• exercise
• implementation
• knee surgery rehabilitation
• preoperative care
• telerehabilitation
• treatment efficacy

• Humans
• Pilot Projects
• Arthroplasty, Replacement, Knee/rehabilitation
• Female
• Male
• COVID-19/epidemiology
• Aged
• Middle Aged
• Preoperative Exercise
• SARS-CoV-2
• Quality of Life
• Qualitative Research
• Aged, 80 and over

• Health Education England

• Vietnam
• exploratory factor analysis (EFA)
• healthy aging
• multivariate Tobit regression
• older persons

• Humans
• Vietnam
• Female
• Aged
• Male
• Healthy Aging
• Middle Aged
• Aged, 80 and over
• Socioeconomic Factors
• Surveys and Questionnaires
• Health Status
• Social Welfare

• TA 6767-REG Asian Development Bank

Arthritis is a prevalent and debilitating condition that affects a significant proportion of middle-aged and older adults worldwide. Characterized by chronic pain, inflammation, and joint dysfunction, arthritis can severely impact physical function, quality of life, and mental health. The overall burden of arthritis is further compounded in this population due to its frequent association with depression. As the global population both the prevalence and severity of arthritis are anticipated to increase.

To investigate depressive symptoms in the middle-aged and elderly arthritic population in China, a risk prediction model was constructed, and its effectiveness was validated.

Using the China Health and Retirement Longitudinal Study 2018 data on middle-aged and elderly arthritic individuals, the population was randomly divided into a training set (n = 4349) and a validation set (n = 1862) at a 7:3 ratio. Based on 10-fold cross-validation, least absolute shrinkage and selection regression was used to screen the model for the best predictor variables. Logistic regression was used to construct the nomogram model. Subject receiver operating characteristic and calibration curves were used to determine model differentiation and accuracy. Decision curve analysis was used to assess the net clinical benefit.

The prevalence of depressive symptoms in the middle-aged and elderly arthritis population in China was 47.1%, multifactorial logistic regression analyses revealed that gender, age, number of chronic diseases, number of pain sites, nighttime sleep time, education, audiological status, health status, and place of residence were all predictors of depressive symptoms. The area under the curve values for the training and validation sets were 0.740 (95% confidence interval: 0.726-0.755) and 0.731 (95% confidence interval: 0.709-0.754), respectively, indicating good model differentiation. The calibration curves demonstrated good prediction accuracy, and the decision curve analysis curves demonstrated good clinical utility.

The risk prediction model developed in this study has strong predictive performance and is useful for screening and assessing depression symptoms in middle-aged and elderly arthritis patients.

• Middle-aged and elderly individuals
• Arthritis
• Depression symptoms
• Current status
• Influencing factors
• Risk prediction models

• Ca(V)2.2
• Osteoarthritis pain
• collapsin response mediator protein 2
• voltage-gated calcium channel 2.2

• Animals
• Calcium Channels, N-Type/drug effects
• Calcium Channels, N-Type/metabolism
• Nerve Tissue Proteins/metabolism
• Intercellular Signaling Peptides and Proteins/pharmacology
• Intercellular Signaling Peptides and Proteins/administration & dosage
• Disease Models, Animal
• Male
• Rats
• Arthralgia/drug therapy
• Rats, Sprague-Dawley
• Analgesics/pharmacology
• Analgesics/administration & dosage

• RF1 NS131165 NINDS NIH HHS
• K00 NS124190 NINDS NIH HHS
• F32 NS128392 NINDS NIH HHS
• R61 NS126026 NINDS NIH HHS
• R01 NS120663 NINDS NIH HHS

• RF1 NS131165 NINDS NIH HHS
• K00 NS124190 NINDS NIH HHS
• F32 NS128392 NINDS NIH HHS
• R61 NS126026 NINDS NIH HHS
• R01 NS120663 NINDS NIH HHS

• blood flow restriction training
• meta-analysis
• osteoarthritis
• resistance training
• rheumatoid arthritis
• systematic review

• 2022R1F1A1063548 National Research Foundation of Korea
• Ministry of Science and ICT
• Konkuk University

