilament detection (defined as ≥3 of 4 touches) was related to faster narrow walking speed (β=0.049, p=0.006) and faster speed in the repeated chair stand (β=0.015, p=0.007)ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2337/dc08-0433.A.I.V.", "author" : [ { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rekeneire", "given" : "Schwartz", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V.", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Faulkner", "given" : "Kimberly A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Resnick", "given" : "Helaine E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodpaster", "given" : "Bret H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shorr", "given" : "Ronald I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "Tamara B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Diabetes Care", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "1767-1772", "title" : "The Relationship of Reduced Peripheral Nerve Function and Diabetes With Physical Performance in Older White and Black", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁵", "plainTextFormattedCitation" : "35", "previouslyFormattedCitation" : "³⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }35. Chiles et al. had similar findings, with inability to detect 2-g and 4-g monofilament resulting in a lower mobility outcomes including a lower SPPB score (β=0.05, p<0.05)ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jdiacomp.2013.08.007", "ISBN" : "2122633255", "ISSN" : "10568727", "PMID" : "24120281", "abstract" : "Objective Diabetes among older adults causes many complications, including decreased lower-extremity function and physical disability. Diabetes can cause peripheral nerve dysfunction, which might be one pathway through which diabetes leads to decreased physical function. The study aims were to determine the following: (1) whether diabetes and impaired fasting glucose are associated with objective measures of physical function in older adults, (2) which peripheral nerve function (PNF) tests are associated with diabetes, and (3) whether PNF mediates the diabetes-physical function relationship. Research Design and Methods This study included 983 participants, age 65 years and older from the InCHIANTI study. Diabetes was diagnosed by clinical guidelines. Physical performance was assessed using the Short Physical Performance Battery (SPPB), scored from 0 to 12 (higher values, better physical function) and usual walking speed (m/s). PNF was assessed via standard surface electroneurographic study of right peroneal nerve conduction velocity, vibration and touch sensitivity. Clinical cutpoints of PNF tests were used to create a neuropathy score from 0 to 5 (higher values, greater neuropathy). Multiple linear regression models were used to test associations. Results and Conclusion One hundred twenty-six (12.8%) participants had diabetes. Adjusting for age, sex, education, and other confounders, diabetic participants had decreased SPPB (\u03b2 = - 0.99; p < 0.01), decreased walking speed (\u03b2 = - 0.1 m/s; p < 0.01), decreased nerve conduction velocity (\u03b2 = - 1.7 m/s; p < 0.01), and increased neuropathy (\u03b2 = 0.25; p < 0.01) compared to non-diabetic participants. Adjusting for nerve conduction velocity and neuropathy score decreased the effect of diabetes on SPPB by 20%, suggesting partial mediation through decreased PNF. \u00a9 2014 Elsevier Inc.", "author" : [ { "dropping-particle" : "", "family" : "Chiles", "given" : "Nancy S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Phillips", "given" : "Caroline L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Volpato", "given" : "Stefano", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bandinelli", "given" : "Stefania", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ferrucci", "given" : "Luigi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guralnik", "given" : "Jack M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V.", "family" : "Patel", "given" : "Kushang", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Diabetes and its Complications", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "91-95", "title" : "Diabetes, peripheral neuropathy, and lower-extremity function", "type" : "article-journal", "volume" : "28" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁵¹", "plainTextFormattedCitation" : "51", "previouslyFormattedCitation" : "⁵¹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }51. 1.4-g and 10-g monofilament insensitivity also differed in diabetic and non-diabetic individuals. 1.4-g monofilament insensitivity was 19.2% vs. 10.4% (p ≤ 0.001) and 6.7% vs. 5.6% (p=NS) for diabetic vs. non-diabetic males and females, respectivelyADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jdiacomp.2013.08.007", "ISBN" : "2122633255", "ISSN" : "10568727", "PMID" : "24120281", "abstract" : "Objective Diabetes among older adults causes many complications, including decreased lower-extremity function and physical disability. Diabetes can cause peripheral nerve dysfunction, which might be one pathway through which diabetes leads to decreased physical function. The study aims were to determine the following: (1) whether diabetes and impaired fasting glucose are associated with objective measures of physical function in older adults, (2) which peripheral nerve function (PNF) tests are associated with diabetes, and (3) whether PNF mediates the diabetes-physical function relationship. Research Design and Methods This study included 983 participants, age 65 years and older from the InCHIANTI study. Diabetes was diagnosed by clinical guidelines. Physical performance was assessed using the Short Physical Performance Battery (SPPB), scored from 0 to 12 (higher values, better physical function) and usual walking speed (m/s). PNF was assessed via standard surface electroneurographic study of right peroneal nerve conduction velocity, vibration and touch sensitivity. Clinical cutpoints of PNF tests were used to create a neuropathy score from 0 to 5 (higher values, greater neuropathy). Multiple linear regression models were used to test associations. Results and Conclusion One hundred twenty-six (12.8%) participants had diabetes. Adjusting for age, sex, education, and other confounders, diabetic participants had decreased SPPB (\u03b2 = - 0.99; p < 0.01), decreased walking speed (\u03b2 = - 0.1 m/s; p < 0.01), decreased nerve conduction velocity (\u03b2 = - 1.7 m/s; p < 0.01), and increased neuropathy (\u03b2 = 0.25; p < 0.01) compared to non-diabetic participants. Adjusting for nerve conduction velocity and neuropathy score decreased the effect of diabetes on SPPB by 20%, suggesting partial mediation through decreased PNF. \u00a9 2014 Elsevier Inc.", "author" : [ { "dropping-particle" : "", "family" : "Chiles", "given" : "Nancy S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Phillips", "given" : "Caroline L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Volpato", "given" : "Stefano", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bandinelli", "given" : "Stefania", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ferrucci", "given" : "Luigi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guralnik", "given" : "Jack M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V.", "family" : "Patel", "given" : "Kushang", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Diabetes and its Complications", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "91-95", "title" : "Diabetes, peripheral neuropathy, and lower-extremity function", "type" : "article-journal", "volume" : "28" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁵¹", "plainTextFormattedCitation" : "51", "previouslyFormattedCitation" : "⁵¹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }51. Further, 10-g monofilament insensitivity was 61.9% vs. 50.4% (p ≤ 0.001) and 44.0% vs. 38.1% (p=NS) for diabetic vs. non-diabetic males and femalesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jdiacomp.2013.08.007", "ISBN" : "2122633255", "ISSN" : "10568727", "PMID" : "24120281", "abstract" : "Objective Diabetes among older adults causes many complications, including decreased lower-extremity function and physical disability. Diabetes can cause peripheral nerve dysfunction, which might be one pathway through which diabetes leads to decreased physical function. The study aims were to determine the following: (1) whether diabetes and impaired fasting glucose are associated with objective measures of physical function in older adults, (2) which peripheral nerve function (PNF) tests are associated with diabetes, and (3) whether PNF mediates the diabetes-physical function relationship. Research Design and Methods This study included 983 participants, age 65 years and older from the InCHIANTI study. Diabetes was diagnosed by clinical guidelines. Physical performance was assessed using the Short Physical Performance Battery (SPPB), scored from 0 to 12 (higher values, better physical function) and usual walking speed (m/s). PNF was assessed via standard surface electroneurographic study of right peroneal nerve conduction velocity, vibration and touch sensitivity. Clinical cutpoints of PNF tests were used to create a neuropathy score from 0 to 5 (higher values, greater neuropathy). Multiple linear regression models were used to test associations. Results and Conclusion One hundred twenty-six (12.8%) participants had diabetes. Adjusting for age, sex, education, and other confounders, diabetic participants had decreased SPPB (\u03b2 = - 0.99; p < 0.01), decreased walking speed (\u03b2 = - 0.1 m/s; p < 0.01), decreased nerve conduction velocity (\u03b2 = - 1.7 m/s; p < 0.01), and increased neuropathy (\u03b2 = 0.25; p < 0.01) compared to non-diabetic participants. Adjusting for nerve conduction velocity and neuropathy score decreased the effect of diabetes on SPPB by 20%, suggesting partial mediation through decreased PNF. \u00a9 2014 Elsevier Inc.", "author" : [ { "dropping-particle" : "", "family" : "Chiles", "given" : "Nancy S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Phillips", "given" : "Caroline L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Volpato", "given" : "Stefano", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bandinelli", "given" : "Stefania", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ferrucci", "given" : "Luigi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guralnik", "given" : "Jack M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V.", "family" : "Patel", "given" : "Kushang", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Diabetes and its Complications", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "91-95", "title" : "Diabetes, peripheral neuropathy, and lower-extremity function", "type" : "article-journal", "volume" : "28" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁵¹", "plainTextFormattedCitation" : "51", "previouslyFormattedCitation" : "⁵¹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }51. Ward et al. examined 1.4-g and 10-g monofilament insensitivity (defined as <3 of 4 touches). 