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Predictors of Exercise Adherence in Patients With Meniscal Tear and Osteoarthritis

  • Yetsa A. Tuakli-Wosornu
    Affiliations
    Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

    Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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  • Faith Selzer
    Affiliations
    Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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  • Elena Losina
    Affiliations
    Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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  • Jeffrey N. Katz
    Correspondence
    Corresponding author Jeffrey N. Katz, MD, MS, Director, Orthopaedic and Arthritis Center for Outcomes Research, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis St, PBB-B3, Boston, MA 02115.
    Affiliations
    Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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      Abstract

      Objective

      To identify predictors of poor exercise adherence in patients with osteoarthritis (OA) and meniscal tear.

      Design

      Secondary analysis of data gathered over the first 12 weeks in the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial, a multicenter, randomized controlled trial.

      Setting

      Seven referral centers.

      Participants

      Most of the patients in the MeTeOR trial (N=325 of 351) were included in the analysis, each of whom was aged ≥45 years and had a meniscal tear and osteoarthritic changes on imaging studies; 26 were excluded because of missing data from which to derive the primary outcome variable.

      Interventions

      All patients received a structured, supervised exercise program focused on strengthening, along with prescribed home exercises; half were randomly assigned to also receive arthroscopic partial meniscectomy.

      Main Outcome Measure

      Poor exercise adherence through 12 weeks, defined as performing <50% of prescribed exercise.

      Results

      Thirty-eight percent of the MeTeOR cohort showed poor exercise adherence. In the multivariate model, adjusting for treatment group, those who earned ≤$29,000 per year had 1.64 times the risk of nonadherence (95% confidence interval [CI], 1.10–2.43) than those who earned >$100,000 per year; and those without baseline pain with pivoting and twisting had 1.60 times greater risk of nonadherence than those with these symptoms (95% CI, 1.14–2.25).

      Conclusions

      Low income was associated with poor exercise adherence among patients aged ≥45 years with OA and a meniscal tear, as was absence of pain with pivoting and twisting. Our findings highlight the need for further research into exercise adherence and for interventions to enhance adherence among those with low incomes.

      Keywords

      List of abbreviations:

      APM (arthroscopic partial meniscectomy), CI (confidence interval), MeTeOR (Meniscal Tear in Osteoarthritis Research), MRI (magnetic resonance imaging), OA (osteoarthritis), PT (physical therapy), SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey)
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      References