• Macrophage migration inhibitory factor
• Osteoarthritis
• Platelet-rich plasma therapy
• Point-of-Care testing
• Surface-enhanced Raman spectroscopy

• Humans
• Macrophage Migration-Inhibitory Factors
• Biosensing Techniques
• Enzyme-Linked Immunosorbent Assay
• Platelet-Rich Plasma

• corticosteroids
• hip osteoarthritis
• hyaluronic acid
• ultrasound-guided intra-articular injections

• calcification
• cartilage
• chondrocytes
• osteoarthritis
• senescence
• sortilin

• DFG BE 4328/9-1 Deutsche Forschungsgemeinschaft

• Continuing care
• WeChat
• arthritis
• medication compliance
• quality of life
• self-efficacy
• self-management

• Xiamen University
• National Natural Science Foundation of China

• Mexican Americans
• arthritis
• disability
• grip strength
• mobility
• older adult
• physical function

• Aged
• Humans
• Female
• Mexican Americans/psychology
• Activities of Daily Living
• Disability Evaluation
• Hand Strength
• Prospective Studies
• Follow-Up Studies
• Disabled Persons
• Arthritis

• P30 AG059301 NIA NIH HHS
• R01 AG010939 NIA NIH HHS
• R01 AG017638 NIA NIH HHS
• R01 MD010355 NIMHD NIH HHS

• disability
• latent class analysis
• middle-aged and older adults
• multimorbidity
• older people

• Aged
• Chronic Disease
• Persons with Disabilities
• Humans
• Longitudinal Studies
• Middle Aged
• Morbidity
• Multimorbidity

• K23 AG056638 NIA NIH HHS
• Foshan Municipal Government
• NIH

• Pain catastrophizing
• chronic pain
• disability
• ethnicity/race
• knee osteoarthritis

• Black or African American/ethnology
• Aged
• Catastrophization/ethnology
• Chronic Pain/ethnology
• Cross-Sectional Studies
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Osteoarthritis, Knee/ethnology
• United States/ethnology
• White People/ethnology

• R00 AG052642 NIA NIH HHS
• K22 NS102334 NINDS NIH HHS
• R25 NS117367 NINDS NIH HHS
• R01 AG054370 NIA NIH HHS
• UL1 TR001417 NCATS NIH HHS
• K01 HL153210 NHLBI NIH HHS
• K23 AR076463 NIAMS NIH HHS
• R33 AG056540 NIA NIH HHS
• UL1 TR001427 NCATS NIH HHS
• R37 AG033906 NIA NIH HHS

• clinical outcomes
• disparities
• economic outcomes
• ethnic
• osteoarthritis
• prevalence
• racial
• treatment utilization

• Cartilage
• Orthopaedic
• Osteoarthritis
• PRP
• Platelet-rich plasma

• Adult
• Aged
• Humans
• Injections, Intra-Articular
• Osteoarthritis, Hip/drug therapy
• Osteoarthritis, Knee/drug therapy
• Platelet-Rich Plasma
• Prospective Studies
• Treatment Outcome

The use of digital therapeutic solutions for rehabilitation of conditions such as osteoarthritis provides scalable access to rehabilitation. Few validated technological solutions exist to ensure supervision of users while they exercise at home. Motion Coach (Kaia Health GmbH) provides audiovisual feedback on exercise execution in real time on conventional smartphones.

We hypothesized that the interrater agreement between physiotherapists and Motion Coach would be noninferior to physiotherapists’ interrater agreement for exercise evaluations in a cohort with osteoarthritis.

Patients diagnosed with osteoarthritis of the knee or hip were recruited at a university hospital to perform a set of 6 exercises. Agreement between Motion Coach and 2 physiotherapists’ corrections for segments of the exercises were compared using Cohen κ and percent agreement.

Participants (n=24) were enrolled and evaluated. There were no significant differences between interrater agreements (Motion Coach app vs physiotherapists: percent agreement 0.828; physiotherapist 1 vs physiotherapist 2: percent agreement 0.833; P<.001). Age (70 years or under, older than 70 years), gender (male, female), or BMI (30 kg/m² or under, greater than 30 kg/m²) subgroup analysis revealed no detectable difference in interrater agreement. There was no detectable difference in levels of interrater agreement between Motion Coach vs physiotherapists and between physiotherapists in any of the 6 exercises.