1.4-g monofilament insensitivity was 36.1% vs. 39.6% and 10-g monofilament insensitivity was 7.5% vs. 13.7% for non-diabetic and diabetic participants, respectivelyADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.14336/AD.2015.1127", "ISSN" : "2152-5250", "abstract" : "The objective of this study is to systematically review the relationship between lower-extremity peripheral nerve function and mobility in older adults. The National Library of Medicine (PubMed) was searched on March 23, 2015 with no limits on publication dates. One reviewer selected original research studies of older adults (\u226565 years) that assessed the relationship between lower-extremity peripheral nerve function and mobility-related outcomes. Participants, study design and methods of assessing peripheral nerve impairment were evaluated and results were reported and synthesized. Eight articles were identified, including 6 cross-sectional and 2 longitudinal studies. These articles investigated 6 elderly cohorts (4 from the U.S. and 2 from Italy): 3 community-dwelling (including 1 with only disabled women and 1 without mobility limitations at baseline), 1 with both community-dwelling and institutionalized residents, 1 from a range of residential locations, and 1 of patients with peripheral arterial disease. Mean ages ranged from 71-82 years. Nerve function was assessed by vibration threshold (n=2); sensory measures and clinical signs and symptoms of neuropathy (n=2); motor nerve conduction (n=1); and a combination of both sensory measures and motor nerve conduction (n=3). Each study found that worse peripheral nerve function was related to poor mobility, although relationships varied based on the nerve function measure and mobility domain assessed. Six studies found that the association between nerve function and mobility persisted despite adjustment for diabetes. Evidence suggests that peripheral nerve function impairment at various levels of severity is related to poor mobility independent of diabetes. Relationships varied depending on peripheral nerve measure, which may be particularly important when investigating specific biological mechanisms. Future research needs to identify risk factors for peripheral nerve decline beyond diabetes, especially those common in late-life and modifiable. Interventions to preserve nerve function should be investigated with regard to their effect on postponing or preventing disability in older adults.;", "author" : [ { "dropping-particle" : "", "family" : "Ward", "given" : "Rachel E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caserotti", "given" : "Paolo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cauley", "given" : "Jane A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boudreau", "given" : "Robert M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodpaster", "given" : "Bret H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Aging and Disease", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "466", "title" : "Mobility-Related Consequences of Reduced Lower-Extremity Peripheral Nerve Function with Age: A Systematic Review", "type" : "article-journal", "volume" : "7" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁴⁷", "plainTextFormattedCitation" : "47", "previouslyFormattedCitation" : "⁴⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }47. Using monofilament testing in diabetic and non-diabetic populations is important in examining PN impairment in more generalizable populations. Peroneal CMAP and motor NCV tests were also used in previous literature to assess peripheral motor nerve measures and mobility outcomes. Strotmeyer et al. found from the Health ABC study that higher CMAP amplitude resulted in a higher performance battery score (β=0.105, p<0.001), faster usual walking speed (β=0.008, p=0.004), faster narrow walking speed (β=0.029, p<0.001), and higher standing balance ratio (β=0.014, p<0.001)ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2337/dc08-0433.A.I.V.", "author" : [ { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rekeneire", "given" : "Schwartz", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V.", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Faulkner", "given" : "Kimberly A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Resnick", "given" : "Helaine E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodpaster", "given" : "Bret H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shorr", "given" : "Ronald I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "Tamara B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Diabetes Care", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "1767-1772", "title" : "The Relationship of Reduced Peripheral Nerve Function and Diabetes With Physical Performance in Older White and Black", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁵", "plainTextFormattedCitation" : "35", "previouslyFormattedCitation" : "³⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }35. Analyses were adjusted for demographics including body composition, lifestyle factors, and chronic conditions including diabetesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2337/dc08-0433.A.I.V.", "author" : [ { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rekeneire", "given" : "Schwartz", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V.", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Faulkner", "given" : "Kimberly A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Resnick", "given" : "Helaine E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodpaster", "given" : "Bret H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shorr", "given" : "Ronald I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "Tamara B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Diabetes Care", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "1767-1772", "title" : "The Relationship of Reduced Peripheral Nerve Function and Diabetes With Physical Performance in Older White and Black", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁵", "plainTextFormattedCitation" : "35", "previouslyFormattedCitation" : "³⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }35. Using the same methodology as Strotmeyer et al., Evans et al. found an association between worse CMAP scores and lower test scores in the Walking Impairment Questionnaire (WIQ) walking and stair climbing scoreADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/1358863X10395656", "ISBN" : "1477-0377 (Electronic)\\n1358-863X (Linking)", "ISSN" : "1358-863X", "PMID" : "21471147", "abstract" : "We determined whether more adverse calf muscle characteristics and poorer peripheral nerve function were associated with impairments in self-perceived physical functioning and walking ability in persons with lower extremity peripheral artery disease (PAD). Participants included 462 persons with PAD; measures included the ankle-brachial index (ABI), medical history, electrophysiologic characteristics of nerves, and computed tomography of calf muscle. Self-perceived physical functioning and walking ability were assessed using the 36-Item Short Form Health Survey (SF-36) and the Walking Impairment Questionnaire (WIQ). Results were adjusted for age, sex, race, ABI, body mass index, comorbidities, and other confounders. Lower calf muscle area was associated with a poorer SF-36 physical function (PF) score (overall p-trend < 0.001, 33.76 PF score for the lowest quartile versus 59.74 for the highest, pairwise p < 0.001) and a poorer WIQ walking distance score (p-trend = 0.001, 29.71 WIQ score for the lowest quartile versus 48.43 for the highest, pairwise p < 0.001). Higher calf muscle percent fat was associated with a poorer SF-36 PF score (p-trend < 0.001, 53.76 PF score for the lowest quartile versus 40.28 for the highest, pairwise p = 0.009). Slower peroneal nerve conduction velocity was associated with a poorer WIQ speed score ( p-trend = 0.023, 30.49 WIQ score for the lowest quartile versus 40.48 for the highest, pairwise p = 0.031). In summary, adverse calf muscle characteristics and poorer peripheral nerve function are associated significantly and independently with impairments in self-perceived physical functioning and walking ability in PAD persons.", "author" : [ { "dropping-particle" : "", "family" : "Evans", "given" : "Natalie S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liu", "given" : "Kiang", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Criqui", "given" : "Michael H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ferrucci", "given" : "Luigi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guralnik", "given" : "Jack M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tian", "given" : "Lu", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liao", "given" : "Yihua", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McDermott", "given" : "Mary M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Vascular Medicine", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "3-11", "title" : "Associations of calf skeletal muscle characteristics and peripheral nerve function with self-perceived physical functioning and walking ability in persons with peripheral artery disease.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁵²", "plainTextFormattedCitation" : "52", "previouslyFormattedCitation" : "⁵²" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }52. Lower peroneal motor NCV was also found by Evans and colleagues to be related to decreased WIQ questionnaire scoresADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/1358863X10395656", "ISBN" : "1477-0377 (Electronic)\\n1358-863X (Linking)", "ISSN" : "1358-863X", "PMID" : "21471147", "abstract" : "We determined whether more adverse calf muscle characteristics and poorer peripheral nerve function were associated with impairments in self-perceived physical functioning and walking ability in persons with lower extremity peripheral artery disease (PAD). Participants included 462 persons with PAD; measures included the ankle-brachial index (ABI), medical history, electrophysiologic characteristics of nerves, and computed tomography of calf muscle. Self-perceived physical functioning and walking ability were assessed using the 36-Item Short Form Health Survey (SF-36) and the Walking Impairment Questionnaire (WIQ). Results were adjusted for age, sex, race, ABI, body mass index, comorbidities, and other confounders. Lower calf muscle area was associated with a poorer SF-36 physical function (PF) score (overall p-trend < 0.001, 33.76 PF score for the lowest quartile versus 59.74 for the highest, pairwise p < 0.001) and a poorer WIQ walking distance score (p-trend = 0.001, 29.71 WIQ score for the lowest quartile versus 48.43 for the highest, pairwise p < 0.001). Higher calf muscle percent fat was associated with a poorer SF-36 PF score (p-trend < 0.001, 53.76 PF score for the lowest quartile versus 40.28 for the highest, pairwise p = 0.009). Slower peroneal nerve conduction velocity was associated with a poorer WIQ speed score ( p-trend = 0.023, 30.49 WIQ score for the lowest quartile versus 40.48 for the highest, pairwise p = 0.031). In summary, adverse calf muscle characteristics and poorer peripheral nerve function are associated significantly and independently with impairments in self-perceived physical functioning and walking ability in PAD persons.", "author" : [ { "dropping-particle" : "", "family" : "Evans", "given" : "Natalie S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liu", "given" : "Kiang", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Criqui", "given" : "Michael H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ferrucci", "given" : "Luigi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guralnik", "given" : "Jack M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tian", "given" : "Lu", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liao", "given" : "Yihua", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McDermott", "given" : "Mary M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Vascular Medicine", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "3-11", "title" : "Associations of calf skeletal muscle characteristics and peripheral nerve function with self-perceived physical functioning and walking ability in persons with peripheral artery disease.", "type" : "article-journal", "volume" : "16" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁵²", "plainTextFormattedCitation" : "52", "previouslyFormattedCitation" : "⁵²" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }52. Previous PN research has indicated that PN impairment leads to poorer mobility outcomes and decreased physical function in older adults.Gaps in literature Important gaps exist in the current literature to be addressed for future studies on PN function and knee OA. Subclinical measures for peripheral nerve impairment need to be