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Cheville AL, Basford JR. Role of rehabilitation medicine and physical agents in the treatment of cancer-associated pain. J Clin Oncol 2014; 32:1691-702. [PMID: 24799472 PMCID: PMC5569680 DOI: 10.1200/jco.2013.53.6680] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To provide an overview of rehabilitation medicine- and physical modality-based approaches to cancer pain management, and to highlight the fact that these approaches are generally used in conjunction and that a majority are focused on minimizing pain during periods of mobility and the performance of activities of daily living. METHODS We performed a nonsystematic literature review and provide a description of the current standard of care. RESULTS Rehabilitative and physical modalities used to manage pain can be grouped into four categories: those that modulate nociception, stabilize or unload painful structures, influence physiological processes that indirectly influence nociception, or alleviate pain arising from the overloading of muscles and connective tissues that often occurs after surgery or with sarcopenia in late-stage cancer. Most modalities have been pragmatically refined over the years, and many have an evidence base, although few have been explicitly validated in the oncologic setting. With few exceptions, they are patient controlled and free of adverse effects. CONCLUSION Physical modalities and rehabilitation medicine offer a range of pain management approaches that may serve as beneficial adjuncts to the conventional systemic and interventional analgesic strategies used to control cancer-related pain. These approaches may be particularly beneficial to patients with movement-associated pain and those who are ambivalent regarding pharmacoanalgesia.
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Musumeci G, Mobasheri A, Trovato FM, Szychlinska MA, Imbesi R, Castrogiovanni P. Post-operative rehabilitation and nutrition in osteoarthritis. F1000Res 2014; 3:116. [PMID: 26962431 PMCID: PMC4765713 DOI: 10.12688/f1000research.4178.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 12/20/2022] Open
Abstract
Osteoarthritis (OA) is a degenerative process involving the progressive loss of articular cartilage, synovial inflammation and structural changes in subchondral bone that lead to loss of synovial joint structural features and functionality of articular cartilage. OA represents one of the most common causes of physical disability in the world. Different OA treatments are usually considered in relation to the stage of the disease. In the early stages, it is possible to recommend physical activity programs that can maintain joint health and keep the patient mobile, as recommended by OA Research Society International (OARSI) and European League Against Rheumatism (EULAR). In the most severe and advanced cases of OA, surgical intervention is necessary. After, in early postoperative stages, it is essential to include a rehabilitation exercise program in order to restore the full function of the involved joint. Physical therapy is crucial for the success of any surgical procedure and can promote recovery of muscle strength, range of motion, coordinated walking, proprioception and mitigate joint pain. Furthermore, after discharge from the hospital, patients should continue the rehabilitation exercise program at home associated to an appropriate diet. In this review, we analyze manuscripts from the most recent literature and provide a balanced and comprehensive overview of the latest developments on the effect of physical exercise on postoperative rehabilitation in OA. The literature search was conducted using PubMed, Scopus, Web of Science and Google Scholar, using the keywords 'osteoarthritis', 'rehabilitation', 'exercise' and 'nutrition'. The available data suggest that physical exercise is an effective, economical and accessible to everyone practice, and it is one of the most important components of postoperative rehabilitation for OA.
