Research Isabel Baert

Abstract

Total knee replacement (TKR) surgery is the most common surgical treatment for knee osteoarthritis (OA) worldwide. Despite a good outcome for the majority of patients, approximately 20% of patients experience chronic pain after surgery. Therefore, it is desirable and useful to define predictive factors for this postoperative chronic pain. It is hypothesized that the presence of altered central pain processing (CPP) may be a determinant of chronic pain after TKR surgery. Besides altered CPP, metabolic disorders such as obesity and diabetes might also contribute to postoperative chronic pain. Both disorders are risk factors for developing knee OA in the first place, but their relationship with postoperative chronic pain is not yet clear. In addition, the association between altered CPP on the one hand and obesity and diabetes on the other hand needs to be examined. Given the prediction that the incidence of TKR will increase in the future, prevention of chronic postoperative pain is of tremendous importance. Therefore, the aim of this research proposal is to unravel the contribution of preoperative altered CPP, obesity and diabetes to chronic postoperative pain after TKR surgery.

Researcher(s)

• Promoter: Meeus Mira
• Co-promoter: Baert Isabel
• Fellow: Vervullens Sophie

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Total knee replacement (TKR) surgery is the most common surgical treatment for knee osteoarthritis (OA) worldwide. Despite a good outcome for the majority of patients, approximately 20% of patients experience chronic pain after surgery. Therefore, it is desirable and useful to define predictive factors for this postoperative chronic pain. It is hypothesized that the presence of altered central pain processing (CPP) may be a determinant of chronic pain after TKR surgery. Besides altered CPP, metabolic disorders such as obesity and diabetes might also contribute to postoperative chronic pain. Both disorders are risk factors for developing knee OA in the first place, but their relationship with postoperative chronic pain is not yet clear. In addition, the association between altered CPP on the one hand and obesity and diabetes on the other hand needs to be examined. Due to their shared relation with low grade inflammation, there might exist an undiscovered link between these conditions. Given the prediction that the incidence of TKR will increase in the future, prevention of chronic postoperative pain is of tremendous importance. Therefore, the aim of this research proposal is to unravel the contribution of preoperative altered CPP, obesity and diabetes to chronic postoperative pain after TKR surgery.

Researcher(s)

• Promoter: Meeus Mira
• Co-promoter: Baert Isabel
• Fellow: Meert Lotte

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Sarcopenia, which means loss of muscle mass and function, is an independent predictor of death in heart failure patients with reduced ejection fraction (HFrEF). Traditionally, dynamic resistance training is used to counter muscle loss and is characterized by a concentric phase (=shortening) and an eccentric phase (lengthening) causing movement of the limb. Since muscle strength and muscle mass increase more with eccentric training than conventional concentric training without greater cardiorespiratory demands, this modality seems promising in heart failure patients. In this blinded randomized controlled trial, the effectivity and feasability of eccentric training will be assessed in heart failure patients. Forty patients with HFrEF will be randomly assigned to a Control Group (traditional resistance training + aerobic training) or an Intervention Group (eccentric training + aerobic training). Primary outcome parameters are exercise capacity (VO2 peak), muscle strength and muscle mass. It is hypothesized that greater muscle strength and muscle mass will be obtained in the eccentric training group in comparison with traditional resistance training. This better outcome will influence VO2 peak.

Researcher(s)

• Promoter: Baert Isabel
• Co-promoter: Van Craenenbroeck Emeline

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Even though a Total Knee Replacement (TKR) is an effective surgical treatment for end-stage knee osteoarthritis (KOA) and the majority of patients report substantial pain relief and functional improvement following this surgical procedure, literature shows that 20-40% of patients are dissatisfied with the postsurgical outcome. Given the high costs related to TKR surgery and the substantial number of patients who do not meet the level of improvement after surgery, the decision to implant a TKR should be very well-considered. It is crucial to improve our understanding of the mechanisms contributing to persisting pain and disability following TKR. There is growing body of research suggesting that in a subgroup of patients with KOA the clinical picture is dominated by sensitization of central nervous system pain pathways (i.e. central sensitization) rather than by structural dysfunctions causing nociceptive pain. Briefly, this means that the pain is to a considerable degree due to hypersensitivity of the central nervous system, rather than being just caused by structural joint damage. Therefore, with our current ongoing study (funded BOF-DOCPRO4 project initiated November 1st 2017) we aim to understand the role of central pain processing in addition to structural and functional impairments related to KOA to predict unsatisfactory outcome (in terms of pain, symptoms, physical performance and QOL) after a TKR in patients with KOA. However, within the context of recent research developments in OA and recent suggestions proposed in international literature, we would like to upgrade our current research project and add a few measurements. In very recent systematic reviews, several OA phenotypes have been proposed, which are in part in line with the aims of our current ongoing study. However, we additionally want to investigate to what extent metabolic and inflammatory factors are related to the clinical expression of OA and are contributing to prognosis and treatment response. Moreover, in literature, different phenotypes are hypothesised and it is also plausible that the proposed phenotypes are not complete distinct entities and that interactions may exist. Therefore, we want to upgrade our research study and add some measurements to investigate the role of different OA characteristics, namely structural joint damage, inflammatory and metabolic factors and pain processing factors, in the clinical expression of KOA before and after a TKR. Moreover, we aim to unravel the interrelationship between these factors and to determine different phenotypes in relation to the outcome and prognosis after TKR, since these phenotypes may be particularly important for tailored treatment. In order to reach these objectives, a longitudinal prospective study will be performed, with specific data collection presurgical (T0) and 6 months (T1) and 1 year (T2) postsurgical. The strength of our current research study (including the proposal to upgrade the project and to add measurements) is that we will examine all putative prognostic factors on the basis of the biopsychosocial model. Besides several psychological factors (cognitive emotional modulation), we assess biomechanical factors (i.e. structural impairments, such as radiographic severity of OA, and functional impairments such as muscle weakness and proprioceptive deficits) and metabolic and inflammatory factors, and examine the role of altered central pain processing. We want to define OA phenotypes that are easy interpretable and possibly related to the outcome and prognosis after TKR.