explored, especially those not diagnosed with diabetesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Gregg", "given" : "Edward W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sorlie", "given" : "Paul", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Paulose-Ram", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gu", "given" : "Q", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Eberhardt", "given" : "MS", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wolz", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Burt", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Curtin", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Engelgau", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Geiss", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Diabetes Care", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2004" ] ] }, "page" : "1591-1597", "title" : "Prevalence of Lower-Extremity Disease in the U . S . Adult Population \u2265 40 Years of Age with and without diabetes: 1999-2000 National Health and Nutrition Examination Survey", "type" : "article-journal", "volume" : "27" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁸", "plainTextFormattedCitation" : "38" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }38. Future studies should explore the prevalence and incidence of peripheral neuropathy in the population, not just those with diabetes, and include subgroups such as older populations and those with knee OA. Measures such as the tuning fork are less sensitive tests for PN impairment and are not typically used in subgroups of older populations. PN measures such as the 1.4-g monofilament are reliable testing measures for subclinical PN impairment and should be implemented. Previous literature has also shown that diabetes cannot fully explain to relationship between peripheral neuropathy and mobility limitations.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1532-5415.2009.02487.x.Sensory", "ISBN" : "4123831931", "ISSN" : "1532-5415", "PMID" : "19793163", "abstract" : "Objectives\u2014To determine if sensory and motor nerve function was associated cross-sectionally with quadriceps strength or ankle dorsiflexion strength in an older community-based population. Design, Setting, Participants\u2014Health, Aging, and Body Composition Study participants (N=2059; 50% men; 37% black, aged 73-82 years) in 2000-2001. Intervention\u2014n/aMeasurements\u2014Quadriceps and ankle strength were measured with an isokinetic dynamometer. Sensory and motor peripheral nerve function in the legs/feet was assessed by 10-g and 1.4-g monofilaments, vibration threshold, and peroneal motor nerve conduction amplitude and velocity. Results\u2014Monofilament insensitivity, poorest vibration threshold quartile (>60 ?), and poorest motor nerve conduction amplitude quartile (<1.7 mV) were associated with 11%, 7%, and 8% lower quadriceps strength (all p<0.01), respectively, compared to the best peripheral nerve function categories in adjusted linear regression models. Monofilament insensitivity and lowest amplitude quartile were both associated with 17% lower ankle strength (p<0.01). In multivariate analyses, with monofilament insensitivity (?=-7.19), vibration threshold (?=-0.097), and motor nerve conduction amplitude (?=2.01) in the same model, each contributed independently to lower quadriceps strength (all p<0.01). Monofilament insensitivity (?=-5.29) and amplitude (?=1.17) each contributed independently to lower ankle strength (all p<0.01). Lean mass did not explain the associations of peripheral nerve function with strength. Conclusions\u2014Reduced sensory and motor peripheral nerve function is related to poorer lower- extremity strength in older adults, suggesting a mechanism for the relationship with lower-extremity disability", "author" : [ { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "De", "family" : "Rekeneire", "given" : "Nathalie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Resnick", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodpaster", "given" : "Bret H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Faulkner", "given" : "Kimberly A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shorr", "given" : "Ronald I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "Tamara B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Geriatrics Society", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "2004-2010", "title" : "Sensory and Motor Peripheral Nerve Function and Lower- Extremity Quadriceps Strength: The Health ABC Study", "type" : "article-journal", "volume" : "57" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1111/jgs.13152", "abstract" : "\u00a9 2014, Copyright the Authors Journal compilation \u00a9 2014, The American Geriatrics Society.", "author" : [ { "dropping-particle" : "", "family" : "Ward", "given" : "Rachel E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boudreau", "given" : "Robert M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caserotti", "given" : "Paolo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "Tamara B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zivkovic", "given" : "Sasa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodpaster", "given" : "Bret H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Satterfield", "given" : "Suzanne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kritchevsky", "given" : "Stephen B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cauley", "given" : "Jane A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Simonsick", "given" : "Eleanor M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Health", "given" : "Aging and Body Composition Study", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the American Geriatrics Society", "id" : "ITEM-2", "issue" : "12", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "2273-2279", "title" : "Sensory and motor peripheral nerve function and incident mobility disability", "type" : "article-journal", "volume" : "62" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^34,53", "plainTextFormattedCitation" : "34,53", "previouslyFormattedCitation" : "^34,53" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }34,53 Future studies in PN function and mobility disability need to include more diverse, generalizable populations. Other risk factors such as presence of knee OA, age and sex differences should continue to be studied to evaluate other contributors to PN impairment. Past prospective studies have indicated important findings on mobility outcomes such as falls and mobility disability from previous studies of sensory and motor nerve impairmentADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1532-5415.2005.00584.x", "ISBN" : "0002-8614 (Print)\\r0002-8614 (Linking)", "ISSN" : "00028614", "PMID" : "16460385", "abstract" : "OBJECTIVES: To examine risk and predictors of motor-performance (MP) decline targeting subjects performing normally at an initial observation. DESIGN: Cohort study. SETTING: A subsample of the Italian Longitudinal Study on Aging (aged 65-84). PARTICIPANTS: One thousand fifty-two subjects (mean age+/-standard deviation = 71+/-5, 69% men) with normal MP at baseline. MEASUREMENTS: Six tests (standing up from a chair, stepping up, tandem walk, standing on one leg, walking speed, and steps turning 180 degrees ) were used to assess MP at baseline and after 3 years. Baseline characteristics were potential predictors of MP decline. RESULTS: Of the 1,052 subjects performing normally at baseline, 166 (15.8%) had declined in MP at follow-up. Older age, female sex, lower education, symptoms of distal symmetrical neuropathy, cognitive impairment without dementia, parkinsonism, heart failure, anemia, depressive symptoms, worse Mini-Mental State Examination score, and lost activities of daily living and instrumental activities of daily living (IADLs) were significantly associated with MP decline in univariate comparisons. Older age (odds ratio (OR) = 3.84, 95% confidence interval (CI) = 2.14-6.88 comparing age classes > or =80 with 65-69), female sex (OR=1.50, 95% CI = 1.03-2.20), distal symmetric neuropathy (OR = 2.00, 95% CI = 1.03-3.87), depressive symptoms (OR = 1.85, 95% CI = 1.17-2.24), and baseline IADLs (OR = 1.22, 95% CI = 1.08-1.37 for each lost activity) independently predicted MP decline after regression analysis. CONCLUSION: In a population-based cohort of elderly people with normal MP, one-sixth declined in 3 years. Age, sex, distal symmetrical neuropathy, depressive symptoms, and baseline IADLs independently predicted this decline. Distal symmetrical neuropathy is underestimated in the clinical and epidemiological evaluation of motor decline in older people.", "author" : [ { "dropping-particle" : "", "family" : "Inzitari", "given" : "Marco", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Carlo", "given" : "Antonio", "non-dropping-particle" : "Di", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Baldereschi", "given" : "Marzia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pracucci", "given" : "Giovanni", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Maggi", "given" : "Stefania", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gandolfo", "given" : "Carlo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bonaiuto", "given" : "Salvatore", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Farchi", "given" : "Gino", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scafato", "given" : "Emanuele", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Carbonin", "given" : "Pierugo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Inzitari", "given" : "Domenico", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the American Geriatrics Society", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2006" ] ] }, "page" : "318-324", "title" : "Risk and predictors of motor-performance decline in a normally functioning population-based sample of elderly subjects: The Italian longitudinal study on aging", "type" : "article-journal", "volume" : "54" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.14336/AD.2015.1127", "ISSN" : "2152-5250", "abstract" : "The objective of this study is to systematically review the relationship between lower-extremity peripheral nerve function and mobility in older adults. The National Library of Medicine (PubMed) was searched on March 23, 2015 with no limits on publication dates. One reviewer selected original research studies of older adults (\u226565 years) that assessed the relationship between lower-extremity peripheral nerve function and mobility-related outcomes. Participants, study design and methods of assessing peripheral nerve impairment were evaluated and results were reported and synthesized. Eight articles were identified, including 6 cross-sectional and 2 longitudinal studies. These articles investigated 6 elderly cohorts (4 from the U.S. and 2 from Italy): 3 community-dwelling (including 1 with only disabled women and 1 without mobility limitations at baseline), 1 with both community-dwelling and institutionalized residents, 1 from a range of residential locations, and 1 of patients with peripheral arterial disease. Mean ages ranged from 71-82 years. Nerve function was assessed by vibration threshold (n=2); sensory measures and clinical signs and symptoms of neuropathy (n=2); motor nerve conduction (n=1); and a combination of both sensory measures and motor nerve conduction (n=3). Each study found that worse peripheral nerve function was related to poor mobility, although relationships varied based on the nerve function measure and mobility domain assessed. Six studies found that the association between nerve function and mobility persisted despite adjustment for diabetes. Evidence suggests that peripheral nerve function impairment at various levels of severity is related to poor mobility independent of diabetes. Relationships varied depending on peripheral nerve measure, which may be particularly important when investigating specific biological