The results demonstrated that Motion Coach is noninferior to physiotherapist evaluations. Interrater agreement did not differ between 2 physiotherapists or between physiotherapists and the Motion Coach app. This finding was valid for all investigated exercises and subgroups. These results confirm the ability of Motion Coach to detect user form during exercise and provide valid feedback to users with musculoskeletal disorders.

• digital health
• digital rehabilitation
• exercise therapy
• mHealth
• machine learning
• osteoarthritis
• smartphone

• Arthritis
• Bidirectional relationship
• CHARLS
• Depression

Osteoarthritis (OA) is one of the most common degenerative diseases worldwide. Many researchers are studying the pathogenesis of OA, however, it is still unclear.

Screening and validation of OA relevant hub genes are an important part of exploring their potential molecular mechanism. Therefore, this study aims to explore and verify the mechanisms of hub genes in the OA by bioinformatics, qPCR, fluorescence and propidium iodide staining.

Microarray datasets GSE43923, GSE55457 and GSE12021 were collected in the Gene Expression Omnibus (GEO), including 45 samples, which divided into 23 osteoarthritis knee joint samples and 22 samples of normal knee joint. Thereafter, 265 differentiallyexpressedgenes (DEGs) were identified in all, which divided into 199 upregulated genes and 66 downregulated genes. The hub genes MAPK-14, PTPRC, PTPN12 were upregulated, while B9D1 was downregulated. In order to further confirm the expression of screening differential genes in human chondrocytes, the human chondrocytes were extracted from a joint replacement surgery and stained with toluidine blue for identification. Compared with normal chondrocytes, OA chondrocytes had high expression of COL I protein and low expression of COL II protein. The expression levels of MAPK-14, PTPRC and PTPN12 in OA chondrocytes were significantly higher than the expression levels of B9D1 in normal chondrocytes. Moreover, the inflammatory necrosis of OA chondrocytes was increased compared with the normal chondrocytes by propidium iodide staining.

The high expression of MAPK-14 works as a promoter of chondrocytes death and an important signal of the osteoarthritis process.

• Chondrocytes
• Differentially expressed genes
• Gene Ontology
• MAPK-14
• Osteoarthritis
• Protein-protein interaction

Rehabilitation has been shown to improve functional outcomes following total knee replacement (TKR). However, its delivery and associated costs are highly variable. The authors have developed and previously validated the accuracy of a remote (wearable) rehabilitation monitoring platform (interACTION). The present study’s objective was to assess the feasibility of utilizing interACTION for the remote management of rehabilitation after TKR and to determine a preliminary estimate of the effects of the interACTION system on the value of rehabilitation. Specifically, we tested post-operative outpatient rehabilitation supplemented with interACTION (n = 13) by comparing it to a standard post-operative outpatient rehabilitation program (n = 12) using a randomized design. Attrition rates were relatively low and not significantly different between groups, indicating that participants found both interventions acceptable. A small (not statistically significant) decrease in the number of physical therapy visits was observed in the interACTION Group, therefore no significant difference in total cost could be observed. All patients and physical therapists in the interACTION Group indicated that they would use the system again in the future. Therefore, the next steps are to address the concerns identified in this pilot study and to expand the platform to include behavioral change strategies prior to conducting a full-scale randomized controlled trial. Trial registration: ClinicalTrials.gov NCT02646761 “interACTION: A Portable Joint Function Monitoring and Training System for Remote Rehabilitation Following TKA” 6 January 2016.

• interactive health technologies
• remote rehabilitation
• total knee replacement

• Aged
• Arthroplasty, Replacement, Knee/rehabilitation
• Female
• Humans
• Male
• Middle Aged
• Physical Therapy Modalities
• Pilot Projects
• Telerehabilitation
• Treatment Outcome

• Biomechanical Phenomena
• Femoracetabular Impingement/diagnostic imaging
• Hip
• Hip Joint/diagnostic imaging
• Humans
• Radiography
• Young Adult

The effect of joint health on the quality of life of middle-aged and older women is becoming more widely recognized with the aging of the world’s population. However, the association of long-term breastfeeding with joint pain and knee osteoarthritis has not been fully examined. The aim of this study was to determine the association of prior breastfeeding duration with current joint pain and knee osteoarthritis in middle-aged Korean women.

