title: Fear of Movement/(Re)injury in Chronic Low Back Pain: Education or Exposure In Vivo as Mediator to Fear Reduction? Cross-cultural adaptation and validation of the Oxford 12-item knee score in Japanese Bath thermal waters in the treatment of knee osteoarthritis: a randomized controlled clinical trial. Questionnaire on the perceptions of patients about total knee replacement. Factor structure of the Hospital Anxiety and Depression Scale in Japanese psychiatric outpatient and student populations Efficacy of Therapeutic Ultrasound for the Management of Knee Osteoarthritis: A Randomized, Controlled, and Double-Blind Study The efficacy and safety of a combination of glucosamine hydrochloride, chondroitin sulfate and bio-curcumin with exercise in the treatment of knee osteoarthritis: a randomized, double-blind, placebo-controlled study.
abstract: Clinical research of grade d exposure in vivo with behavioral experiments in patients with chronic low back pain who reported fear of movement/(re)injury shows abrupt changes in self-reported pain-related fears and cognitions . The abrupt changes are more characteristics of insight learning rather than the usual gradual progression of trial and error learning . The educational session at the start of the exposure might have contributed to this insight . The current study examines the contribution of education and grade d exposure versus grade d activity in the reduction of pain-related fear and associated disability and physical activity .  Six consecutive patients with chronic low back pain who reported substantial fear of movement/(re)injury were included in the study . After a no-treatment baseline measurement period , all the patients received a single educational session , followed again by a no-treatment period . Patients were then r and omly assigned to either a grade d exposure with behavioral experiments or an operant grade d activity program . A diary was used to assess daily changes in pain intensity , pain-related fear , pain catastrophizing , and activity goal achievement . St and ardized question naires of pain-related fear , pain vigilance , pain intensity , and pain disability were administered before and after each intervention and at the 6-month follow-up . An activity monitor was carried at baseline , during the interventions , and 1 week at 6-month follow-up . R and omization tests of the daily measures showed that improvements in pain-related fear and catastrophizing occurred after the education was introduced . The results also showed a further improvement when exposure in vivo followed the no-treatment period after the education and not during the operant grade d activity program . Performance of relevant daily activities , however , were not affected by the educational session and improved significantly only in the exposure in vivo condition . All improvements remained at half-year follow-up only in patients receiving the exposure in vivo . These patients also reported a significant decrease in pain intensity at follow-up Introduction With the high incidence of knee osteoarthritis ( OA ) in Japan , there is a strong need not only for surgical therapies , but also for vali date d outcome measures . For this study , we completed cross-cultural adaptation , testing and validation of the Oxford knee score ( OKS ) for prospect i ve use in national and international clinical studies involving Japanese patients . Material s and methods The Japanese version of the OKS was developed according to the st and ard cross-cultural adaptation guidelines . For validation , the OKS was tested on 54 patients diagnosed with OA , osteonecrosis , ligament or meniscus injury . Reliability was tested using the intraclass correlation coefficient ( ICC ) . Internal consistency or homogeneity was assessed using Cronbach ’s alpha . The correlation between the Japanese OKS , WOMAC and SF-36 question naires was used to assess construct validity . Results No major difficulties were encountered with the translation and pre-testing stages . For reliability and validity , the Japanese OKS was completed without any missed responses by 53 ( 98.15 % ) and 52 ( 96.30 % ) patients at the first and second distribution , respectively . The total OKS showed good reliability with an ICC of 0.85 . Internal consistency was strong ( Cronbach ’s alpha = 0.90 ) . Strong construct validity ( ICC values of 0.51–0.84 ) was obtained against the WOMAC and SF-36 ( physical functioning , role-physical , bodily pain , and social functioning subscales ) scores . Notable “ ceiling ” effects of the OKS were reported for 11 of the 12 question naire items . Conclusion The Japanese OKS has proven to be a reliable and valid instrument for the self- assessment of knee pain and function in Japanese speaking patients with knee OA and other knee complaints BACKGROUND Osteoarthritis is a degenerative disease associated with pain , reduced range of motion , and impaired function . Balneotherapy or bathing in thermal or mineral waters is used as a non-invasive treatment for various rheumatic diseases . AIM To evaluate the effectiveness of hot sulfurous and non-sulfurous waters in the treatment of  knee osteoarthritis  . DESIGN A r and omized , assessor-blind , controlled trial . SETTING A spa resort . POPULATION One hundred and forty patients of both genders , mean age of 64.8±8.9 years , with knee osteoarthritis and chronic knee pain . METHODS Patients were r and omized into three groups : the sulfurous water ( SW ) group ( N.