mechanisms. Future research needs to identify risk factors for peripheral nerve decline beyond diabetes, especially those common in late-life and modifiable. Interventions to preserve nerve function should be investigated with regard to their effect on postponing or preventing disability in older adults.;", "author" : [ { "dropping-particle" : "", "family" : "Ward", "given" : "Rachel E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caserotti", "given" : "Paolo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cauley", "given" : "Jane A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boudreau", "given" : "Robert M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodpaster", "given" : "Bret H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Aging and Disease", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "466", "title" : "Mobility-Related Consequences of Reduced Lower-Extremity Peripheral Nerve Function with Age: A Systematic Review", "type" : "article-journal", "volume" : "7" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.2337/dc08-0433.A.I.V.", "author" : [ { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rekeneire", "given" : "Schwartz", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V.", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Faulkner", "given" : "Kimberly A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Resnick", "given" : "Helaine E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodpaster", "given" : "Bret H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shorr", "given" : "Ronald I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "Tamara B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Diabetes Care", "id" : "ITEM-3", "issue" : "9", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "1767-1772", "title" : "The Relationship of Reduced Peripheral Nerve Function and Diabetes With Physical Performance in Older White and Black", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^35,47,54", "plainTextFormattedCitation" : "35,47,54", "previouslyFormattedCitation" : "^35,47,54" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }35,47,54. Future prospective studies should examine PN impairment in high-risk subgroups such as those with knee OA. From these studies, we can explore how age and sex-related functional declines and knee OA affect PN function. public health significance Knee OA continues to be burden on the US population in terms of economic costs, limited mobility because of pain, lost productivity, and overall poor health. Furthermore, the link between sensorimotor declines later in life needs to be explored further to gain better understanding. TKR surgery is the most widely used and a best practice for relieving symptoms. However, patients who undergo TKR surgery rarely return to normal function and are subsequently are at risk for mobility limitations and prolonged pain. By studying TKR surgery and PN function in patients with knee OA, we have the opportunity to gain knowledge that may lead to better health outcomes, reduced pain, prescription and exercise recommendations, and higher overall quality of life. objectives The goal of this study is to understand the relationship of the sensory nerves to TKR surgery patients with knee OA using a standard clinical screen for peripheral neuropathy. Specifically, we will determine if impaired monofilament detection is related to the TKR knee vs. the non-TKR knee. The hypothesis is that impaired monofilament detection will be worse in the TKR knee compared to the non-surgical knee. MethodsReCruitmentPatients were recruited directly from University of Pittsburgh Medical Center (UPMC) surgeons who performed the TKRs. Following the surgery, letters were mailed out to patients providing information about the study. Surgeons who participated in recruitment for the study perform more than a thousand TKRs per year and have had success with study recruitment in previous studies. This method was the primary recruitment tool for participants as approximately 80% of all participants for the study were recruited from letters from surgeons. In addition, two research registries were used in the recruitment process. The University of Pittsburgh Clinical and Translational Science Institute (CTSI) Research Registry started in 2006 and has enrolled approximately 33,000 participants. One of the strengths of the registry is that it is reflective of the outreach CTSI has done to be inclusive of minority groups in the local Pittsburgh area. The University of Pittsburgh Pepper Center Registry started by the Claude D. Pepper Older Americans Independence Center includes 2,500 consenting participants and were specifically enrolled by the Pepper Center to reach out to urban neighborhoods with residents of lower socio-economic and minority status. Recruitment from these two registries accounted for approximately 10% of participants.Recruitment was facilitated through media announcements and informational brochures posted at the Vintage Community Senior Center and the Squirrel Hill Jewish Community Center. Both of these locations are participating locations in the study and are designated community senior citizen centers by the Allegheny County Area Agency for Aging. Emails and print announcements from the two community center’s monthly newsletter were also sent out to potential participants. Recruiting through these senior centers accounted for approximately 10% all of participants. All participants were compensated $40 for their participation to offset lost wages and also received free parking. Study populationParticipants enrolled in the study had to be above the age of 60 and have had a recent unilateral TKR surgery, between two to four months prior to the beginning of the study. No exclusions were made based on sex, race, or ethnicity. Due to the higher prevalence of knee OA and TKR in women compared to men (60% vs 40%), female enrollment was emphasized more compared to male recruitment. The participants were part of a larger randomized control trial, which is evaluating the effect of exercise to reduce the burden of physical limitations of patients who undergo TKR. The intervention trial compared usual care following TKR surgery to a clinic-based individual outpatient rehabilitative exercise and a community-based group exercise class. The aims of the parent study was to compare outcomes of physical function and physical activity between the three exercise groups and to identify baseline predictors of functional recovery for the clinical and community based exercise groups.Participants also had to have a Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) score of nine or higher (Appendix I) on the physical function (PF) portion to ensure that participants had a modest amount of functional limitations to be included in the study. The WOMAC index is a disease specific 24-item questionnaire designed to apply a quantitative score on self-reported physical function. The WOMAC has been extensively validated and is the recommended instrument in studies of knee OAADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Bellamy", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Buchanan", "given" : "WV", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goldsmith", "given" : "CH", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Campbell", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stitt", "given" : "LW", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Rheumatol", "id" : "ITEM-1", "issue" : "12", "issued" : { "date-parts" : [ [ "1988" ] ] }, "page" : "1833-40", "title" : "Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee", "type" : "article-journal", "volume" : "15" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁵⁵", "plainTextFormattedCitation" : "55", "previouslyFormattedCitation" : "⁵⁵" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }55. Participants also had to be able to speak English, be willing to be randomized into one of three treatment groups, and have the appropriate medical clearances from their surgeon. Participants were excluded from the study if they had contraindications to exercise training as defined by the American College of Cardiology/American Heart Association standards: History of uncontrolled cardiovascular disease or hypertension, were unable to walk 50 meter without an assistance device, or were unable to comfortably bear weight on both their surgical knee and non-surgical kneeADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "8006116083", "author" : [ { "dropping-particle" : "", "family" : "(ACC)", "given" : "American College of Cardiology", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "(AHA)", "given" : "American Heart Association", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gibbons", "given" : "R J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issue" : "2006", "issued" : { "date-parts" : [ [ "2002" ] ] }, "title" : "ACC/AHA 2002 guideline update for exercise testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing)", "type" : "book" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁵⁶", "plainTextFormattedCitation" : "56", "previouslyFormattedCitation" : "⁵⁶" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }56. Participants were excluded if they reported a history of any muscular disease (eg. muscular dystrophy) or any neurological disorder, which may affect lower body function (eg. Parkinson’s disease, clinical neuropathy, cerebrovascular accidents, multiple sclerosis). Participants who reported regular exercise activity were also excluded from the study. In an effort to maximize adherence, participants were excluded if they had an acute or terminal illness, were planning to have an additional joint replacement surgery (hip or knee) in the next year, or were planning to relocate out of the region within the next year. All study participants who were included in the parent study signed an informed consent document stating that they agreed to be involved in the study and were willing to be randomized into one of three exercise groups. Study measuresMonofilament testingParticipants were tested for touch sensation using a monofilament. The monofilament is a small instrument made of a thin nylon thread that is attached to a pen-like handle (North Coast Medical, Inc.). When applied to a skin surface, the filament tests sensory nerve levels by delivering a standard, calibrated amount of force as the filament buckle into a “C” shape (Figure 2). Pressure is higher for nylon filaments with larger diameters. Three different monofilaments were used for this study: the 5.07 monofilament (delivering a standardized 10-g force), the 4.56 monofilament (providing a standardized 4-g force), and the 4.17 monofilament (providing a standardized force of 1.4-g). The 5.07 monofilament is the standard test for peripheral neuropathyADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1519/JPT.0b013e31820aabe5", "ISBN" : "2152-0895 (Electronic)\\r1539-8412 (Linking)", "ISSN" : "1539-8412", "PMID" : "21937899", "abstract" : "Older persons including those with diabetes are at increased risk for loss of protective sensation in the feet. The 5.07 (10-g) monofilament is recognized as a valid instrument to test for the presence or absence of protective sensation in the foot. Few studies report reliability and no studies report responsiveness for a multisite examination using the 10-g monofilament. The purpose of this study was to determine the responsiveness and reliability for the 10-g monofilament in evaluating protective sensation in the feet.", "author" : [ { "dropping-particle" : "", "family" : "Young", "given" : "Daniel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schuerman", "given" : "Sue", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Flynn", "given" : "Kimberly", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hartig", "given" : "Krista", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moss", "given" : "Danielle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Altenburger", "given" : "Beth", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Geriatric