This cross-sectional study was conducted among 3454 women aged ≥50 years who underwent knee radiography and answered a questionnaire on breastfeeding and joint pain for the 5th Korea National Health and Nutrition Examination Survey (2010–2011). After adjusting for confounding sociodemographic, medical history, and obstetric and gynecologic variables, logistic regression analysis was conducted to analyze the prevalence of joint pain and knee osteoarthritis according to breastfeeding and its duration.

Among the 3454 participants, 298 had not breastfed and 1042, 815, and 1299 had breastfed for 1–24, 25–48, and ≥ 49 months, respectively. Of all participants, 1731 had joint pain and 739 were diagnosed with knee osteoarthritis after radiography.

Using the non-breastfeeding group as a reference, the odds ratio (OR) for joint pain among women who breastfed ≥1 month was 1.49 (95% confidence interval [CI] 1.01–2.21). As the breastfeeding duration increased, the OR of joint pain prevalence also increased (p for trend; p = 0.002). For knee osteoarthritis, the OR was 2.30 in the 25–48 months group (95% CI 1.09–4.86). The OR of knee osteoarthritis in the ≥49 months group was 2.17 (95% CI 1.01–4.64). Sensitivity analysis after selecting only participants aged ≥60 years showed that the prevalence of joint pain and knee osteoarthritis was more positively correlated with extended breastfeeding duration (joint pain, p for trend; p = 0.005) (knee osteoarthritis, p for trend; p = 0.012).

Long-term feeding for more than 25 months was associated with an increased prevalence of joint pain and degenerative arthritis in Korean women aged ≥50 years.

• Arthralgia
• KNHANES
• Knee osteoarthritis
• Lactation
• Menopause

• Cost-effectiveness
• Physiotherapy
• Systematic review
• Total hip replacement

• Aged
• Arthroplasty, Replacement, Hip/rehabilitation
• Cost of Illness
• Exercise Therapy/economics
• Exercise Therapy/methods
• Female
• Humans
• Length of Stay
• Male
• Middle Aged
• Quality of Life
• Treatment Outcome

• Arthritis
• Exercise
• Function
• Outcomes
• Physical performance

• Arthritis
• Cox regression models
• depression
• depressive symptoms

• Disability
• Meta-analysis
• Osteoarthritis
• Pain
• Race/ethnicity

• arthritis
• child health
• epidemiology of chronic non communicable diseases
• fetal

• Arthritis
• Geriatric
• Spine

To investigate the correlations between clinical outcomes and biopsychological variables in female patients with knee osteoarthritis (OA).

Seventy-seven patients with symptomatic knee OA were enrolled in this study. We investigated the age, body mass index (BMI), pain catastrophizing scale (PCS) and radiographic severity of bilateral knees using a Kellgren-Lawrence (K-L) grading system of the subjects. Subsequently, a multiple linear regression was conducted to determine which variables best correlated with main outcomes of knee OA, which were pain severity, moving capacity by measuring timed-up-and-go test and Japanese Knee Osteoarthritis Measure (JKOM).

We found that the significant contributor to pain severity was PCS (β = 0.555) and BMI (β = 0.239), to moving capacity was K-L grade (β = 0.520) and to PCS (β = 0.313), and to a JKOM score was PCS (β = 0.485) and K-L grade (β = 0.421), respectively.

The results suggest that pain catastrophizing as well as biological factors were associated with clinical outcomes in female patients with knee OA, irrespective of radiographic severity.