=47 ) , non-sulfurous water ( NSW ) group ( N.=50 ) , or control group ( N.=43 ) who received no treatment . Patients were not blinded to treatment allocation . Treatment groups received 30 individual thermal baths ( three 20-minute baths a week for 10 weeks ) at 37 - 39 ° C . The outcome measures were pain ( visual analog scale , VAS ) , physical function ( Western Ontario and McMaster Universities Osteoarthritis Index , WOMAC ; Lequesne Algofunctional Index , LAFI ; Stanford Health Assessment Question naire , HAQ ) , and use of pain medication . Patients were assessed before treatment ( T1 ) , at treatment endpoint ( T2 ) , and two months post-intervention ( T3 ) . Intra- and intergroup comparisons were performed at a significance level of 0.05 ( P<0.05 ) . RESULTS A significant decrease in VAS pain scores ( pain during movement , at rest , and at night ) and use of pain medication , and improvement in WOMAC , LAFI and HAQ scores were observed from baseline to T2 and T3 within treatment groups ( P<0.001 ) , and between controls and both treatment groups at T2 and T3 ( P<0.001 ) . No significant differences in these variables were observed between treatment groups at T2 , but patients in the SW group reported less pain and better functional status than those in the NSW group at T3 , showing a lasting effect of sulfurous water baths . CONCLUSIONS Both therapeutic methods were effective in the treatment of knee osteoarthritis ; however , sulfurous baths yielded longer-lasting effects than non-sulfurous water baths . CLINICAL REHABILITATION IMPACT Baths in thermal waters , especially those in sulfurous waters , are effective in reducing pain and improving physical function in patients with knee osteoarthritis We have developed a 12-item question naire for patients having a total knee replacement ( TKR ) . We made a prospect i ve study of 117 patients before operation and at follow-up six months later , asking them to complete the new question naire and the form SF36 . Some also filled in the Stanford Health Assessment Question naire ( HAQ ) . An orthopaedic surgeon completed the American Knee Society ( AKS ) clinical score . The single score derived from the new question naire had high internal consistency , and its reproducibility , examined by test-retest reliability , was found to be satisfactory . Its validity was established by obtaining significant correlations in the expected direction with the AKS scores and the relevant parts of the SF36 and HAQ . Sensitivity to change was assessed by analysing the differences between the preoperative scores and those at follow-up . We also compared change in scores with the patients ' retrospective judgement of change in their condition . The effect size for the new question naire compared favourably with those for the relevant parts of the SF36 . The change scores for the new knee question naire were significantly greater ( p < 0.0001 ) for patients who reported the most improvement in their condition . The new question naire provides a measure of outcome for TKR that is short , practical , reliable , valid and sensitive to clinical ly important changes over time Background The Hospital Anxiety and Depression Scale ( HADS ) is a common screening instrument excluding somatic symptoms of depression and anxiety , but previous studies have reported inconsistencies of its factor structure . The construct validity of the Japanese version of the HADS has yet to be reported . To examine the factor structure of the HADS in a Japanese population is needed . Methods Exploratory and confirmatory factor analyses were conducted in the combined data of 408 psychiatric out patients and 1069 undergraduate students . The data pool was r and omly split in half for a cross validation . An exploratory factor analysis was performed on one half of the data , and the fitness of the plausible model was examined in the other half of the data using a confirmatory factor analysis . Simultaneous multi-group analyses between the subgroups ( out patients vs. students , and men vs. women ) were subsequently conducted . Results A two-factor model where items 6 and 7 had dual loadings was supported . These factors were interpreted as reflecting anxiety and depression . Item 10 showed low contributions to both of the factors . Simultaneous multi-group analyses indicated a factor pattern stability across the subgroups . Conclusion The Japanese version of HADS indicated good factorial validity in our sample s. However , ambiguous wording of item 7 should be clarified in future revisions Objective The aim of this study was to compare whether the effectiveness of continuous ultrasound ( US ) was superior against pulsed US and against sham US in knee osteoarthritis . Design A r and omized controlled study was carried out on 60 patients diagnosed with knee osteoarthritis according to American College of Rheumatology . The patients were r and omized into the following three treatments : ( 1 ) continuous US ( at a frequency of 1 MHz with intensity of 1 W/cm2 ) , ( 2 ) pulse US ( same frequency and intensity on 1:4 pulse ratio ) , and ( 3 ) sham US . All treatments were applied with 5-cm2 head US device five times a week for 2 weeks in addition to home