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Affiliation(s)
- Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Catania, 95123, Italy
| | - Ali Mobasheri
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK; Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nottingham University Hospitals, Nottingham, NG7 2UH, UK; Center of Excellence in Genomic Medicine Research (CEGMR), King Fahd Medical Research Center (KFMRC), King AbdulAziz University, Jeddah, 21589, Saudi Arabia
| | - Francesca Maria Trovato
- Department of Clinical and Experimental Medicine, Internal Medicine Division, School of Medicine, University of Catania, Catania, 95123, Italy
| | - Marta Anna Szychlinska
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Catania, 95123, Italy
| | - Rosa Imbesi
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Catania, 95123, Italy
| | - Paola Castrogiovanni
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Catania, 95123, Italy
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Guerreiro JPF, Claro RFT, Rodrigues JD, Freire BFA. Effect of watergym in knee osteoarthritis. ACTA ORTOPEDICA BRASILEIRA 2014; 22:25-8. [PMID: 24644416 PMCID: PMC3952867 DOI: 10.1590/s1413-78522014000100004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 11/30/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Evaluate the effectiveness of watergym to alleviate knee osteoarthritis (OA) symptoms and improve locomotor function. METHODS Forty-two volunteers, 38 women and four men with OA, practicing watergym, divided into the following groups: beginners, intermediate, advanced, and advanced level with other physical activities in addition to watergym were included in the study. Individuals were assessed at times zero, 8 and 12 weeks, with classes lasting 45 minutes, twice a week. Function was assessed by the Aggregate Locomotor Function (ALF) score, and pain and other symptoms by the visual analogical scale (VAS) and by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Statistical analysis was carried out by the variance analysis for repeated measurements, followed by Tukey's method for comparison of time point means whenever required. RESULTS None of the tests showed a significant improvement of pain or locomotion. CONCLUSION Watergym was not effective in improving symptoms and did not affect the locomotor capacity of individuals with knee OA. Level of evidence IV, Case series.
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What Does the Cochrane Collaboration Say about Stretching Exercises? Physiother Can 2014; 65:302. [PMID: 24403702 DOI: 10.3138/ptc.65.3.cochrane] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Effect of swimming on clinical functional parameters and serum biomarkers in healthy and osteoarthritic dogs. ISRN VETERINARY SCIENCE 2014; 2014:459809. [PMID: 24977044 PMCID: PMC4060742 DOI: 10.1155/2014/459809] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/16/2013] [Indexed: 01/08/2023]
Abstract
This study aimed to determine whether swimming could improve function of osteoarthritic joints in canine hip OA. Fifty-five dogs were categorized into three groups. The OA with swimming group (OA-SW; n = 22), the healthy (non-OA; n = 18) with swimming group (H-SW), and the healthy (non-OA; n = 15) without swimming group (H-NSW). All animals were allowed to swim for a total of 8 weeks (2-day period, 3 cycles of swimming for 20 minutes, and resting period for 5 minutes in each cycle). Three ml of blood was collected every 2 weeks for evaluation of the levels of biomarkers for OA, including chondroitin sulfate epitope WF6 (CS-WF6) and hyaluronan (HA). Clinical evaluation of the OA-SW group found that most parameters showed improvement (P < 0.01) at week 8 compared to pretreatment, while pain on palpation was improved (P < 0.01) at week 6. The relative level of serum CS-WF6 in the OA-SW group was found to be significantly different (P < 0.01) at weeks 6 and 8 compared with the preexercise. The levels of serum HA of the H-SW group in weeks 2-8 were significantly (P < 0.01) higher than preexercise. Conclusion, swimming over 2-day period, 8 weeks continually, can improve the function of OA joint.
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Alshami AM. Knee osteoarthritis related pain: a narrative review of diagnosis and treatment. Int J Health Sci (Qassim) 2014; 8:85-104. [PMID: 24899883 PMCID: PMC4039588 DOI: 10.12816/0006075] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Osteoarthritis is a common progressive joint disease, involving not only the joint lining but also cartilage, ligaments, and bone. For the last ten years, majority of published review articles were not specific to osteoarthritis of the knee, and strength of evidence and clinical guidelines were not appropriately summarized. OBJECTIVES To appraise the literature by summarizing the findings of current evidence and clinical guidelines on the diagnosis and treatment of knee osteoarthritis pain. METHODOLOGY English journal articles that focused on knee osteoarthritis related pain were searched via PubMed (1 January 2002 - 26 August 2012) and Physiotherapy Evidence Database (PEDro) databases, using the terms 'knee', 'osteoarthritis' and 'pain'. In addition, reference lists from identified articles and related book chapters were included as comprehensive overviews. RESULTS For knee osteoarthritis, the highest diagnostic accuracy can be achieved by presence of pain and five or more clinical or laboratory criteria plus osteophytes. Some inconsistencies in the recommendations and findings were found between the clinical guidelines and systematic reviews. Generally, paracetamol, oral and topical non-steroidal anti-inflammatory drugs, opioids, corticosteroid injections and physical therapy techniques, such as therapeutic exercises, joint manual therapy and transcutaneous electrical nerve stimulation, can help reduce pain and improve function. Patient education programs and weight reduction for overweight patients are important to be considered. CONCLUSIONS Some inconsistencies in the recommendations and findings were found between the clinical guidelines and systematic reviews. However, it is likely that a combination of pharmacological and non-pharmacological treatments is most effective in treating patients with knee osteoarthritis.
