Carol Oatis - Academia.edu (original) (raw)

Papers by Carol Oatis

Annals of Internal Medicine, Jul 12, 2016

Osteoarthritis is a common disease affecting large portions of the population (1). It is often ac... more Osteoarthritis is a common disease affecting large portions of the population (1). It is often accompanied by significant joint pain, and the knee is the most commonly affected site. Many patients with knee osteoarthritis try anything and everything to relieve the pain, often to no avail. Pain medications are recommended mostly for temporary relief rather than for long-term treatment. Physical therapy and prescribed exercise can provide benefit over the long term, but adherence often wanes and pain is often a barrier to regular exercise (2, 3). Many patients resort to alternative remedies, but because such therapies often have not been carefully studied, providers do not commonly recommend them. Thus, pain remains the enemy for patients with osteoarthritis and their health care providers. One approach to reducing knee pain in osteoarthritis is to reduce loading on the knee. This can be done through weight loss, use of a cane, or a varus knee brace that applies forces to realign the knee and redistributes load over the knee. Footwear, specifically variable-stiffness shoes, may be another means of unloading the knee. The premise underlying shoe modifications to reduce load on the knee is that repositioning the foot when it is in contact with the ground produces proximal alignment changes because the foot and knee are parts of the closed kinetic chain of the lower extremity. Most clinical guidelines recommend appropriate footwear for patients with knee osteoarthritis, but little evidence exists to inform shoe choice. Although laboratory studies have shown that footwear can change knee biomechanics (4, 5), clinical studies have been lacking. Hinman and colleagues report a promising avenue for patients with knee osteoarthritis (6). They randomly assigned 164 persons with knee osteoarthritis to new shoes with modified midsoles to unload the knee or to new conventional walking shoes, similar in appearance to the unloading shoes, to examine the effect of unloading shoes on knee pain and physical function. At 6 months, both groups showed large and clinically relevant improvements but no differences in pain or function. This study applied a relevant biomechanical intervention and used recommended outcome measures for knee osteoarthritis clinical trials. Differing designs, uses, and lifespans of shoes make footwear interventions difficult to study, but the researchers conducted a good head-to-head comparison of 2 footwear groups. The fact that outcomes improved in both groups leads one to wonder whether readily available, new, supportive lace-up shoes should be the current evidence-based recommendation for appropriate footwear while we await future studies of the biomechanics of knee osteoarthritis that might result in more effective special footwear. The trial has several limitations worth noting. First, collected data on biomechanical measures of foot posture, foot function, and gait were not included in the analyses. These data could identify subgroups whose improvements might be attributable to biomechanics that the study shoes should have corrected. Second, longer-term study of biomechanical aspects would enable exploration of whether unloading shoes slow the progression of knee osteoarthritis. Also, there was no control group of participants wearing their usual shoes. As noted by the authors, three quarters of osteoarthritis treatment effects for pain can be attributed to the placebo effect (6). The authors outline clear biomechanical links to radiographic severity, dysfunction, and osteoarthritis progression (6). Thus, it is unclear why documented changes in knee biomechanics that unload the knee joint in a laboratory do not yield benefits when applied outside the laboratory. Of note, the first study to report reduction in knee adduction moment with variable-stiffness shoes (7) noted that 18% of participants actually showed an increase in adduction moment and 30% had a reduction of less than 5%. Because the intervention is directed at a distant limb segment (the foot), perhaps the body acclimates to the intervention over time, thus reverting to the patient's original loading pattern. Transmission of the load-altering mechanism up to the knee may depend on the structure and function of the foot and lower leg joints. In addition, maybe the unique mechanical properties of the shoes decrease with time, diminishing the biomechanical benefit of the intervention. Closer examination of the lower extremity kinetic chain may provide insights into the mechanical pathways that contribute to knee pain and the best ways to alter them. The current knee osteoarthritis treatment paradigm is characterized by late disease identification, poor alignment of patient pain-relief needs with available treatments, and a unified treatment approach despite heterogeneous clinical presentations. Knee osteoarthritis is a disease with a broad spectrum of expression and multiple mechanisms contributing to progression. There is a desperate…