Physical Therapy", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "95-98", "title" : "Reliability and Responsiveness of an 18 Site, 10-g Monofilament Examination for Assessment of Protective Foot Sensation", "type" : "article-journal", "volume" : "34" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁵⁷", "plainTextFormattedCitation" : "57", "previouslyFormattedCitation" : "⁵⁷" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }57 while the 4.56141668523558500Figure 2. Monofilament Testing Procedurehas been used in studies as an intermediate measurement between the 4.17 and 5.07ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1532-5415.2004.52113.x", "ISBN" : "0002-8614 (Print)\\r0002-8614 (Linking)", "ISSN" : "00028614", "PMID" : "14962156", "abstract" : "OBJECTIVES: To define the relationships between lower extremity peripheral arterial disease (PAD), pathophysiological findings in lower extremity muscles and nerves, and lower extremity performance. DESIGN: Cross-sectional. SETTING: Two communities in Italy. PARTICIPANTS: Nine-hundred seventy-nine community-dwelling men and women aged 60 and older (109 with PAD). MEASUREMENTS: Presence and degree of lower extremity arterial obstruction were determined using the ankle-brachial index (ABI). Lower extremity muscle cross-sectional area was measured using computed tomography. Peroneal nerve conduction velocity (NCV) and leg power were also determined. Measures of lower extremity functioning were fast walking speed over 4 meters, time required to walk 400 meters, and the summary performance score. RESULTS: Participants with PAD had significantly poorer performance on functional outcomes than participants without PAD. Adjusting for age and sex, presence of PAD was associated with reduced leg muscle power (83.69 vs 103.51 watts, P<.001), reduced muscle cross-sectional area (61.5 vs 63.5 cm2, P=.14), and reduced NCV (43.0 vs 44.2 m/s, P=.003). Adjustment for leg power diminished the independent association between ABI and the functional outcomes measures. CONCLUSION: In community-dwelling individuals, PAD is associated with reduced NCV and reduced muscle power in the lower extremities. Muscle power may mediate the association between lower ABI levels and poorer functional performance.", "author" : [ { "dropping-particle" : "", "family" : "McDermott", "given" : "Mary Mc Grae", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guralnik", "given" : "Jack M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Albay", "given" : "Monique", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bandinelli", "given" : "Stefania", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Miniati", "given" : "Benedetta", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ferrucci", "given" : "Luigi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the American Geriatrics Society", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2004" ] ] }, "page" : "405-410", "title" : "Impairments of Muscles and Nerves Associated with Peripheral Arterial Disease and Their Relationship with Lower Extremity Functioning: The InCHIANTI Study", "type" : "article-journal", "volume" : "52" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁵⁸", "plainTextFormattedCitation" : "58", "previouslyFormattedCitation" : "⁵⁸" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }58. Monofilament screening has been shown to be reproducibleADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Perkins", "given" : "B A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Olaleye", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zinman", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Diabetes Care", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2001" ] ] }, "page" : "250-256", "title" : "Simple screening tests for peripheral neuropathy in the diabetes clinic", "type" : "article-journal", "volume" : "24" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁵⁹", "plainTextFormattedCitation" : "59", "previouslyFormattedCitation" : "⁵⁹" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }59 and has been shown to predict musculoskeletal outcomes in older adultsADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1532-5415.2009.02487.x.Sensory", "ISBN" : "4123831931", "ISSN" : "1532-5415", "PMID" : "19793163", "abstract" : "Objectives\u2014To determine if sensory and motor nerve function was associated cross-sectionally with quadriceps strength or ankle dorsiflexion strength in an older community-based population. Design, Setting, Participants\u2014Health, Aging, and Body Composition Study participants (N=2059; 50% men; 37% black, aged 73-82 years) in 2000-2001. Intervention\u2014n/aMeasurements\u2014Quadriceps and ankle strength were measured with an isokinetic dynamometer. Sensory and motor peripheral nerve function in the legs/feet was assessed by 10-g and 1.4-g monofilaments, vibration threshold, and peroneal motor nerve conduction amplitude and velocity. Results\u2014Monofilament insensitivity, poorest vibration threshold quartile (>60 ?), and poorest motor nerve conduction amplitude quartile (<1.7 mV) were associated with 11%, 7%, and 8% lower quadriceps strength (all p<0.01), respectively, compared to the best peripheral nerve function categories in adjusted linear regression models. Monofilament insensitivity and lowest amplitude quartile were both associated with 17% lower ankle strength (p<0.01). In multivariate analyses, with monofilament insensitivity (?=-7.19), vibration threshold (?=-0.097), and motor nerve conduction amplitude (?=2.01) in the same model, each contributed independently to lower quadriceps strength (all p<0.01). Monofilament insensitivity (?=-5.29) and amplitude (?=1.17) each contributed independently to lower ankle strength (all p<0.01). Lean mass did not explain the associations of peripheral nerve function with strength. Conclusions\u2014Reduced sensory and motor peripheral nerve function is related to poorer lower- extremity strength in older adults, suggesting a mechanism for the relationship with lower-extremity disability", "author" : [ { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "De", "family" : "Rekeneire", "given" : "Nathalie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Resnick", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodpaster", "given" : "Bret H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Faulkner", "given" : "Kimberly A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shorr", "given" : "Ronald I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "Tamara B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Geriatrics Society", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "2004-2010", "title" : "Sensory and Motor Peripheral Nerve Function and Lower- Extremity Quadriceps Strength: The Health ABC Study", "type" : "article-journal", "volume" : "57" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.exger.2017.04.007", "ISSN" : "1873-6815 (Electronic)", "PMID" : "28442382", "abstract" : "BACKGROUND: Age-related peripheral nervous system (PNS) impairments are highly prevalent in older adults. Although sensorimotor and cardiovascular autonomic function have been shown to be related in persons with diabetes, the nature of the relationship in general community-dwelling older adult populations is unknown. METHODS: Health, Aging and Body Composition participants (n=2399, age=76.5+/-2.9years, 52% women, 38% black) underwent peripheral nerve testing at the 2000/01 clinic visit. Nerve conduction amplitude and velocity were measured at the peroneal motor nerve. Sensory nerve function was assessed with vibration detection threshold and monofilament (1.4-g/10-g) testing at the big toe. Symptoms of lower-extremity peripheral neuropathy were collected by self-report. Cardiovascular autonomic function indicators included postural hypotension, resting heart rate (HR), as well as HR response to and recovery from submaximal exercise testing (400m walk). Multivariable modeling adjusted for demographic/lifestyle factors, medication use and comorbid conditions. RESULTS: In fully adjusted models, poor motor nerve conduction velocity (<40m/s) was associated with greater odds of postural hypotension, (OR=1.6, 95% CI: 1.0-2.5), while poor motor amplitude (<1mV) was associated with 2.3beats/min (p=0.003) higher resting HR. No associations were observed between sensory nerve function or symptoms of peripheral neuropathy and indicators of cardiovascular autonomic function. CONCLUSIONS: Motor nerve function and indicators cardiovascular autonomic function remained significantly related even after considering many potentially shared risk factors. Future studies should investigate common underlying processes for developing multiple PNS impairments in older adults.", "author" : [ { "dropping-particle" : "", "family" : "Lange-Maia", "given" : "Brittney S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jakicic", "given" : "John M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cauley", "given" : "Jane A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boudreau", "given" : "Robert M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Simonsick", "given" : "Eleanor M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Satterfield", "given" : "Suzanne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zivkovic", "given" : "Sasa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "Tamara B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Experimental gerontology", "id" : "ITEM-2", "issue" : "2016", "issued" : { "date-parts" : [ [ "2017" ] ] }, "publisher" : "Elsevier Inc", "title" : "Relationship between sensorimotor peripheral nerve function and indicators of cardiovascular autonomic function in older adults from the Health, Aging and Body composition Study.", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^36,53", "plainTextFormattedCitation" : "36,53", "previouslyFormattedCitation" : "^36,53" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }36,53. Participants were instructed to lay supine with their eyes closed. The monofilament was applied against the dorsum of the big toe surgical knee (SK) and non-surgical knee (NSK) between the nail and knuckle. Participants were tested four times per side, each time asked to indicate if they felt the monofilament. Inability to detect was defined as <3 of 4 touches per side. The protocol begins with the 4.17 monofilament, and if the participants failed to detect three or more touches, they were then tested with the 4.56. If they failed to detect the 4.56 monofilament, they were tested with the 5.07 monofilament. Demographic Characteristics Demographic characteristics such as age, sex, and race/ethnicity were ascertained at baseline via questionnaire. During a clinical examination, participants were screened for their blood pressure, height, weight, and BMI. statistical analysis The statistical approach for this cross-sectional study was to evaluate PN function in participants before the exercise intervention. The study aim of relating monofilament detection in the TKR-knee to the non-operative knee were analyzed through conditional logistic regression. Conditional logistic models were also stratified by sex and age (≤70 and >70) to test for differences based on previous research findings. Studies before have been conducted using conditional logistic regression for adults suffering from knee OAADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1136/bmj.b2844", "ISBN" : "1468-5833 (Electronic)\\r0959-535X (Linking)", "ISSN" : "1756-1833", "PMID" : "19700505", "abstract" : "OBJECTIVE: To examine the relation of radiographic features of osteoarthritis to knee pain in people with knees discordant for knee pain in two cohorts. DESIGN: Within person, knee matched, case-control study. SETTING AND PARTICIPANTS: Participants in the Multicenter Osteoarthritis (MOST) and