Researcher(s)

• Promoter: Meeus Mira
• Co-promoter: Baert Isabel

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Even though a Total Knee Replacement (TKR) is an effective surgical treatment for end-stage knee osteoarthritis (KOA) and the majority of patients report substantial pain relief and functional improvement following this surgical procedure, literature shows that 20-40% of patients are dissatisfied with the postsurgical outcome. Similar to other chronic pain conditions, there is growing body of research suggesting that in a subgroup of patients with KOA the clinical picture is dominated by sensitization of central nervous system pain pathways (i.e. central sensitization) rather than by structural dysfunctions causing nociceptive pain. Briefly, this means that the pain is to a considerable degree due to hypersensitivity of the central nervous system, rather than being just caused by structural joint damage. Therefore, it is not surprising that surgical interventions such as TKRs do not guarantee pain reduction and functional recovery, as the pain goes beyond the joint. Given the high costs related to TKR surgery and the substantial number of patients who do not meet the level of improvement after surgery, the decision to implant a TKR should be very well-considered. It is crucial to improve our understanding of the mechanisms contributing to persisting pain and disability following TKR and it emphasizes the need for further research on the role of altered central pain processing in patients with end stage KOA awaiting TKR surgery. This research proposal has two main objectives: 1) to unravel to which extent central pain processing and structural and functional impairments contribute to the clinical expression of KOA (pain, symptoms, physical performance and quality of life) in patients with end-stage KOA before (at baseline) and 6 months after primary TKR surgery. 2) to unravel which factors are predictive for an unsatisfactory outcome (in terms of pain, symptoms, physical performance and quality of life) 6 months and 1 year after a primary TKR. In order to reach these objectives, a longitudinal prospective study will be performed, with specific data collection presurgical (T0) and 6 months (T1) and 1 year (T2) postsurgical. This study allows identification of prognostic factors for unsatisfactory outcome in KOA patients after a primary TKR. Previous longitudinal studies investigating predictors of poor outcome after TKR, mainly focused on structural and functional factors related to the knee joint, while central pain processing was left unnoticed. Other studies mainly focused on psychological factors as potential predictors of poor outcome. The strength of the recent proposal is that we will examine all putative prognostic factors on the basis of the biopsychosocial model. Besides several psychological factors (cognitive emotional modulation), we assess biomechanical factors (i.e. structural impairments, such as radiographic severity of OA, and functional impairments such as muscle weakness and proprioceptive deficits) and examine the role of altered central pain processing measured in four ways (Pressure Pain Thresholds, Conditioned Pain Modulation, tactile acuity, Central Sensitization Inventory questionnaire). In this study, it is hypothesized that in patients with altered central pain processing an unsatisfactory effect of TKR surgery on KOA pain, symptoms, physical performance and quality of life can be expected, as there is no clear relation between peripheral input and perceived pain. It is possible that in this subgroup interventions aiming to desensitize the central nervous system might be more beneficial. In future interventional research, it can be clarified whether new interventions, such as cognitive-behavioral therapy or therapeutic pain neuroscience education, whether or not in combination with surgery, are useful. These new interventions target different aspects such as the central nervous system in contrast to therapeutic modalities that are only directed to structural knee joint pathology.

Researcher(s)

• Promoter: Meeus Mira
• Co-promoter: Baert Isabel
• Fellow: Meert Lotte

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

Abstract

Factors predicting poor outcome in knee osteoarthritis patients following total knee joint replacement (TKR) surgery will be investigated, with focus on the role of pain due to neuroplasticity (i.e. hyperexcitability of the central nervous system). This will increase insight in the success rate and reasons behind the highly varying satisfaction after TKR and may help in future decision making regarding need for and timing of TKR, as well as the needs for pre- and postsurgical rehabilitation.

Researcher(s)

• Promoter: Meeus Mira
• Co-promoter: Baert Isabel

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project