IFAC Proceedings Volumes, Mar 1, 1994

Arthritis Care and Research, Aug 30, 2019

Physical therapy, Nov 1, 1993

Stiffness is a common clinical complaint but is rarely quantified by clinicians. The purpose of t... more Stiffness is a common clinical complaint but is rarely quantified by clinicians. The purpose of this study was to determine the reliability of a relaxed oscillation test that yields stiffness and damping coefficients of the knee. These coefficients describe the knee joint's resistance to bending and the time-dependent nature of that resistance. Effects of age, gender, and knee position on these coefficients were assessed in 96 healthy volunteers aged 20 to 79 years. Measures were based on the premise that the knee joint can be modeled as a damped spring. Oscillations of the knee were recorded using an electrogoniometer with the knee oscillating through about 45 and 75 degrees of knee flexion. Intraclass correlation coefficients revealed moderate to high reliability in the measurements taken three times in the same test session and on three separate days. Analysis of variance showed significant increases in stiffness and damping coefficients in the male subjects as compared with the female subjects. Analysis of variance also suggested an age effect on stiffness coefficients at the 75-degree test position, with decreasing stiffness with age. Both stiffness and damping coefficients were significantly smaller when measured at the 75-degree test position compared with the 45-degree position (Student's t test). These results demonstrate a reliable method of measuring knee joint stiffness, and they correlate well with known morphological differences related to age and gender. This measure may prove to be more useful in evaluating the function of the knee than more commonly used assessments. It may also lead to a better understanding of how the knee functions in such activities as locomotion.

Gait & Posture, Mar 1, 2013

JMIR rehabilitation and assistive technologies, Oct 27, 2022

ACR open rheumatology, Jun 16, 2022

Journal of Rehabilitation Research and Development, 2003

Physical therapy, Dec 1, 1988

UNSTRUCTURED Introduction: The electronic health record (EHR) has the potential to facilitate con... more UNSTRUCTURED Introduction: The electronic health record (EHR) has the potential to facilitate consistent clinical data capture to support excellence in patient care, quality improvement, and knowledge generation. Despite widespread EHR use, the vision to transform the healthcare system, and its data, to a “learning healthcare system” generating knowledge from real-world data is limited by the lack of consistent, structured clinical data. The purpose of this paper is to demonstrate the design of a web-based structured clinical intervention data capture system and its evaluation in practice. The use case is ambulatory physical therapy (PT) treatment after total knee replacement (TKR), one of the most common and costly procedures today. Methods: To identify the PT intervention type and intensity (dose) used to treat knee arthritis patients following TKR, an iterative user-centered design process refined an initial list of PT interventions generated during preliminary chart reviews. Input from practicing PTs and national and international experts refined and categorized the interventions. Next, a web-based, hierarchical, structured system for intervention and intensity documentation was designed and deployed. Results: The PT documentation system was implemented by 114 PTs agreeing to record all interventions at patient visits. Data for 161 patients with 2615 PT visits were entered by 83 PTs. No technical problems with data entry were reported, and data entry required less than two minutes per visit. Two percent of interventions could not be categorized and were recorded using free text. Discussion: The use of user-centered design principles provides a roadmap for developing clinically feasible data capture systems that employ structured collection of uniform data for use by multiple practitioners across institutions to complement and augment existing EHRs. Secondarily, these data can be analyzed to define best practices and to disseminate knowledge to practice.

Physical therapy, Jan 12, 2022

Journal of Medical Internet Research, Apr 11, 2013

Arthritis & Rheumatology

ObjectiveTo provide evidence‐based recommendations on the use of vaccinations in children and adu... more ObjectiveTo provide evidence‐based recommendations on the use of vaccinations in children and adults with rheumatic and musculoskeletal diseases (RMDs).MethodsThis guideline follows American College of Rheumatology (ACR) policy guiding management of conflicts of interest and disclosures and the ACR guideline development process, which includes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. It also adheres to the Appraisal of Guidelines for Research and Evaluation (AGREE) criteria. A core leadership team consisting of adult and pediatric rheumatologists and a guideline methodologist drafted clinical population, intervention, comparator, outcomes (PICO) questions. A review team performed a systematic literature review for the PICO questions, graded the quality of evidence, and produced an evidence report. An expert Voting Panel reviewed the evidence and formulated recommendations. The panel included adult and pediatric rheumatology providers...