Framingham Osteoarthritis studies who had knee radiographs and assessments of knee pain. MAIN OUTCOME MEASURES: Association of each pain measure (frequency, consistency, and severity) with radiographic osteoarthritis, as assessed by Kellgren and Lawrence grade (0-4) and osteophyte and joint space narrowing grades (0-3) among matched sets of two knees within individual participants whose knees were discordant for pain status. RESULTS: 696 people from MOST and 336 people from Framingham were included. Kellgren and Lawrence grades were strongly associated with frequent knee pain-for example, for Kellgren and Lawrence grade 4 v grade 0 the odds ratio for pain was 151 (95% confidence interval 43 to 526) in MOST and 73 (16 to 331) in Framingham (both P<0.001 for trend). Similar results were also seen for the relation of Kellgren and Lawrence scores to consistency and severity of knee pain. Joint space narrowing was more strongly associated with each pain measure than were osteophytes. CONCLUSIONS: Using a method that minimises between person confounding, this study found that radiographic osteoarthritis and individual radiographic features of osteoarthritis were strongly associated with knee pain.", "author" : [ { "dropping-particle" : "", "family" : "Neogi", "given" : "Tuhina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Felson", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Niu", "given" : "Jingbo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nevitt", "given" : "Michael C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lewis", "given" : "Cora E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Aliabadi", "given" : "Piran", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sack", "given" : "Burt", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Torner", "given" : "James", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bradley", "given" : "Lawrence", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zhang", "given" : "Yuqing", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMJ (Clinical research ed.)", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "b2844", "title" : "Association between radiographic features of knee osteoarthritis and pain: results from two cohort studies.", "type" : "article-journal", "volume" : "339" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "⁶⁰", "plainTextFormattedCitation" : "60", "previouslyFormattedCitation" : "⁶⁰" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }60. All analyses were performed using SAS version 9.4 (SAS institute, Cary, NC). ResultsA total of 143 participants were enrolled for baseline testing. Participants were excluded from analyses if they did not have TKR and non-TKR sides tested, not having test results for both sides, or refusing to have testing done on both knees (N=17), leaving 126 participants who underwent monofilament testing on both knees at baseline and were included in the analysis. Participants were 63.5% women, mean age 69.8±6.5 years, had a mean WOMAC-PF score of 20.1±7.8, and a mean BMI of 31.29±5.8 kg/m2. Monofilament insensitivity between the TKR knee and non-surgical knee (NSK) respectively were as follows: 31.8% vs. 29.4% for 1.4-g monofilament, 15.9% vs. 15.1% for 4-g monofilament, and 8.7% vs 10.3% for 10-g monofilament (Figure 3). All differences between TKR and non-TKR knees were non-significant (p>0.05). Conditional logistic regression odds ratios are as follows: OR=1.30 (95% CI: 0.57 - 3.00) for 1.4-g, OR=1.20 (95% CI: 0.39 - 3.50) for 4-g and OR=0.50 (95% CI: 0.09 - 2.70) for 10-g monofilament (Figure 4). Although not significant, the odds of monofilament insensitivity in the TKR knee were 1.3 and 1.2 times higher for the 1.2-g and 1.4-g monofilament, respectively. Interestingly, the 10-g monofilament had a protective effect in regards to TKR, with the odds of monofilament insensitivity being 50% lower in the TKR-knee. After stratifying by sex, neither males nor females showed differences in monofilament detection. Conditional logistic models for females only models were OR=2.25 (95% CI: 0.69 – 7.31) for 1.4g and OR=1.50 (95% CI: 0.25 – 8.98) for 4-g monofilament (Figure 5). 10-g monofilament detection could not be analyzed due to small sample size for women. Stratified by males, conditional logistic models resulted in OR=0.67 (95% CI: 0.19 – 2.36) for 1.4-g, OR=1.00 (95% CI: 0.25 – 4.00) for 4-g, and OR=0.25 (95% CI: 0.03 – 2.24) for 10-g (Figure 6). Models were also stratified by age for those younger than and older than 70. For those 70 or younger, conditional logistic regression models were OR=1.40 (95% CI: 0.44 – 4.41) for 1.4g, OR=1.00 (95% CI: 0.20 – 4.95) for 4-g, and OR=1.00 (95% CI: 0.06 – 15.99) for 10-g monofilament (Figure 7). For those over 70 years of age, logistic models were as follows: OR=1.20 (95% CI: 0.37 – 3.93) for 1.4-g, OR=1.33 (95% CI: 0.30 – 5.96) for 4-g, and OR=0.33 (95% CI: 0.04 – 3.21) for 10-g monofilament (Figure 8). DiscussionThe purpose of this study was to describe sensory nerve impairments in patients with knee OA who have undergone unilateral TKR surgery. Results from this study show that monofilament insensitivity remains highly prevalent in both the TKR knee and the NSK, though monofilament detection was similar in both knees. Factoring in age and sex into conditional logistic regression analyses between TKR and non-TKR knees did not attenuate overall results. Overall, the findings of the study did not support that impaired monofilament detection was worse in the TKR knee compared to the NSK. For monofilament insensitivity, knee OA rather than the TKR surgery may by more responsible for PN impairments.Monofilament testing of sensory nerve function have not often been done in older populations with and without diabetes. In Health ABC, 1.4-g monofilament insensitivity was 36.8% and 10-g monofilament insensitivity was 8.9%ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.exger.2017.04.007", "ISSN" : "1873-6815 (Electronic)", "PMID" : "28442382", "abstract" : "BACKGROUND: Age-related peripheral nervous system (PNS) impairments are highly prevalent in older adults. Although sensorimotor and cardiovascular autonomic function have been shown to be related in persons with diabetes, the nature of the relationship in general community-dwelling older adult populations is unknown. METHODS: Health, Aging and Body Composition participants (n=2399, age=76.5+/-2.9years, 52% women, 38% black) underwent peripheral nerve testing at the 2000/01 clinic visit. Nerve conduction amplitude and velocity were measured at the peroneal motor nerve. Sensory nerve function was assessed with vibration detection threshold and monofilament (1.4-g/10-g) testing at the big toe. Symptoms of lower-extremity peripheral neuropathy were collected by self-report. Cardiovascular autonomic function indicators included postural hypotension, resting heart rate (HR), as well as HR response to and recovery from submaximal exercise testing (400m walk). Multivariable modeling adjusted for demographic/lifestyle factors, medication use and comorbid conditions. RESULTS: In fully adjusted models, poor motor nerve conduction velocity (<40m/s) was associated with greater odds of postural hypotension, (OR=1.6, 95% CI: 1.0-2.5), while poor motor amplitude (<1mV) was associated with 2.3beats/min (p=0.003) higher resting HR. No associations were observed between sensory nerve function or symptoms of peripheral neuropathy and indicators of cardiovascular autonomic function. CONCLUSIONS: Motor nerve function and indicators cardiovascular autonomic function remained significantly related even after considering many potentially shared risk factors. Future studies should investigate common underlying processes for developing multiple PNS impairments in older adults.", "author" : [ { "dropping-particle" : "", "family" : "Lange-Maia", "given" : "Brittney S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jakicic", "given" : "John M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cauley", "given" : "Jane A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boudreau", "given" : "Robert M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Simonsick", "given" : "Eleanor M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Satterfield", "given" : "Suzanne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zivkovic", "given" : "Sasa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "Tamara B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Experimental gerontology", "id" : "ITEM-1", "issue" : "2016", "issued" : { "date-parts" : [ [ "2017" ] ] }, "publisher" : "Elsevier Inc", "title" : "Relationship between sensorimotor peripheral nerve function and indicators of cardiovascular autonomic function in older adults from the Health, Aging and Body composition Study.", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁶", "plainTextFormattedCitation" : "36", "previouslyFormattedCitation" : "³⁶" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }36. The 4-g intermediate monofilament was not used for this study. Compared to our results, monofilament insensitivity is similar for 10-g and slightly lower for 1.4-g. This may be explained by age of participants for Health ABC vs. the current analyses. The median age of participants was 76.5±2.9 where our median age was lower at 69.8±6.5. This age difference is important due to previous research indicating higher PN impairment levels as individuals ageADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Gregg", "given" : "Edward W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sorlie", "given" : "Paul", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Paulose-Ram", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gu", "given" : "Q", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Eberhardt", "given" : "MS", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wolz", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Burt", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Curtin", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Engelgau", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Geiss", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Diabetes Care", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2004" ] ] }, "page" : "1591-1597", "title" : "Prevalence of Lower-Extremity Disease in the U . S . Adult Population \u2265 40 Years of Age with and without diabetes: 1999-2000 National Health and Nutrition Examination Survey", "type" : "article-journal", "volume" : "27" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "³⁸", "plainTextFormattedCitation" : "38", "previouslyFormattedCitation" : "³⁸" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }38. More research is needed in diverse older adult populations to determine prevalence of sensory nerve loss. This study also adds to the literature of monofilament testing in populations that includes older adults with diabetes.One of the main strengths of this study is that it contributes to research evaluating the role PN impairment has on knee OA has on older populations. More research in this area is needed to answer important questions such as whether PN impairments are reversible in knee OA. Monofilament testing is an affordable, reliable testing instrumentADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.exger.2017.04.007", "ISSN" : "1873-6815 (Electronic)", "PMID" : "28442382", "abstract" : "BACKGROUND: Age-related peripheral nervous system (PNS) impairments are highly prevalent in older adults. Although sensorimotor and cardiovascular autonomic function have been shown to be related in persons with diabetes, the nature of the relationship in general community-dwelling older adult populations is unknown. METHODS: Health, Aging and Body Composition participants (n=2399, age=76.5+/-2.9years, 52% women, 38% black) underwent peripheral nerve testing at the 2000/01 clinic visit. Nerve conduction amplitude and velocity were measured at the peroneal motor nerve. Sensory nerve function was