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Affiliation(s)
- Ali M. Alshami
- Assistant Professor, Department of Physical Therapy, College of Applied Medical Sciences, University of Dammam
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Abstract
BACKGROUND This is an update of a Cochrane review first published in 2002. Osteoarthritis is a disease that affects the synovial joints, causing degeneration and destruction of hyaline cartilage and subchondral bone. Electromagnetic field therapy is currently used by physiotherapists and may promote growth and repair of bone and cartilage. It is based on principles of physics which include Wolff's law, the piezoelectric effect and the concept of streaming potentials. OBJECTIVES To assess the benefits and harms of electromagnetic fields for the treatment of osteoarthritis as compared to placebo or sham. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9), PreMEDLINE for trials published before 1966, MEDLINE from 1966 to October 2013, CINAHL and PEDro up to and including October 2013. Electronic searches were complemented by handsearches. SELECTION CRITERIA Randomised controlled trials of electromagnetic fields in osteoarthritis, with four or more weeks treatment duration. We included papers in any language. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion in the review and resolved differences by consensus with a third review author. We extracted data using pre-developed data extraction forms. The same review authors assessed the risk of bias of the trials independently using the Cochrane 'Risk of bias' tool. We extracted outcomes for osteoarthritis from the publications according to Outcome Measures in Rheumatology Clinical Trials (OMERACT) guidelines. We expressed results for continuous outcome measures as mean difference (MD) or standardised mean difference (SMD) with 95% confidence interval (CI). We pooled dichotomous outcome measures using risk ratio (RR) and calculated the number needed to treat (NNT). MAIN RESULTS Nine studies with a total of 636 participants with osteoarthritis were included, six of which were added in this update of the review. Selective outcome reporting was unclear in all nine included studies due to inadequate reporting of study design and conduct, and there was high risk of bias for incomplete outcome data in three studies. The overall risk of bias across the nine studies was low for the other domains.Participants who were randomised to electromagnetic field treatment rated their pain relief 15.10 points more on a scale of 0 to 100 (MD 15.10, 95% CI 9.08 to 21.13; absolute improvement 15%) after 4 to 26 weeks' treatment compared with placebo. Electromagnetic field treatment had no statistically significant effect on physical function (MD 4.55, 95% CI -2.23 to 11.32; absolute improvement 4.55%) based on the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scale from 0 to 100 after 12 to 26 weeks' treatment. We also found no statistically significant difference in quality of life on a scale from 0 to 100 (SMD 0.09, 95% CI -0.36 to 0.54; absolute improvement 0.09%) after four to six weeks' treatment, based on the SF-36. No data were available for analysis of radiographic changes. Safety was evaluated in four trials including up to 288 participants: there was no difference in the experience of any adverse event after 4 to 12 weeks of treatment compared with placebo (RR 1.17, 95% CI 0.72 to 1.92). There was no difference in participants who withdrew because of adverse events (measured in one trial) after four weeks of treatment (RR 0.90, 95% CI 0.06 to 13.92). No participants experienced any serious adverse events. AUTHORS' CONCLUSIONS Current evidence suggests that electromagnetic field treatment may provide moderate benefit for osteoarthritis sufferers in terms of pain relief. Further studies are required to confirm whether this treatment confers clinically important benefits in terms of physical function and quality of life. Our conclusions are unchanged from the previous review conducted in 2002.