        • Cross M.
        • Smith E.
        • Hoy D.
        • et al.
        The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study.
        Ann Rheum Dis. 2014; 73: 1323-1330
        • Glyn-Jones S.
        • Palmer A.J.
        • Agricola R.
        • et al.
        Osteoarthritis.
        Lancet. 2015; 386: 376-387
        • March L.
        • Smith E.U.
        • Hoy D.G.
        • et al.
        Burden of disability due to musculoskeletal (MSK) disorders.
        Best Pract Res Clin Rheumatol. 2014; 28: 353-366
        • Jevsevar D.S.
        • Brown G.A.
        • Jones D.L.
        • et al.
        The American Academy of Orthopaedic Surgeons evidence-based guideline on: treatment of osteoarthritis of the knee, 2nd edition.
        J Bone Joint Surg Am. 2013; 95: 1885-1886
        • Fernandes L.
        • Hagen K.B.
        • Bijlsma J.W.
        • et al.
        EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis.
        Ann Rheum Dis. 2013; 72: 1125-1135
        • Hochberg M.C.
        • Altman R.D.
        • April K.T.
        • et al.
        American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee.
        Arthritis Care Res (Hoboken). 2012; 64: 465-474
        • McAlindon T.E.
        • Bannuru R.R.
        • Sullivan M.C.
        • et al.
        OARSI guidelines for the non-surgical management of knee osteoarthritis.
        Osteoarthritis Cartilage. 2014; 22: 363-388
        • Musumeci G.
        • Aiello F.C.
        • Szychlinska M.A.
        • Di Rosa M.
        • Castrogiovanni P.
        • Mobasheri A.
        Osteoarthritis in the XXIst century: risk factors and behaviours that influence disease onset and progression.
        Int J Mol Sci. 2015; 16: 6093-6112
        • Prieto-Alhambra D.
        • Judge A.
        • Javaid M.K.
        • Cooper C.
        • Diez-Perez A.
        • Arden N.K.
        Incidence and risk factors for clinically diagnosed knee, hip and hand osteoarthritis: influences of age, gender and osteoarthritis affecting other joints.
        Ann Rheum Dis. 2014; 73: 1659-1664
        • Kim S.
        • Bosque J.
        • Meehan J.P.
        • Jamali A.
        • Marder R.
        Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006.
        J Bone Joint Surg Am. 2011; 93: 994-1000
        • Caspersen C.J.
        • Powell K.E.
        • Christenson G.M.
        Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research.
        Public Health Rep. 1985; 100: 126-131
        • Bennell K.
        • Hinman R.S.
        • Wrigley T.V.
        • Creaby M.W.
        • Hodges P.
        Exercise and osteoarthritis: cause and effects.
        Compr Physiol. 2011; 1: 1943-2008
        • Campbell R.
        • Evans M.
        • Tucker M.
        • Quilty B.
        • Dieppe P.
        • Donovan J.L.
        Why don't patients do their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee.
        J Epidemiol Community Health. 2001; 55: 132-138
        • Ettinger Jr., W.H.
        • Burns R.
        • Messier S.P.
        • et al.
        A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST).
        JAMA. 1997; 277: 25-31
        • Herrlin S.
        • Hållander M.
        • Wange P.
        • Weidenhielm L.
        • Werner S.
        Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial.
        Knee Surg Sports Traumatol Arthrosc. 2007; 15: 393-401
        • Herrlin S.V.
        • Wange P.O.
        • Lapidus G.
        • Hållander M.
        • Werner S.
        • Weidenhielm L.
        Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up.
        Knee Surg Sports Traumatol Arthrosc. 2013; 21: 358-364
        • Katz J.N.
        • Brophy R.H.
        • Chaisson C.E.
        • et al.
        Surgery versus physical therapy for a meniscal tear and osteoarthritis.
        N Engl J Med. 2013; 368 ([published erratum appears in N Engl J Med 2013;369:683]): 1675-1684
        • Pisters M.F.
        • Veenhof C.
        • Schellevis F.G.
        • Twisk J.W.
        • Dekker J.
        • De Bakker D.H.
        Exercise adherence improving long-term patient outcome in patients with osteoarthritis of the hip and/or knee.
        Arthritis Care Res (Hoboken). 2010; 62: 1087-1094
        • Pisters M.F.
        • Veenhof C.
        • van Meeteren N.L.
        • et al.
        Long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review.
        Arthritis Rheum. 2007; 57: 1245-1253
        • van Baar M.E.
        • Dekker J.
        • Oostendorp R.A.
        • Bijl D.
        • Voorn T.B.
        • Bijlsma J.W.
        Effectiveness of exercise in patients with osteoarthritis of hip or knee: nine months' follow up.
        Ann Rheum Dis. 2001; 60: 1123-1130
        • Dias J.M.
        • Mazuquin B.F.
        • Mostagi F.Q.
        • et al.
        The effectiveness of postoperative physical therapy treatment in patients who have undergone arthroscopic partial meniscectomy: systematic review with meta-analysis.
        J Orthop Sports Phys Ther. 2013; 43: 560-576
        • Roddy E.
        • Zhang W.
        • Doherty M.
        • et al.
        Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee—the MOVE consensus.
        Rheumatology (Oxford). 2005; 44: 67-73
        • Dacey M.
        • Baltzell A.
        • Zaichkowsky L.
        Older adults' intrinsic and extrinsic motivation toward physical activity.
        Am J Health Behav. 2008; 32: 570-582
        • Martin J.E.
        • Dubbert P.M.
        Exercise applications and promotion in behavioral medicine: current status and future directions.
        J Consult Clin Psychol. 1982; 50: 1004-1017
        • Dubbert P.M.
        Exercise in behavioral medicine.
        J Consult Clin Psychol. 1992; 60: 613-618
        • Marcus B.H.
        • Dubbert P.M.
        • Forsyth L.H.
        • et al.
