Online yoga programs may improve knee function in the short term

1. Online yoga programs may improve knee function in the short term

Abstract: https://www.acpjournals.org/doi/10.7326/M22-1761

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A randomized trial of adults with symptomatic knee osteoarthritis has found that a 12-week online yoga program improved knee function in participants. However, the program did not significantly improve knee pain during walking. The findings are published in Annals of Internal Medicine.

Knee osteoarthritis is a major contributor to pain and disability. Exercise can improve pain, function, muscle strength, and quality of life in people with knee osteoarthritis and is universally recommended. Yoga is an increasingly popular low-impact exercise combining both static and dynamic postures with mindfulness strategies, making it a possibly beneficial exercise for people living with knee osteoarthritis. However, limited low-quality research in knee osteoarthritis shows some benefits on pain, function, and knee stiffness from yoga programs delivered via supervised in-person group classes.

Researchers from the University of Melbourne assigned 212 adults with symptomatic knee osteoarthritis to complete either an unsupervised 12-week online yoga program with an education component or online education only. They then compared improvements in knee pain during walking and physical function at 12 and 24 weeks after starting the program. The researchers found that participants assigned to yoga successfully completed two-thirds of the program and reported improved knee function and less difficulty with function compared to those who engaged in education only. However, both groups reported similar levels of knee pain during walking. The authors note that knee function benefits were not maintained among yoga program participants during the optional 12-week period following the initial mandatory program.

According to the authors, their findings suggest that an unsupervised online yoga program is feasible and improved physical function at 12 weeks while participants were engaged in the program. However, the improvement was modest and not sustained. They advise that additional research is needed to improve and sustain the effectiveness of online yoga programs.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Kim L. Bennell, PhD, please contact Annie Rahilly at anne.rahilly@unimelb.edu.au.

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2. Most CVD-related PROMs fall short of quality standards needed to guide clinical research and practice

Abstract: https://www.acpjournals.org/doi/10.7326/M22-2234

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A systematic review of patient-reported outcome measures (PROMs) used in cardiovascular disease (CVD) populations has found that most fall short of quality standards required to guide clinical research and practice. Few measurements reported on the validation of all Food and Drug Administration (FDA)-recommended psychometric properties, had psychometric properties rated as sufficient by Consensus-based Standards for the selection of health Measurement Instruments (COSMIN), or had minimally important differences established. The review is published in Annals of Internal Medicine.

Patient-reported outcomes are important measures of treatment effect and can be used to inform the approval of cardiovascular drugs and devices by the FDA. Health status PROMs assess symptom burden, functional status, and health-related quality of life and are more reproducible than clinician-elicited measures, which can be limited by reporting variability. Despite recognition of the stated importance of PROMs in clinical and research settings, they remain underused in CVD trials.

Cardiovascular researchers from McMaster University and University of Calgary created a comprehensive evidence map of 50 health status PROMs from 83 studies. They identified 45 disease-specific and 5 generic PROMs. The disease-specific PROMs had been testing in specific CVD conditions such as heart failure, ischemic heart disease, and arrhythmias. The investigators report that 22 percent of the 50 PROMs validated in CVDs had minimally important differences (MIDs) established, and 16 percent reported on the validation of all psychometric properties recommended by the FDA. By COSMIN standards, only 2 PROMs had all of their psychometric properties rated as sufficient in quality, and 64 percent of PROMs had less than 50% of psychometric properties rated as sufficient. The authors found that no generic PROM and only 1 in 6 disease-specific PROMs fulfilled all the FDA requirements for product approval. They also report that no generic PROMs and only 2 disease specific PROMs had all 9 COSMIN-defined properties classified as sufficient.

According to the authors, their work highlights the need for careful adherence to standardized methodological criteria for PROM development and validation and clear reporting of the psychometric properties of existing instruments. They add that given the use of PROMs to guide FDA approvals of drugs and devices in CVDs, there is a need for better adherence to quality standards in PROM validation studies.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the senior and corresponding author, Harriette G.C. Van Spall, MD, MPH, please email Veronica McGuire at vmcguir@mcmaster.ca.

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3. Synopsis of VA/DoD guidelines for management of major depressive disorder focuses on key recommendations including the use of telehealth

Guideline: https://www.acpjournals.org/doi/10.7326/M22-1603

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Earlier this year, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved a joint clinical practice guideline for the management of major depressive disorders (MDD). These updated guidelines are diverse, and the synopsis focuses on key recommendations with new evidence for pharmacologic management, pharmacogenomics, psychotherapy, complementary and alternative therapies, and the use of telehealth, which became an important component of treatment during the COVID-19 pandemic. A summary of key recommendations is published in Annals of Internal Medicine.

In a change from the 2016 guideline, the 2022 guideline has two sections that refer to “treatment of uncomplicated MDD” and “treatment of MDD that is severe or has a partial or limited response to initial treatment” to better align with the body of evidence and clinical practice. Several interventions that did not meet inclusion criteria or had a limited recommendation in the 2016 guideline now are included or have higher-level recommendations. The VA/DoD guidelines recommend a range of psychotherapies for treatment of depression and are the only major guidelines to address the use of ketamine, esketamine, and psychedelics. The guidelines suggest use of ketamine and esketamine in patients who have not responded to other treatments and psychedelic treatments only in a research setting. Interventional Treatments, such as electroconvulsive therapy, are recommended for patients with multiple failed attempts at therapy or a need for immediate relief from symptoms. Telemedicine, or virtual treatment, became more widely available during the COVID-19 pandemic, even for mental health issues. While limited evidence suggests some benefit to computer-guided treatment, the guideline authors found insufficient evidence overall to recommend for or against telehealth for treatment of MDD.

Depressive disorders are common and are ranked third after headaches and pain in terms of years lived with disability. Although a broad range of effective treatments are available to treat depressive disorders, most people with depression do not receive adequate care. As such, it is important for patients and providers to have knowledge of and access evidence-based interventions. The guideline work group found a broad and expanding range of treatment options for major depression and the resulting VA/DoD clinical practice guidelines are best practices for health care.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the author of the synopsis, James Sall, PhD, please email James.Sall@va.gov.

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