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Affiliation(s)
- Shasha Li
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, No.37 Guo-xue-xiang Street, Chengdu, Sichuan Province, China, 610041
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Shead D, Aswegen HV. Hydrotherapy in the management of chronic obstructive pulmonary disease: a qualitative systematic review. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x12y.0000000024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Affiliation(s)
- Wei Yang
- Chinese PLA General Hospital; Department of Endocrinology; 28 Fuxing Road Haidian district Beijing Beijing China 100853
| | - Qi Zhuo
- Chinese PLA General Hospital; Department of Orthopaedic Surgery; 28 Fuxing Road Haidian district Beijing China 100853
| | - Wei Chai
- Chinese PLA General Hospital; Department of Orthopaedic Surgery; 28 Fuxing Road Haidian district Beijing China 100853
| | - Jiying Chen
- Chinese PLA General Hospital; Department of Orthopaedic Surgery; 28 Fuxing Road Haidian district Beijing China 100853
| | - Cheng Sun
- Peking University Third Hospital; Department of Orthopaedic Surgery; 49 North Garden Road Haidian district Beijing China 100191
| | - Yan Wang
- Chinese PLA General Hospital; Department of Orthopaedic Surgery; 28 Fuxing Road Haidian district Beijing China 100853
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Susko AM, Fitzgerald GK. The pain-relieving qualities of exercise in knee osteoarthritis. Open Access Rheumatol 2013; 5:81-91. [PMID: 27790027 PMCID: PMC5074793 DOI: 10.2147/oarrr.s53974] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The purpose of this review article is to explore the role of therapeutic exercise in managing the pain associated with knee osteoarthritis (OA). Therapeutic exercise is often recommended as a first-line conservative treatment for knee OA, and current evidence supports exercise as an effective pain-relieving intervention. We explore the current state of evidence for exercise as a pain-relieving intervention for knee OA. Next, the mechanisms by which knee OA pain occurs and the potential ways in which exercise may act on those mechanisms are discussed. Clinical applicability and future research directions are suggested. Although evidence demonstrates that exercise reduces knee OA pain, optimal exercise mode and dosage have not been determined. In addition, it is not clearly understood whether exercise provides pain relief via peripheral or central mechanisms or a combination of both. Published clinical trials have explored a variety of interventions, but these interventions have not been specifically designed to target pain pathways. Current evidence strongly supports exercise as a pain-relieving option for those with knee OA. Future research needs to illuminate the mechanisms by which exercise reduces the pain associated with knee OA and the development of therapeutic exercise interventions to specifically target these mechanisms.