• Osteoarthritis
• Pain catastrophizing
• Knee pain
• Physical function
• Japanese Knee Osteoarthritis Measure

• Arthritis
• Burden of disease
• Epidemiology
• Impact
• Models of care
• Osteoporosis
• Pain

• Diet quality
• Healthy Eating Index
• disease activity
• functional status
• rheumatoid arthritis

• autologous chondrocyte implantation
• biological knee
• cartilage
• meniscus
• meniscus allograft transplant

Primary total knee replacement is a common operation that is performed to provide pain relief and restore functional ability. Inpatient physiotherapy is routinely provided after surgery to enhance recovery prior to hospital discharge. However, international variation exists in the provision of outpatient physiotherapy after hospital discharge. While evidence indicates that outpatient physiotherapy can improve short-term function, the longer term benefits are unknown. The aim of this randomised controlled trial is to evaluate the long-term clinical effectiveness and cost-effectiveness of a 6-week group-based outpatient physiotherapy intervention following knee replacement.

Two hundred and fifty-six patients waiting for knee replacement because of osteoarthritis will be recruited from two orthopaedic centres. Participants randomised to the usual-care group (n = 128) will be given a booklet about exercise and referred for physiotherapy if deemed appropriate by the clinical care team. The intervention group (n = 128) will receive the same usual care and additionally be invited to attend a group-based outpatient physiotherapy class starting 6 weeks after surgery. The 1-hour class will be run on a weekly basis over 6 weeks and will involve task-orientated and individualised exercises.

The primary outcome will be the Lower Extremity Functional Scale at 12 months post-operative. Secondary outcomes include: quality of life, knee pain and function, depression, anxiety and satisfaction. Data collection will be by questionnaire prior to surgery and 3, 6 and 12 months after surgery and will include a resource-use questionnaire to enable a trial-based economic evaluation. Trial participation and satisfaction with the classes will be evaluated through structured telephone interviews. The primary statistical and economic analyses will be conducted on an intention-to-treat basis with and without imputation of missing data. The primary economic result will estimate the incremental cost per quality-adjusted life year gained from this intervention from a National Health Services (NHS) and personal social services perspective.

This research aims to benefit patients and the NHS by providing evidence on the long-term effectiveness and cost-effectiveness of outpatient physiotherapy after knee replacement. If the intervention is found to be effective and cost-effective, implementation into clinical practice could lead to improvement in patients’ outcomes and improved health care resource efficiency.

ISRCTN32087234, registered on 11 February 2015.

• Economic evaluation
• Function
• Physiotherapy
• Randomised controlled trial
• Total knee replacement

Total hip replacement (THR) is successful in treating hip arthritis. Prosthetic survivorship may depend on the medications taken by the patient; particularly, the role of benzodiazepines and related drugs (Z-drugs) with THR revision has been poorly investigated. Our objective was to compare THR short-term survivorship according to level of exposure to benzodiazepine and Z-drugs.

All French patients aged 40 years or older, having undergone primary THR from January 1, 2009, through December 31, 2012, for arthritis according to French national health insurance databases were included in the cohort. Outcome of interest was THR revision, including any surgical procedure in which the implant or any component was changed or removed. Follow-up started the day the primary THR was performed. Observations were right-censored on December 31, 2014, if neither revision nor death had yet occurred. Exposure of interest was the cumulative defined daily doses per day (cDDD/day) of benzodiazepines and Z-drugs dispensed within 6 months before or after inclusion. We defined four exposure groups; cDDD/d = 0: unexposed; <0.08: low exposure;] 0.08–0.38]: medium exposure; >0.38: high exposure. THR survivorship was assessed according to level of exposure to benzodiazepines and Z-drugs in univariate and multivariate Cox models adjusted for patient, THR and implanting center characteristics.

The study cohort comprised 246,940 individuals: mean age at baseline, 69.9 years; women, 57.9%; unexposed: 51.7%; low exposure: 16.7%; medium exposure: 15.9%; and high exposure: 15.7%. During the median 45-month follow-up, 9043 individuals underwent prosthetic revision. Adjusted hazard ratios in low, medium and high exposed groups were 1.18 (95%CI, 1.12–1.26; P<0.001), 1.32 (95%CI, 1.24–1.40; P<0.001) and 1.37 (95%CI, 1.29–1.45; P<0.001), respectively, compared to unexposed.