Arthritis Care and Research, May 25, 2023

Arthritis Care & Research

Gestão e políticas públicas em odontologia, 2022

IFAC Proceedings Volumes, 1994

Medicine & Science in Sports & Exercise, 2004

Annals of Internal Medicine, Jul 12, 2016

Osteoarthritis is a common disease affecting large portions of the population (1). It is often ac... more Osteoarthritis is a common disease affecting large portions of the population (1). It is often accompanied by significant joint pain, and the knee is the most commonly affected site. Many patients with knee osteoarthritis try anything and everything to relieve the pain, often to no avail. Pain medications are recommended mostly for temporary relief rather than for long-term treatment. Physical therapy and prescribed exercise can provide benefit over the long term, but adherence often wanes and pain is often a barrier to regular exercise (2, 3). Many patients resort to alternative remedies, but because such therapies often have not been carefully studied, providers do not commonly recommend them. Thus, pain remains the enemy for patients with osteoarthritis and their health care providers. One approach to reducing knee pain in osteoarthritis is to reduce loading on the knee. This can be done through weight loss, use of a cane, or a varus knee brace that applies forces to realign the knee and redistributes load over the knee. Footwear, specifically variable-stiffness shoes, may be another means of unloading the knee. The premise underlying shoe modifications to reduce load on the knee is that repositioning the foot when it is in contact with the ground produces proximal alignment changes because the foot and knee are parts of the closed kinetic chain of the lower extremity. Most clinical guidelines recommend appropriate footwear for patients with knee osteoarthritis, but little evidence exists to inform shoe choice. Although laboratory studies have shown that footwear can change knee biomechanics (4, 5), clinical studies have been lacking. Hinman and colleagues report a promising avenue for patients with knee osteoarthritis (6). They randomly assigned 164 persons with knee osteoarthritis to new shoes with modified midsoles to unload the knee or to new conventional walking shoes, similar in appearance to the unloading shoes, to examine the effect of unloading shoes on knee pain and physical function. At 6 months, both groups showed large and clinically relevant improvements but no differences in pain or function. This study applied a relevant biomechanical intervention and used recommended outcome measures for knee osteoarthritis clinical trials. Differing designs, uses, and lifespans of shoes make footwear interventions difficult to study, but the researchers conducted a good head-to-head comparison of 2 footwear groups. The fact that outcomes improved in both groups leads one to wonder whether readily available, new, supportive lace-up shoes should be the current evidence-based recommendation for appropriate footwear while we await future studies of the biomechanics of knee osteoarthritis that might result in more effective special footwear. The trial has several limitations worth noting. First, collected data on biomechanical measures of foot posture, foot function, and gait were not included in the analyses. These data could identify subgroups whose improvements might be attributable to biomechanics that the study shoes should have corrected. Second, longer-term study of biomechanical aspects would enable exploration of whether unloading shoes slow the progression of knee osteoarthritis. Also, there was no control group of participants wearing their usual shoes. As noted by the authors, three quarters of osteoarthritis treatment effects for pain can be attributed to the placebo effect (6). The authors outline clear biomechanical links to radiographic severity, dysfunction, and osteoarthritis progression (6). Thus, it is unclear why documented changes in knee biomechanics that unload the knee joint in a laboratory do not yield benefits when applied outside the laboratory. Of note, the first study to report reduction in knee adduction moment with variable-stiffness shoes (7) noted that 18% of participants actually showed an increase in adduction moment and 30% had a reduction of less than 5%. Because the intervention is directed at a distant limb segment (the foot), perhaps the body acclimates to the intervention over time, thus reverting to the patient's original loading pattern. Transmission of the load-altering mechanism up to the knee may depend on the structure and function of the foot and lower leg joints. In addition, maybe the unique mechanical properties of the shoes decrease with time, diminishing the biomechanical benefit of the intervention. Closer examination of the lower extremity kinetic chain may provide insights into the mechanical pathways that contribute to knee pain and the best ways to alter them. The current knee osteoarthritis treatment paradigm is characterized by late disease identification, poor alignment of patient pain-relief needs with available treatments, and a unified treatment approach despite heterogeneous clinical presentations. Knee osteoarthritis is a disease with a broad spectrum of expression and multiple mechanisms contributing to progression. There is a desperate…