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Affiliation(s)
- Allyn M Susko
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - G Kelley Fitzgerald
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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Uthman OA, van der Windt DA, Jordan JL, Dziedzic KS, Healey EL, Peat GM, Foster NE. Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis. BMJ 2013; 347:f5555. [PMID: 24055922 PMCID: PMC3779121 DOI: 10.1136/bmj.f5555] [Citation(s) in RCA: 214] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine whether there is sufficient evidence to conclude that exercise interventions are more effective than no exercise control and to compare the effectiveness of different exercise interventions in relieving pain and improving function in patients with lower limb osteoarthritis. DATA SOURCES Nine electronic databases searched from inception to March 2012. STUDY SELECTION Randomised controlled trials comparing exercise interventions with each other or with no exercise control for adults with knee or hip osteoarthritis. DATA EXTRACTION Two reviewers evaluated eligibility and methodological quality. Main outcomes extracted were pain intensity and limitation of function. Trial sequential analysis was used to investigate reliability and conclusiveness of available evidence for exercise interventions. Bayesian network meta-analysis was used to combine both direct (within trial) and indirect (between trial) evidence on treatment effectiveness. RESULTS 60 trials (44 knee, two hip, 14 mixed) covering 12 exercise interventions and with 8218 patients met inclusion criteria. Sequential analysis showed that as of 2002 sufficient evidence had been accrued to show significant benefit of exercise interventions over no exercise control. For pain relief, strengthening, flexibility plus strengthening, flexibility plus strengthening plus aerobic, aquatic strengthening, and aquatic strengthening plus flexibility, exercises were significantly more effective than no exercise control. A combined intervention of strengthening, flexibility, and aerobic exercise was also significantly more effective than no exercise control for improving limitation in function (standardised mean difference -0.63, 95% credible interval -1.16 to -0.10). CONCLUSIONS As of 2002 sufficient evidence had accumulated to show significant benefit of exercise over no exercise in patients with osteoarthritis, and further trials are unlikely to overturn this result. An approach combining exercises to increase strength, flexibility, and aerobic capacity is likely to be most effective in the management of lower limb osteoarthritis. The evidence is largely from trials in patients with knee osteoarthritis. PROTOCOL REGISTRATION PROSPERO (www.crd.york.ac.uk/prospero/) No CRD42012002267.
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Affiliation(s)
- Olalekan A Uthman
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire ST5 5BG, UK
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Schencking M, Wilm S, Redaelli M. A comparison of Kneipp hydrotherapy with conventional physiotherapy in the treatment of osteoarthritis: a pilot trial. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2013; 11:17-25. [PMID: 23464642 DOI: 10.3736/jintegrmed2013004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND An increasingly aging population implies an increasing prevalence of osteoarthritis (OA) of hip or knee. It has been ascertained that unspecific hydrotherapy of OA according to Sebastian Kneipp not only improves the range of mobility but also reduces pain significantly and increases the quality of life of the patients affected. OBJECTIVE The main aim of this pilot study was to determine the effects of hydrotherapy in comparison to conventional physiotherapy, and to analyze the feasibility of the study design under clinical circumstances. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS The study design is a prospective randomized controlled three-arm clinical pilot trial, carried out at a specialist clinic for integrative medicine. Thirty patients diagnosed with symptomatic OA of hip or knee and radiologic findings were randomly assigned to one of two intervention groups and a control group: hydrotherapy (group 1), physiotherapy (group 2), and both physiotherapy and hydrotherapy (group 3, control group) of the affected joint. MAIN OUTCOME MEASURES PRIMARY OUTCOME pain intensity of the affected joint in the course of inpatient treatment; secondary outcome: health-related quality of life, joint-specific pain and mobility in the course of the study. RESULTS Concerning the main outcome, intervention group 1 showed most beneficial effects in the course of inpatient treatment, followed by groups 3 and 2, and also the indirect flexion ability of hip or knee together with the general patient mobility through the "timed up and go" test were mainly improved within group 1 followed by groups 3 and 2. CONCLUSION The results of this pilot study demonstrate beneficial effects of hydrotherapy. The study design is feasible. For statistically significant evidence and a robust conclusion of efficacy of Kneipp's hydrotherapy, a larger sample size is necessary. TRIAL REGISTRATION NUMBER NCT 00950326.
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Affiliation(s)
- Martin Schencking
- Institute for General Practice and Family Medicine, University Witten/Herdecke, Germany.
