Graeme L. Jones

There is limited evidence on the comparative effectiveness of different exercise modalities, such as yoga and strengthening exercises, for managing knee osteoarthritis (OA). To compare the effectiveness of yoga vs strengthening exercise for reducing knee pain over 12 weeks in patients with knee OA. This single-center, assessor-blinded (for nonpatient-reported outcomes), parallel-arm, active-controlled, superiority randomized clinical trial included adults aged 40 years or older with knee OA and knee pain levels of 40 or higher on a 100-mm visual analog scale (VAS) in Southern Tasmania, Australia. Participants were recruited from April 2021 to June 2022, and follow-up was completed in December 2022. Data were analyzed from May 2023 to July 2024. Participants were randomized 1:1 to the yoga and strengthening exercise groups. Both groups attended 2 supervised and 1 home-based session per week for 12 weeks followed by 3 unsupervised home-based sessions per week for weeks 13 to 24. The primary outcome was the between-group difference in VAS score over 12 weeks assessed using a range of 0 (no pain) to 100 (worst possible pain) with a prespecified noninferiority margin of 10 mm. Secondary outcomes included knee pain over 24 weeks; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain, function, and stiffness; patient global assessment; Osteoarthritis Research Society International-Outcome Measures in Rheumatology Clinical Trials response; physical performance measures; leg muscle strength; health-related quality of life assessed via the Assessment of Quality of Life-8 Dimensions (AQol-8D) utility score; depression assessed with the Patient Health Questionnaire-9; and neuropathic pain assessment over 12 and 24 weeks. Analyses were based on the intention-to-treat principle. In total, 117 participants were randomized to the yoga (n = 58) or strengthening exercise (n = 59) program. Baseline characteristics of the participants were similar, with a mean (SD) age of 62.5 (8.3) years, and 85 participants (72.6%) were female. The mean (SD) baseline VAS knee pain score of 53.8 (16.0) indicated moderate knee pain. Over 12 weeks, the between-group mean difference in VAS knee pain change was -1.1 mm (95% CI, -7.8 to 5.7 mm), which was not statistically significant but remained within the prespecified noninferiority margin. Of 27 secondary outcomes assessed over 12 and 24 weeks, 7 were statistically significant in favor of yoga. The yoga group showed modestly greater improvements than the strengthening exercise group (between-group differences) over 24 weeks for WOMAC pain (-44.5 mm [95% CI, -70.7 to -18.3 mm]), WOMAC function (-139 mm [95% CI, -228.3 to -49.7 mm]), WOMAC stiffness (-17.6 mm [95% CI, -30.9 to -4.3 mm]), patient global assessment (-7.6 mm [95% CI, -15.1 to -0.2 mm]), and 40-m fast-paced walk test (1.8 [95% CI, 0.4-3.2]). In addition, the yoga group had a modestly greater improvement than the strengthening exercise for depression at 12 weeks (between-group difference in PHQ-9 score, -1.1 [95% CI, -1.9 to -0.2]) and quality of life at 24 weeks (between-group difference in AQoL-8D score, 0.04 [95% CI, 0.0 to 0.07]). Adverse events were similar in both groups and mild. In this randomized clinical trial, yoga did not significantly reduce knee pain compared with strengthening exercises. However, yoga was found to be noninferior to strengthening exercises, suggesting that integrating yoga as an alternative or complementary exercise option in clinical practice may help in managing knee OA. ANZCTR.org Identifier: ACTRN12621000066886.

Non-electroencephalogram seizure detection holds promise for the early identification of generalised onset seizures. However, existing methods often suffer from high false alarm rates and difficulty distinguishing normal movements from seizure manifestations. To address this, we obtained exclusive access to the Open Seizure Database and selected a representative dataset of 94 events (42 generalised tonic-clonic seizures, 19 focal seizures, and 33 labelled as Other), totaling approximately 5 hours and 29 minutes. Each event contains acceleration and heart rate data, which were expertly annotated by a clinician in 5 second timesteps, with each timestep assigned a class label of Normal, Pre-Ictal, or Ictal. We introduce AMBER (Attention-guided Multi-Branching pipeline with Enhanced Residual Fusion), a multimodal seizure detection model designed for Ictal-Phase Detection. AMBER constructs multiple branches to form independent feature extraction pipelines for each sensing modality. The outputs of each branch are passed to a Residual Fusion layer, where the extracted features are combined into a fused representation and propagated through two densely connected blocks. The results of these experiments highlight the effectiveness of Ictal Phase Detection, with the model recording an accuracy and f1-score of 0.9027 and 0.9035, respectively, on unseen test data. Further experiments recorded True Positive Rate of 0.8342, 0.9485, and 0.9118 for the Normal, Pre-Ictal, and Ictal phases, respectively, with an average False Positive Rate of 0.0502. This study presents a novel Ictal Phase Detection technique that enhances seizure phase classification while showing reduced false alarms, laying the groundwork for further advancements in non-electroencephalogram-based seizure detection research.