Exposure to benzodiazepines and Z-drugs is associated with an increased risk of THR revision, with a dose-response relationship. Cautious prescribing might be needed as well as careful history examination and assessment of risk for patients with a hip prosthesis.

• Chronic pain
• Disability evaluation
• Epidemiologic studies
• Osteoarthritis
• Quality of life
• Rheumatology

• Activities of daily living
• Occupational therapy
• Population-based study

Understanding the mapping between individual outcome measures and the latent functional domains of interest is critical to a quantitative evaluation and rehabilitation of hand function. We examined whether and how the associations among six hand-specific outcome measures reveal latent functional domains in elderly individuals. We asked 66 healthy older adult participants (38F, 28M, 66.1 ± 11.6 years, range: 45–88 years) and 33 older adults (65.8 ± 9.7 years, 44–81 years, 51 hands) diagnosed with osteoarthritis (OA) of the carpometacarpal (CMC) joint, to complete six functional assessments: hand strength (Grip, Key and Precision Pinch), Box and Block, Nine Hole Pegboard, and Strength-Dexterity tests. The first three principal components suffice to explain 86% of variance among the six outcome measures in healthy older adults, and 84% of variance in older adults with CMC OA. The composition of these dominant associations revealed three distinct latent functional domains: strength, coordinated upper extremity function, and sensorimotor processing. Furthermore, in participants with thumb CMC OA we found a blurring of the associations between the latent functional domains of strength and coordinated upper extremity function. This motivates future work to understand how the physiological effects of thumb CMC OA lead upper extremity coordination to become strongly associated with strength, while dynamic sensorimotor ability remains an independent functional domain. Thus, when assessing the level of hand function in our growing older adult populations, it is particularly important to acknowledge its multidimensional nature—and explicitly consider how each outcome measure maps to these three latent and fundamental domains of function. Moreover, this ability to distinguish among latent functional domains may facilitate the design of treatment modalities to target the rehabilitation of each of them.

• aging
• dexterity
• hand
• sensorimotor processing
• strength

Rehabilitation, with an emphasis on physiotherapy and exercise, is widely promoted after total knee replacement. However, provision of services varies in content and duration. The aim of this study is to update the review of Minns Lowe and colleagues 2007 using systematic review and meta-analysis to evaluate the effectiveness of post-discharge physiotherapy exercise in patients with primary total knee replacement.

We searched MEDLINE, Embase, PsycInfo, CINAHL and Cochrane CENTRAL to October 4^th 2013 for randomised evaluations of physiotherapy exercise in adults with recent primary knee replacement.

Outcomes were: patient-reported pain and function, knee range of motion, and functional performance. Authors were contacted for missing data and outcomes. Risk of bias and heterogeneity were assessed. Data was combined using random effects meta-analysis and reported as standardised mean differences (SMD) or mean differences (MD).

Searches identified 18 randomised trials including 1,739 patients with total knee replacement. Interventions compared: physiotherapy exercise and no provision; home and outpatient provision; pool and gym-based provision; walking skills and more general physiotherapy; and general physiotherapy exercise with and without additional balance exercises or ergometer cycling.

Compared with controls receiving minimal physiotherapy, patients receiving physiotherapy exercise had improved physical function at 3–4 months, SMD −0.37 (95% CI −0.62, −0.12), and pain, SMD −0.45 (95% CI −0.85, −0.06). Benefit up to 6 months was apparent when considering only higher quality studies.

There were no differences for outpatient physiotherapy exercise compared with home-based provision in physical function or pain outcomes. There was a short-term benefit favouring home-based physiotherapy exercise for range of motion flexion.

There were no differences in outcomes when the comparator was hydrotherapy, or when additional balancing or cycling components were included. In one study, a walking skills intervention was associated with a long-term improvement in walking performance. However, for all these evaluations studies were under-powered individually and in combination.

After recent primary total knee replacement, interventions including physiotherapy and exercise show short-term improvements in physical function. However this conclusion is based on meta-analysis of a few small studies and no long-term benefits of physiotherapy exercise interventions were identified. Future research should target improvements to long-term function, pain and performance outcomes in appropriately powered trials.