assessed with vibration detection threshold and monofilament (1.4-g/10-g) testing at the big toe. Symptoms of lower-extremity peripheral neuropathy were collected by self-report. Cardiovascular autonomic function indicators included postural hypotension, resting heart rate (HR), as well as HR response to and recovery from submaximal exercise testing (400m walk). Multivariable modeling adjusted for demographic/lifestyle factors, medication use and comorbid conditions. RESULTS: In fully adjusted models, poor motor nerve conduction velocity (<40m/s) was associated with greater odds of postural hypotension, (OR=1.6, 95% CI: 1.0-2.5), while poor motor amplitude (<1mV) was associated with 2.3beats/min (p=0.003) higher resting HR. No associations were observed between sensory nerve function or symptoms of peripheral neuropathy and indicators of cardiovascular autonomic function. CONCLUSIONS: Motor nerve function and indicators cardiovascular autonomic function remained significantly related even after considering many potentially shared risk factors. Future studies should investigate common underlying processes for developing multiple PNS impairments in older adults.", "author" : [ { "dropping-particle" : "", "family" : "Lange-Maia", "given" : "Brittney S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jakicic", "given" : "John M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cauley", "given" : "Jane A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boudreau", "given" : "Robert M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Simonsick", "given" : "Eleanor M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Satterfield", "given" : "Suzanne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zivkovic", "given" : "Sasa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "Tamara B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Experimental gerontology", "id" : "ITEM-1", "issue" : "2016", "issued" : { "date-parts" : [ [ "2017" ] ] }, "publisher" : "Elsevier Inc", "title" : "Relationship between sensorimotor peripheral nerve function and indicators of cardiovascular autonomic function in older adults from the Health, Aging and Body composition Study.", "type" : "article-journal" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1111/j.1532-5415.2009.02487.x.Sensory", "ISBN" : "4123831931", "ISSN" : "1532-5415", "PMID" : "19793163", "abstract" : "Objectives\u2014To determine if sensory and motor nerve function was associated cross-sectionally with quadriceps strength or ankle dorsiflexion strength in an older community-based population. Design, Setting, Participants\u2014Health, Aging, and Body Composition Study participants (N=2059; 50% men; 37% black, aged 73-82 years) in 2000-2001. Intervention\u2014n/aMeasurements\u2014Quadriceps and ankle strength were measured with an isokinetic dynamometer. Sensory and motor peripheral nerve function in the legs/feet was assessed by 10-g and 1.4-g monofilaments, vibration threshold, and peroneal motor nerve conduction amplitude and velocity. Results\u2014Monofilament insensitivity, poorest vibration threshold quartile (>60 ?), and poorest motor nerve conduction amplitude quartile (<1.7 mV) were associated with 11%, 7%, and 8% lower quadriceps strength (all p<0.01), respectively, compared to the best peripheral nerve function categories in adjusted linear regression models. Monofilament insensitivity and lowest amplitude quartile were both associated with 17% lower ankle strength (p<0.01). In multivariate analyses, with monofilament insensitivity (?=-7.19), vibration threshold (?=-0.097), and motor nerve conduction amplitude (?=2.01) in the same model, each contributed independently to lower quadriceps strength (all p<0.01). Monofilament insensitivity (?=-5.29) and amplitude (?=1.17) each contributed independently to lower ankle strength (all p<0.01). Lean mass did not explain the associations of peripheral nerve function with strength. Conclusions\u2014Reduced sensory and motor peripheral nerve function is related to poorer lower- extremity strength in older adults, suggesting a mechanism for the relationship with lower-extremity disability", "author" : [ { "dropping-particle" : "", "family" : "Strotmeyer", "given" : "Elsa S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "De", "family" : "Rekeneire", "given" : "Nathalie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Schwartz", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Resnick", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodpaster", "given" : "Bret H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Faulkner", "given" : "Kimberly A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shorr", "given" : "Ronald I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vinik", "given" : "Aaron I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "Tamara B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Geriatrics Society", "id" : "ITEM-2", "issue" : "11", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "2004-2010", "title" : "Sensory and Motor Peripheral Nerve Function and Lower- Extremity Quadriceps Strength: The Health ABC Study", "type" : "article-journal", "volume" : "57" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^36,53", "plainTextFormattedCitation" : "36,53", "previouslyFormattedCitation" : "^36,53" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }36,53 that may be a useful indicator of both subclinical and protective sensation in other older populations with chronic diseases such as knee OA. In addition, this study is the first to our knowledge to look at PN function and TKR surgery in adults with knee OA. With the prevalence of knee OA and TKR surgeries expected to riseADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Centers for Disease Control and Prevention (CDC)", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "MMWR", "id" : "ITEM-1", "issue" : "16", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "421-6", "title" : "Prevalence and Most Common Causes of Disability Among Adults - United States, 2005", "type" : "article-journal", "volume" : "58" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1007/s00330-015-3977-8", "ISBN" : "0938-7994", "ISSN" : "14321084", "PMID" : "26376884", "abstract" : "OBJECTIVE: To evaluate whether change in fixed-location measures of radiographic joint space width (JSW) and cartilage thickness by MRI predict knee replacement. METHODS: Knees replaced between 36 and 60 months' follow-up in the Osteoarthritis Initiative were each matched with one control by age, sex and radiographic status. Radiographic JSW was determined from fixed flexion radiographs and subregional femorotibial cartilage thickness from 3 T MRI. Changes between the annual visit before replacement (T0) and 2 years before T0 (T-2) were compared using conditional logistic regression. RESULTS: One hundred and nineteen knees from 102 participants (55.5 % women; age 64.2 +/- 8.7 [mean +/- SD] years) were studied. Fixed-location JSW change at 22.5 % from medial to lateral differed more between replaced and control knees (case-control [cc] OR = 1.57; 95 % CI: 1.23-2.01) than minimum medial JSW change (ccOR = 1.38; 95 % CI: 1.11-1.71). Medial femorotibial cartilage loss displayed discrimination similar to minimum JSW, and central tibial cartilage loss similar to fixed-location JSW. Location-independent thinning and thickening scores were elevated prior to knee replacement. CONCLUSIONS: Discrimination of structural progression between knee pre-placement cases versus controls was stronger for fixed-location than minimum radiographic JSW. MRI displayed similar discrimination to radiography and suggested greater simultaneous cartilage thickening and loss prior to knee replacement. KEY POINTS: * Fixed-location JSW predicts surgical knee replacement more strongly than minimum JSW. * MRI predicts knee replacement with similar accuracy to radiographic JSW. * MRI reveals greater cartilage thinning and thickening prior to knee replacement", "author" : [ { "dropping-particle" : "", "family" : "Eckstein", "given" : "Felix", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boudreau", "given" : "Robert", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wang", "given" : "Zhijie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hannon", "given" : "Michael J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Duryea", "given" : "Jeff", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wirth", "given" : "Wolfgang", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cotofana", "given" : "Sebastian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guermazi", "given" : "Ali", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roemer", "given" : "Frank", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nevitt", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "John", "given" : "Markus R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ladel", "given" : "Christoph", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sharma", "given" : "Leena", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hunter", "given" : "David J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kwoh", "given" : "C. Kent", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "European Radiology", "id" : "ITEM-2", "issue" : "6", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "1942-1951", "title" : "Comparison of radiographic joint space width and magnetic resonance imaging for prediction of knee replacement: A longitudinal case-control study from the Osteoarthritis Initiative", "type" : "article-journal", "volume" : "26" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^1,23", "plainTextFormattedCitation" : "1,23", "previouslyFormattedCitation" : "^1,23" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1,23, it is important to understand the underlying sensory nerve impairments in these populations to ensure patients who undergo TKR surgery are able to regain maximum function and quality of life. This study also was generalizable to a population affected by knee OA who underwent TKR. Participants recruited from UPMC represent a large, diverse surgery population of high-risk older adults. This research also looked at the effects on an age gradient and how sex differences have an effect on PN impairment and knee OA which is needed based on previous research findingsADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Gregg", "given" : "Edward W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sorlie", "given" : "Paul", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Paulose-Ram", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gu", "given" : "Q", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Eberhardt", "given" : "MS", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wolz", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Burt", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Curtin", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Engelgau", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Geiss", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Diabetes Care", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2004" ] ] }, "page" : "1591-1597", "title" : "Prevalence of Lower-Extremity Disease in the U . S . Adult Population \u2265 40 Years of Age with and without diabetes: 1999-2000 National Health and Nutrition Examination Survey", "type" : "article-journal", "volume" : "27" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Newman", "given" : "Anne B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brach", "given" : "JS", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Epidemiol Rev.", "id" : "ITEM-2", "issue" : "2", "issued" : { "date-parts" : [ [ "2001" ] ] }, "page" : "343-50", "title" : "Gender gap in longevity and disability in older persons.", "type" : "article-journal", "volume" : "23" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "1471-2318-8-21 [pii]\\r10.1186/1471-2318-8-21", "ISBN" : "1471-2318 (Electronic)\\r1471-2318 (Linking)", "PMID" : "18727832", "abstract" : "BACKGROUND: Fracture after falling has been identified as an important problem in public health. Most studies of risk factors for fractures due to falls have been carried out in developed countries, although the size of the elderly population is increasing fast in middle income countries. The objective of this paper is to identify risk factors for fall related to severe fractures in those aged 60 or more in a middle-income country. METHODS: A case-control study was carried out in Rio de Janeiro-Brazil based general hospitals between 2002-2003. Two hundred-fifty hospitalised cases of fracture were matched with 250 community controls by sex, age group and living area. Data were collected for socio-demographic variables, health status and drugs used before the fall. A conditional logistic regression model was fitted to identify variables associated with the risk of fall related severe fracture. RESULTS: Low body mass index, cognitive impairment, stroke and lack of urine control were associated with increased risk of severe fall related fractures. Benzodiazepines and muscle relaxants were also related to an increased risk of severe fractures while moderate use of alcohol was associated with reduced risk. CONCLUSION: Although the association between benzodiazepines and fractures due to fall has been consistently demonstrated for old people, this has not been the case for muscle relaxant drugs. The decision to prescribe muscle relaxants for elderly people should take into account the risk of severe fracture associated with these drugs.", "author" : [ { "dropping-particle" : "", "family" : "Coutinho", "given" : "E S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fletcher", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Bloch", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rodrigues", "given" : "L C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMC Geriatr", "id" : "ITEM-3", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "21", "title" : "Risk factors for falls with severe fracture in elderly people living in a middle-income country: a case control study", "type" : "article-journal", "volume" : "8" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1093/gerona/54.1.M44", "ISSN" : "1079-5006", "PMID" : "10026662", "abstract" : "BACKGROUND: Previous work has found that healthy older men were significantly less able than young male adults to recover balance by taking a single rapid step upon sudden release from forward leans. In light of the higher rates of falls and fall-related injuries among older women compared to older men, we hypothesized that healthy older women would perform more poorly than either female young adults or older men in this test of abilities to recover balance rapidly. METHODS: Ten young (mean age 25.0 years) and 10 older (73.7 years) healthy women were released from forward leans and instructed to regain standing balance by taking a single step forward. The lean angle was incrementally increased from its smallest value, approximately 14 degrees, until the subject failed to regain balance as instructed. Lower extremity kinematics were measured, and findings were compared with those of the earlier study of healthy young and old men. RESULTS: Five of the 10 older women could not recover balance with a single step after release from the smallest of the imposed forward leans. For the 5 older women who succeeded in recovering as instructed from at least one lean, the mean maximum lean angle was significantly smaller than that for young women (16.2 degrees vs 30.7 degrees, p < .001) or older men (16.2 degrees vs 23.9 degrees, p = .014). In contrast, there was no significant difference in mean maximum lean angle between female and male young adults. CONCLUSIONS: Healthy older women, compared to either young women or older men, were significantly less able to recover balance by taking a single rapid step during a forward fall. The decreased abilities of older women appeared to result from limitations in the maximum speeds at which they moved their swing foot during recovery.", "author" : [ { "dropping-particle" : "", "family" : "Wojcik", "given" : "L a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thelen", "given" : "D. G.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schultz", "given" : "a. B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ashton-Miller", "given" : "J. a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Alexander", "given" : "N. B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The journals of gerontology. Series A, Biological sciences and medical sciences", "id" : "ITEM-4", "issue" : "1", "issued" : { "date-parts" : [ [ "1999" ] ] }, "page" : "M44-M50", "title" : "Age and gender differences in single-step recovery from a forward fall.", "type" : "article-journal", "volume" : "54" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "^{38,61\u201363}", "plainTextFormattedCitation" : "38,61\u201363", "previouslyFormattedCitation" : "^{38,61\u201363}" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }38,61–63.Our study had some limitations, namely tests that detect more sensitive PN decline were not done to further elucidate the relationship of PN function and TKR surgery. Only monofilament testing was included to assess sensory nerve function. Tests such as nerve conduction studies should be included in testing in the future to measure both motor and sensory nerve changes that occur after TKR surgery. Examining both motor and sensory nerve changes is important to determine etiology in this population. In addition, tests such as vibration detection threshold should also be included as an additional way to test sensory nerve function. Future studies should include OA duration in order to give detail to how this may affect PN changes. Higher duration of knee OA may lead to higher PN impairment, although further research in needed. Finally, clinical indicators of physical performance decline such as gait speed decline should be included in future studies of knee OA and PN decline. Examining these changes will be important to determine how important mobility outcomes such as walking speed is affected by PN impairment. The next step of this ancillary study is to conduct a prospective exercise intervention to examine whether exercise can reduce mobility limitations and PN decline in knee OA patients. Sensory PN impairments in older populations with knee OA remains an understudied topic, though should be further examined to reduce mobility limitations and lower risk of other health outcomes such as falls. The public health implications from this research include addressing mobility limitations among the older populations with chronic conditions, health outcomes following TKR surgery, and quality of life for adults throughout the aging process. -26733530480000center0Table 1. Results of Studies Used in Literature Review Examining PN Function in Older Adults (N=9)0Table 1. Results of Studies Used in Literature Review Examining PN Function in Older Adults (N=9)-42227557213500-571500381000Figure 3. Monofilament Insensitivity Comparison for TKR vs NSK5321307747000Figure 4. Conditional Logistic Regression for Monofilament Insensitivity between Discordant Knees TKR vs. NSK266700111442500Figure SEQ Figure \* ARABIC 5. Conditional Logistic Regression for Monofilament Insensitivity between Discordant KneesTKR vs. NSK (Females)2667003695700Figure 6. Conditional Logistic Regression for Monofilament Insensitivity between Discordant Knees TKR vs. NSK (Males)00Figure 6. Conditional Logistic Regression for Monofilament Insensitivity between Discordant Knees TKR vs. NSK (Males)16192542164000037338000Figure 7. Conditional Logistic Regression for Monofilament Insensitivity between Discordant Knees TKR vs. NSK (≤70)03679190Figure 8. Conditional Logistic Regression for Monofilament Insensitivity between Discordant KneesTKR vs. NSK (>70)0Figure 8. Conditional Logistic Regression for Monofilament Insensitivity between Discordant KneesTKR vs. NSK (>70)037465000 – WOMAC OSTEOARTHRITIS INDEXWestern Ontario and McMaster Universities (WOMAC) Osteoarthritis Index Section AINSTRUCTIONS TO PATIENTSThe following questions concern the amount of pain you have experienced due to arthritis in your knee joint(s). For each situation please enter the amount of pain experienced in the last 48 hours. (Please mark your answers with and “X”.)QUESTION: How much pain do you have?Walking on a flat surface.NoneMildModerateSevereExtreme□□□□□Going up or down stairs. NoneMildModerateSevereExtreme□□□□□At night while in bed. NoneMildModerateSevereExtreme□□□□□Sitting or lying. NoneMildModerateSevereExtreme□□□□□Standing upright. NoneMildModerateSevereExtreme□□□□□Section BINSTRUCTIONS TO PATIENTSThe following questions concern the amount of joint stiffness (not pain) you have experienced in the last 48 hours in your knee joint(s). Stiffness is a sensation of restriction or slowness in the ease with which you move your joints. (Please mark your answers with and “X”.)How severe is your stiffness after first wakening in the morning? NoneMildModerateSevereExtreme□□□□□How severe is your stiffness after sitting, lying or resting later in the day?NoneMildModerateSevereExtreme□□□□□Section CINSTRUCTIONS TO PATIENTSThe following questions concern your physical function. By this we mean your ability to move around and to look after yourself. For each of the following activities, please indicate the degree of difficulty you have experienced in the last 48 hours due to arthritis in you knee joint(s). (Please mark your answers with and “X”.)QUESTION: What degree of difficulty do you have?Descending stairs. NoneMildModerateSevereExtreme□□□□□Ascending stairs. NoneMildModerateSevereExtreme□□□□□Rising from sitting. NoneMildModerateSevereExtreme□□□□□Standing. NoneMildModerateSevereExtreme□□□□□Bending to floor. NoneMildModerateSevereExtreme□□□□□Walking on flat. NoneMildModerateSevereExtreme□□□□□Getting in/out of car. NoneMildModerateSevereExtreme□□□□□Going shopping.NoneMildModerateSevereExtreme□□□□□Putting on socks/stockings. NoneMildModerateSevereExtreme□□□□□Rising from bed. NoneMildModerateSevereExtreme□□□□□Taking off socks/stockings. NoneMildModerateSevereExtreme□□□□□Lying in bed. NoneMildModerateSevereExtreme□□□□□Getting in/out of bath. NoneMildModerateSevereExtreme□□□□□Sitting. NoneMildModerateSevereExtreme□□□□□Getting on/off toilet. NoneMildModerateSevereExtreme□□□□□Heavy domestic duties. NoneMildModerateSevereExtreme□□□□□Light domestic duties. NoneMildModerateSevereExtreme□□□□□bibliographyADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY 1. Centers for Disease Control and Prevention (CDC). Prevalence and Most Common Causes of Disability Among Adults - United States, 2005. MMWR. 2009;58(16):421-426. . Heidari B. prevalence, risk factors, pathogenesis and features: Part I. Casp J Intern Med. 2011;2(2):205-212.3. Conaghan PG, Peloso PM, Everett S V., et al. 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Adult Population ≥ 40 Years of Age with and without diabetes: 1999-2000 National Health and Nutrition Examination Survey. Diabetes Care. 2004;27(7):1591-1597.39. Robinson LR, Rubner DE, Wahl PW, Fujimoto WY, Stolov WC. Influences of height and gender on normal nerve conduction studies. Arch Phys Med Rehabil. 1993;74(11):1134-1138. . Norbury R, Cutter WJ, Compton J, et al. The neuroprotective effects of estrogen on the aging brain. Exp Gerontol. 2003;38:109-117. doi:S0531556502001663 [pii].41. Baldereschi M, Inzitari M, Di Carlo A, Farchi G, Scafato E, Inzitari D. Epidemiology of distal symmetrical neuropathies in the Italian elderly. Neurology. 2007;68(18):1460-1467. doi:10.1212/01.wnl.0000260606.36443.29.42. Bennell KL, Hinman RS, Metcalf BR, et al. Relationship of knee joint proprioception to pain and disability in individuals with knee osteoarthritis. J Orthop Res. 2003;21(5):792-797. doi:10.1016/S0736-0266(03)00054-8.43. Hall MC. 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