IFAC Proceedings Volumes, Mar 1, 1994

Arthritis Care and Research, Aug 30, 2019

Physical therapy, Nov 1, 1993

Stiffness is a common clinical complaint but is rarely quantified by clinicians. The purpose of t... more Stiffness is a common clinical complaint but is rarely quantified by clinicians. The purpose of this study was to determine the reliability of a relaxed oscillation test that yields stiffness and damping coefficients of the knee. These coefficients describe the knee joint's resistance to bending and the time-dependent nature of that resistance. Effects of age, gender, and knee position on these coefficients were assessed in 96 healthy volunteers aged 20 to 79 years. Measures were based on the premise that the knee joint can be modeled as a damped spring. Oscillations of the knee were recorded using an electrogoniometer with the knee oscillating through about 45 and 75 degrees of knee flexion. Intraclass correlation coefficients revealed moderate to high reliability in the measurements taken three times in the same test session and on three separate days. Analysis of variance showed significant increases in stiffness and damping coefficients in the male subjects as compared with the female subjects. Analysis of variance also suggested an age effect on stiffness coefficients at the 75-degree test position, with decreasing stiffness with age. Both stiffness and damping coefficients were significantly smaller when measured at the 75-degree test position compared with the 45-degree position (Student's t test). These results demonstrate a reliable method of measuring knee joint stiffness, and they correlate well with known morphological differences related to age and gender. This measure may prove to be more useful in evaluating the function of the knee than more commonly used assessments. It may also lead to a better understanding of how the knee functions in such activities as locomotion.

Gait & Posture, Mar 1, 2013

JMIR rehabilitation and assistive technologies, Oct 27, 2022

ACR open rheumatology, Jun 16, 2022

Journal of Rehabilitation Research and Development, 2003

Physical therapy, Dec 1, 1988

UNSTRUCTURED Introduction: The electronic health record (EHR) has the potential to facilitate con... more UNSTRUCTURED Introduction: The electronic health record (EHR) has the potential to facilitate consistent clinical data capture to support excellence in patient care, quality improvement, and knowledge generation. Despite widespread EHR use, the vision to transform the healthcare system, and its data, to a “learning healthcare system” generating knowledge from real-world data is limited by the lack of consistent, structured clinical data. The purpose of this paper is to demonstrate the design of a web-based structured clinical intervention data capture system and its evaluation in practice. The use case is ambulatory physical therapy (PT) treatment after total knee replacement (TKR), one of the most common and costly procedures today. Methods: To identify the PT intervention type and intensity (dose) used to treat knee arthritis patients following TKR, an iterative user-centered design process refined an initial list of PT interventions generated during preliminary chart reviews. Input from practicing PTs and national and international experts refined and categorized the interventions. Next, a web-based, hierarchical, structured system for intervention and intensity documentation was designed and deployed. Results: The PT documentation system was implemented by 114 PTs agreeing to record all interventions at patient visits. Data for 161 patients with 2615 PT visits were entered by 83 PTs. No technical problems with data entry were reported, and data entry required less than two minutes per visit. Two percent of interventions could not be categorized and were recorded using free text. Discussion: The use of user-centered design principles provides a roadmap for developing clinically feasible data capture systems that employ structured collection of uniform data for use by multiple practitioners across institutions to complement and augment existing EHRs. Secondarily, these data can be analyzed to define best practices and to disseminate knowledge to practice.

Physical therapy, Jan 12, 2022

Journal of Medical Internet Research, Apr 11, 2013

Arthritis & Rheumatology

ObjectiveTo provide evidence‐based recommendations on the use of vaccinations in children and adu... more ObjectiveTo provide evidence‐based recommendations on the use of vaccinations in children and adults with rheumatic and musculoskeletal diseases (RMDs).MethodsThis guideline follows American College of Rheumatology (ACR) policy guiding management of conflicts of interest and disclosures and the ACR guideline development process, which includes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. It also adheres to the Appraisal of Guidelines for Research and Evaluation (AGREE) criteria. A core leadership team consisting of adult and pediatric rheumatologists and a guideline methodologist drafted clinical population, intervention, comparator, outcomes (PICO) questions. A review team performed a systematic literature review for the PICO questions, graded the quality of evidence, and produced an evidence report. An expert Voting Panel reviewed the evidence and formulated recommendations. The panel included adult and pediatric rheumatology providers...

Arthritis Care and Research, May 25, 2023

Arthritis Care & Research

Gestão e políticas públicas em odontologia, 2022

IFAC Proceedings Volumes, 1994

Medicine & Science in Sports & Exercise, 2004