        Physical activity behavior change: issues in adoption and maintenance.
        Health Psychol. 2000; 19: 32-41
        • Damush T.M.
        • Perkins S.M.
        • Mikesky A.E.
        • Roberts M.
        • O'Dea J.
        Motivational factors influencing older adults diagnosed with knee osteoarthritis to join and maintain an exercise program.
        J Aging Phys Act. 2005; 13: 45-60
        • Petursdottir U.
        • Arnadottir S.A.
        • Halldorsdottir S.
        Facilitators and barriers to exercising among people with osteoarthritis: a phenomenological study.
        Phys Ther. 2010; 90: 1014-1025
        • Holden M.A.
        • Nicholls E.E.
        • Young J.
        • Hay E.M.
        • Foster N.E.
        Role of exercise for knee pain: what do older adults in the community think?.
        Arthritis Care Res (Hoboken). 2012; 64: 1554-1564
        • Marks R.
        Knee osteoarthritis and exercise adherence: a review.
        Curr Aging Sci. 2012; 5: 72-83
        • Hurley M.V.
        • Walsh N.
        • Bhavnani V.
        • Britten N.
        • Stevenson F.
        Health beliefs before and after participation on an exercised-based rehabilitation programme for chronic knee pain: doing is believing.
        BMC Musculoskelet Disord. 2010; 11: 31
        • Pisters M.F.
        • Veenhof C.
        • de Bakker D.H.
        • Schellevis F.G.
        • Dekker J.
        Behavioural graded activity results in better exercise adherence and more physical activity than usual care in people with osteoarthritis: a cluster-randomised trial.
        J Physiother. 2010; 56: 41-47
        • Bennell K.L.
        • Dobson F.
        • Hinman R.S.
        Exercise in osteoarthritis: moving from prescription to adherence.
        Best Pract Res Clin Rheumatol. 2014; 28: 93-117
        • Dobson F.
        • Bennell K.L.
        • French S.D.
        • et al.
        Barriers and facilitators to exercise participation in people with hip and/or knee osteoarthritis: synthesis of the literature using behavior change theory.
        Am J Phys Med Rehabil. 2016; 95: 372-389
        • Katz J.N.
        • Chaisson C.E.
        • Cole B.
        • et al.
        The MeTeOR trial (Meniscal Tear in Osteoarthritis Research): rationale and design features.
        Contemp Clin Trials. 2012; 33: 1189-1196
        • Hunter D.J.
        • Lo G.H.
        • Gale D.
        • Grainger A.J.
        • Guermazi A.
        • Conaghan P.G.
        The reliability of a new scoring system for knee osteoarthritis MRI and the validity of bone marrow lesion assessment: BLOKS (Boston Leeds Osteoarthritis Knee Score).
        Ann Rheum Dis. 2008; 67: 206-211
        • Ware Jr., J.E.
        • Sherbourne C.D.
        The MOS 36-Item Short-Form Health Survey (SF-36). I. Conceptual framework and item selection.
        Med Care. 1992; 30: 473-483
        • Bellamy N.
        • Buchanan W.W.
        • Goldsmith C.H.
        • Campbell J.
        • Stitt L.W.
        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.
        J Rheumatol. 1988; 15: 1833-1840
        • Roos E.M.
        • Roos H.P.
        • Lohmander L.S.
        • Ekdahl C.
        • Beynnon B.D.
        Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure.
        J Orthop Sports Phys Ther. 1998; 28: 88-96
        • Berwick D.M.
        • Murphy J.M.
        • Goldman P.A.
        • Ware Jr., J.E.
        • Barsky A.J.
        • Weinstein M.C.
        Performance of a five-item mental health screening test.
        Med Care. 1991; 29: 169-176
        • van Gool C.H.
        • Penninx B.W.
        • Kempen G.I.
        • et al.
        Effects of exercise adherence on physical function among overweight older adults with knee osteoarthritis.
        Arthritis Rheum. 2005; 53: 24-32
        • Zou G.
        A modified Poisson regression approach to prospective studies with binary data.
        Am J Epidemiol. 2004; 159: 702-706
        • EuroQol Group
        EuroQol—a new facility for the measurement of health-related quality of life.
        Health Policy. 1990; 16: 199-208
        • Cassetta J.A.
        • Boden-Albala B.
        • Sciacca R.R.
        • Giardina E.G.
        Association of education and race/ethnicity with physical activity in insured urban women.
        J Womens Health (Larchmt). 2007; 16: 902-908
        • Stubbs B.
        • Hurley M.
        • Smith T.
        What are the factors that influence physical activity participation in adults with knee and hip osteoarthritis? A systematic review of physical activity correlates.
        Clin Rehabil. 2015; 29: 80-94
        • Tucker-Seeley R.D.
        • Subramanian S.V.
        • Li Y.
        • Sorensen G.
        Neighborhood safety, socioeconomic status, and physical activity in older adults.
        Am J Prev Med. 2009; 37: 207-213
        • Beinart N.A.
        • Goodchild C.E.
        • Weinman J.A.
        • Ayis S.
        • Godfrey E.L.
        Individual and intervention-related factors associated with adherence to home exercise in chronic low back pain: a systematic review.
        Spine J. 2013; 13: 1940-1950
        • Focht B.C.
        • Garver M.J.
        • Devor S.T.
        • et al.
        Improving maintenance of physical activity in older, knee osteoarthritis patients trial-pilot (IMPACT-P): design and methods.
        Contemp Clin Trials. 2012; 33: 976-982
        • Kellgren J.H.
        • Lawrence J.S.
        Radiological assessment of osteo-arthrosis.
        Ann Rheum Dis. 1957; 16: 494-502
        • Podsiadlo D.
        • Richardson S.
        The Timed “Up & Go”: a test of basic functional mobility for frail elderly persons.
        J Am Geriatr Soc. 1991; 39: 142-148
        • Williams M.
        Manual muscle testing, development and current use.
        Phys Ther Rev. 1956; 36: 797-805