exercise program including quadriceps isometric exercise , muscle strength exercises , and stretching exercises of the lower extremity muscles for at least three times per week . Assessment s were performed at baseline , at the end of the treatment , and at the end of the treatments and at the sixth month using the following measurements : Western Ontario and McMaster University Osteoarthritis Index – pain , stiffness , function , visual analog scale – pain at rest , visual analog scale – pain on movement , visual analog scale – disease severity , and 20-m walking time . Among these parameters , the Western Ontario and McMaster University Osteoarthritis Index – pain was the primary outcome . Results All groups showed a significant improvement in all parameters in both following visits ( P < 0.05 ) . However , there was no significant difference between the groups . Although the mean reduction percent in Western Ontario and McMaster University Osteoarthritis Index – pain was significantly higher in group I ( continuous US ) when compared to sham group ( 46.5 % vs 28.9 % , P < 0.05 ) at the end of the treatment , this result was not found in other pain parameters . Conclusions The present study demonstrated that all assessment parameters significantly improved in all groups without a significant difference . This result suggested that therapeutic US provided no additional benefit in improving pain and functions in addition to exercise training BACKGROUND Knee osteoarthritis ( OA ) conservative treatment aims to delay cartilage degeneration ; chondroprotective agents are a valid approach in this sense . A commercially available dietary supplement , CartiJoint Forte , containing glucosamine hydrochloride ( GH ) , chondroitin sulfate ( CS ) and Bio-Curcumin BCM-95 ® , was used in this trial . AIM The aim of this study was to assess efficacy and safety of CartiJoint Forte combined with physical therapy in treating subjects with knee OA . DESIGN A multicenter , prospect i ve , r and omized , double blind , placebo-controlled clinical trial . SETTING Out patients referred to the Rehabilitation Departments of two University Hospitals . POPULATION Fifty-three patients were r and omly assigned to an experimental group ( N=26 ) or a control group ( N.=27 ) . Experimental subjects received two tablets of CartiJoint Forte each day for 8 weeks , while those in the control group were provided with a placebo . Three subjects dropped out during the course of the study . METHODS The two groups both received 20 sessions of physical therapy during the course of the trial . Primary outcome was pain intensity , measured both at motion and at rest , using the Visual Analogue Scale ( VAS ) . A secondary outcome was an assessment of knee function by Western Ontario and McMaster Universities Arthritis Index and Lequesne Index , knee ROM , and two inflammation markers ( C-reactive protein and erythrocyte sedimentation rate ) . Each assessment was carried out at baseline ( T0 ) , at 8 weeks ( T1 ) and at 12 weeks ( T2 ) . RESULTS VAS at rest was found to be reduced between T0 and T1 , as well as between T0 and T2 ( F=13.712 ; P=0.0001 ) , with no differences between groups ( F=1.724 ; P=0.191 ) . VAS at motion revealed a significant " group × time-check " interaction ( F=2.491 ; P=0.032 ) , with increasing effect of time on VAS reduction ( F=17.748 ; P=0.0001 ) . This was most pronounced in the experimental group at 8 weeks ( F=3.437 ; P=0.045 ) . The Lequesne Index showed reductions at T1 and T2 compared to T0 ( F=9.535 ; P=0.0001 ) , along with group effect , since the experimental group presented a lower score at T2 ( F=7.091 ; P=0.009 ) . No significant changes were found in the knee ROM and inflammation markers .  CONCLUSION CartiJoint Forte , added to physical therapy , may ameliorate pain and help to improve algofunctional score in knee OA patients . CLINICAL REHABILITATION IMPACT Treatment of knee OA with curcuminoids plus glycosaminoglycans , added to physical therapy , improves VAS at motion and Lequesne Index scores
target: Results The FreKAQ-J had acceptable internal consistency , unidimensionality , good test-retest reliability , and was functional on the category rating scale .
  The FreKAQ-J was significantly correlated with pain in motion , disability , pain-related catastrophizing , fear of movement , and anxiety symptomatology .
  Conclusions We developed FreKAQ-J by modifying the FreBAQ-J. The FreKAQ-J fits the Rasch measurement model well and is suitable for use in people with knee OA .
background: Background Recent systematic review s have demonstrated that pain associated with knee osteoarthritis ( OA ) is a complex phenomenon that involves various contributors .
  People with knee OA exhibit symptoms of impaired body-perception , including reduced tactile acuity , impairments in limb laterality recognition , and de grade d proprioceptive acuity .
  The Fremantle Back Awareness Question naire ( FreBAQ ) was developed to assess body-perception specific to the back in people with chronic low back pain .
  The aim of this study was to develop and assess the psychometric properties of a knee-specific version of the FreBAQ-J ( FreKAQ-J ) , determine whether people with knee pain experience perceptual impairments and investigate the relationship between disturbed self-perception and clinical status .