The online version of this article (doi:10.1186/s12891-015-0469-6) contains supplementary material, which is available to authorized users.

The Patient and PRovider Interventions for Managing Osteoarthritis (OA) in Primary Care (PRIMO) study is one of the first health services trials targeting OA in a multi-site, primary care network. This multi-site approach is important for assessing generalizability of the interventions. These analyses describe heterogeneity in clinic and patient characteristics, as well as recruitment metrics, across PRIMO study clinics.

Baseline data were obtained from the PRIMO study, which enrolled n = 537 patients from ten Duke Primary Care practices. The following items were examined across clinics with descriptive statistics: (1) Practice Characteristics, including primary care specialty, numbers and specialties of providers, numbers of patients age 55+, urban/rural location and county poverty level; (2) Recruitment Metrics, including rates of eligibility, refusal and randomization; (3) Participants’ Characteristics, including demographic and clinical data (general and OA-related); and (4) Participants’ Self-Reported OA Treatment Use, including pharmacological and non-pharmacological therapies. Intraclass correlation coefficients (ICCs) were computed for participant characteristics and OA treatment use to describe between-clinic variation.

Study clinics varied considerably across all measures, with notable differences in numbers of patients age 55+ (1,507-5,400), urban/rural location (ranging from “rural” to “small city”), and proportion of county households below poverty level (12%-26%). Among all medical records reviewed, 19% of patients were initially eligible (10%-31% across clinics), and among these, 17% were randomized into the study (13%-21% across clinics). There was considerable between-clinic variation, as measured by the ICC (>0.01), for the following patient characteristics and OA treatment use variables: age (means: 60.4-66.1 years), gender (66%-88% female), race (16%-61% non-white), low income status (5%-27%), presence of hip OA (26%-68%), presence both knee and hip OA (23%-61%), physical therapy for knee OA (24%-61%) and hip OA (0%-71%), and use of knee brace with metal supports (0%-18%).

Although PRIMO study sites were part of one primary care practice network in one health care system, clinic and patient characteristics varied considerably, as did OA treatment use. This heterogeneity illustrates the importance of including multiple, diverse sites in trials for knee and hip OA, to enhance the generalizability and evaluate potential for real-world implementation.

Clinical Trial Registration Number: NCT 01435109

The online version of this article (doi:10.1186/1471-2474-15-413) contains supplementary material, which is available to authorized users.

• Chinese population
• arthritis
• cardiovascular disease
• middle-aged and older
• prevalence
• risk factor

• aging
• dexterity
• hand
• leg
• rehabilitation
• sensorimotor function
• sex differences
• sociobiology

• R01 AR050520 NIAMS NIH HHS
• R01 AR052345 NIAMS NIH HHS

Despite the burden of rheumatic and musculoskeletal diseases (RMDs), these conditions probably deserve more attention from public health authorities in several countries including developed ones. We assessed their contribution to disability.

Data on disabilities associated with RMDs were extracted from the national 2008–2009 Disability-Health Survey of 29,931 subjects representative of the population in France. We used the core set of disability categories for RMDs of the World Health Organization's International Classification of Functioning, Disability and Health for analysis. Diagnosis and disabilities were self-reported. We assessed the risk of disability associated with RMDs using odds ratios (ORs) and the societal impact of RMDs using the average attributable fraction (AAF).

Overall 27.7% (about 17.3 million people) (95% CI 26.9–28.4%) of the population reported having RMDs. The most prevalent RMDs were low back pain (12.5%, 12.1–13.1) and osteoarthritis (12.3%, 11.8–12.7). People reporting osteoarthritis were more disabled in walking (adjusted OR 1.9, 1.7–2.2) than those without. People reporting inflammatory arthritis were more limited in activities of daily living (from 1.4, 1.2–1.8 for walking to 2.1, 1.5–2.9 for moving around). From a societal perspective, osteoarthritis was the main contributor to activity limitations (AAF 22% for walking difficulties). Changing jobs was mainly attributed to neck pain (AAF 13%) and low back pain (11.5%).

RMDs are highly prevalent and significantly affect activity limitations and participation restrictions. More effort is needed to improve care and research in this field.