Evidence suggests that pathogens may influence pain perception and regulation; however, no study has explored the relationship between serological evidence of infection and multisite chronic musculoskeletal pain. Therefore, this study aimed to investigate the association between serological evidence of infection and multisite chronic musculoskeletal pain. Participants (n = 6,814; mean [SD]age, 56.5[8.2] years; females [52.9 %]) in the UK Biobank were included. Multiplex serology panel measuring serum immunoglobulin G antibody levels against 20 infectious agents was performed at baseline. Chronic pain (≥3 months) in the knee, neck/shoulder, hip, back, or 'all over the body' was assessed at baseline and follow-up. Participants were grouped by number of chronic pain sites: no chronic pain, chronic pain in 1-2 sites, or ≥3 sites. Multinomial logistic regression and mixed-effect multinomial logistic regression models were used for the analyses. The seroprevalences of serologically detected infections across the 20 agents ranged from 0.2 % to 95.4 %. In multivariable analyses, serological evidence of infection with Epstein-Barr Virus (EBV), Human T-Cell Lymphotropic Virus Type-1 (HTLV-1), and Chlamydia Trachomatis was cross-sectionally associated with chronic pain in ≥3 sites compared to those without chronic pain. In longitudinal analyses, EBV [relative risk ratio (RRR) = 2.18, 95 %CI:1.17 - 4.05] and Chlamydia Trachomatis [RRR = 1.38, 95 %CI:1.09 - 1.74] were also associated with chronic pain in ≥3 sites. Additionally, serological evidence of single and multiple infections was associated with chronic pain in ≥3 sites, but not in 1-2 sites. Collectively, serological evidence of infection with EBV and Chlamydia Trachomatis is associated with multisite chronic musculoskeletal pain. These findings suggest that infectious agents may play a role in the pathogenesis of widespread chronic pain.

The relationship between rheumatoid arthritis (RA) and fracture risk was estimated in an international meta-analysis of individual-level data from 29 prospective cohorts. RA was associated with an increased fracture risk in men and women, and these data will be used to update FRAX®. Background: RA is a well-documented risk factor for subsequent fracture that is incorporated into the FRAX algorithm. The aim of this study was to evaluate, in an international meta-analysis, the association between rheumatoid arthritis and subsequent fracture risk and its relation to sex, age, duration of follow-up, and bone mineral density (BMD) with a view to updating FRAX. Methods: The resource comprised 1,909,896 men and women, aged 20-116 years, from 29 prospective cohorts in which the prevalence of RA was 3% or less (primary analysis) and an additional 17 cohorts with a prevalence greater than 3% (supplementary analysis). The association between RA and fracture risk (any clinical fracture, osteoporotic fracture, major osteoporotic fracture (MOF), and hip fracture) was examined using an extension of the Poisson regression model in each cohort and each sex, followed by random-effects meta-analyses of the weighted beta coefficients. Results: In the primary analysis, RA was reported in 1.3% of individuals. During 15,683,133 person-years of follow-up, 139,002 fractures occurred, of which 27,518 were hip fractures. RA was associated with an increased risk of any clinical fracture (hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.35-1.65). The HRs were of similar magnitude for osteoporotic fracture and MOF but higher for hip fracture (HR = 2.23; 95% CI 1.85-2.69). For hip fracture, there was a significant interaction with age with higher HRs at younger ages. HRs did not differ between men and women and were independent of exposure to glucocorticoids and femoral neck BMD. Lower HRs were observed in the supplementary analysis cohorts, particularly in those with a high apparent prevalence of RA, possibly from conflation of RA with osteoarthritis. Conclusions: A diagnosis of RA confers an increased risk of fracture that is largely independent of BMD, sex, and corticosteroids. RA should be retained as a risk factor in future iterations of FRAX with updated risk functions to improve fracture risk prediction.

Objective: To study the association between various radiographic definitions of acetabular dysplasia (AD) and incident radiographic hip osteoarthritis (RHOA), and to analyze in subgroups. Methods: Hips free of RHOA at baseline and with follow-up within 4-8 years were drawn from the World COACH consortium. The Wiberg center edge angle (WCEA), acetabular depth width ratio (ADR), and the modified acetabular index (mAI) were calculated. AD was defined as WCEA≤25°, and for secondary analyses as WCEA≤20°, ADR ≤250, mAI ≥ 13°, and a combination. A logistic regression model with generalized mixed effects with 3 levels adjusted for age, biological sex, and body mass index (BMI) was used. Descriptive statistics stratified by age, biological sex and BMI were reported. Results: A total of 18,807 hips from 9 studies were included. Baseline characteristics: age 61.84 (± 8.32) years, BMI 27.40 (± 4.49) kg/m², 70.1% women. 4766 hips (25.3%) had WCEA≤25°. Within 4-8 years (mean 5.8 ±1.6) follow-up, 378 hips (2.0%) developed incident RHOA. We found an association between AD and RHOA (adjusted OR [aOR] 1.80 95% confidence interval [CI] 1.40-2.34). In secondary analyses, all other definitions of AD were also associated with incident RHOA (aOR ranging from 1.52 95% CI 1.19-1.94 to 1.96 95% CI 1.26-3.02). Descriptive statistics showed that the relative risk (RR) in AD hips to develop RHOA was higher compared to non-AD hips in age group 61-70 (RR 1.70), BMI<25 (RR 1.66), and in female hips (RR 1.73). Conclusions: AD was consistently associated with incident RHOA. Explorative analyses show that AD hips in women and age group 61-70 years seem to be more at risk of developing RHOA compared to non-AD hips.