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Jolles BM, Eudier AF, Lécureux E. Unicompartmental arthroplasty for knee osteoarthritis. Hippokratia 2013. [DOI: 10.1002/14651858.cd010563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Brigitte M Jolles
- Centre Hospitalier Universitaire Vaudois and University of Lausanne; Department of Orthopaedic Surgery and Traumatology; Site Hôpital Orthopédique 4 Avenue Pierre Decker Lausanne Switzerland 1011
| | - Antoine F Eudier
- Centre Hospitalier Universitaire Vaudois and University of Lausanne; Department of Orthopaedic Surgery and Traumatology; Site Hôpital Orthopédique 4 Avenue Pierre Decker Lausanne Switzerland 1011
| | - Estelle Lécureux
- Centre Hospitalier Universitaire Vaudois / University of Lausanne; Direction médicale; 21, ch. du Bugnon Lausanne CH Switzerland 1011
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Abstract
One- half of women in the United States do not meet the weekly dose of physical activity recommended by the Centers for Disease Control. Many women could benefit tremendously if they were to adopt a more active lifestyle. Health benefits from exercise include lowering the risk for cardiovascular disease, slowing the rate of bone loss in osteoporosis, and improving mood during pregnancy. In this article, we review the health benefits that women may gain from physical activity and the recommendations for physical activity for adults in the United States. We offer evidence supporting use of the exercise prescription, discuss how to write an exercise prescription, and how to tailor the exercise prescription for women with particular medical problems.
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Affiliation(s)
- Carlin Senter
- />Departments of Medicine and Orthopedics, University of California, San Francisco, 1500 Owens Street, San Francisco, CA 94158 USA
| | - Nicole Appelle
- />Division of General Internal Medicine, University of California, San Francisco, 1545 Divisadero, 2nd Floor, San Francisco, CA 94143 USA
| | - Sarina K. Behera
- />Departments of Cardiology and Pediatrics, California Pacific Medical Center, 3700 California Street, Ste 1560, San Francisco, CA 94118 USA
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Stemberger R, Kerschan-Schindl K. Osteoarthritis: physical medicine and rehabilitation—nonpharmacological management. Wien Med Wochenschr 2013; 163:228-35. [DOI: 10.1007/s10354-013-0181-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 01/15/2013] [Indexed: 12/29/2022]
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Cuesta-Vargas AI, González-Sánchez M, Casuso-Holgado MJ. Effect on health-related quality of life of a multimodal physiotherapy program in patients with chronic musculoskeletal disorders. Health Qual Life Outcomes 2013; 11:19. [PMID: 23414183 PMCID: PMC3577634 DOI: 10.1186/1477-7525-11-19] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 02/13/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Musculoskeletal disorders are major causes of morbidity in the world, and these conditions have a strong negative influence in terms of health-related quality of life. The purpose of this study was to evaluate the effect of an 8-week multimodal physical therapy program on general health state and health-related quality of life in patients with chronic musculoskeletal disorders. METHODS There were 244 participants in this prospective cohort analysis with 8-week follow-up. The primary outcome was general health state (physical and mental components), determined with the Short Form-12 Health Survey (SF-12). The secondary outcome was health related quality of life, determined with the EuroQoL-5D and VAS. The intervention was evaluated by comparing pre- and post-outcome measurements. T-tests were performed for paired data. RESULTS Differences were statistically significant for physical health state: +1.68 (p < 0.05) (baseline: 42.38); mental health state: +3.15 (p < 0.001) (baseline: 46.57); and health related quality of life: +0.18 (EuroQoL 5D) (baseline: 46.57) and +7.22 (EuroQoL_VAS) (p < 0.001) (baseline: 60.81). Intervention resulted in clinically relevant changes in terms of percentage improvement from baseline scores. CONCLUSIONS Eight weeks of a Multimodal Physical Therapy Program seemed to moderately enhance the general health state and HRQoL of patients with chronic musculoskeletal diseases. This kind of therapeutic exercise can be recommended to patients with chronic low back pain, chronic neck pain and osteoarthritis, at least in the short term.
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Affiliation(s)
- Antonio Ignacio Cuesta-Vargas
- School of Clinical Science, Queensland University of Technology, Brisbane, Australia
- Physiotherapy Department, University of Malaga, Malaga, Spain
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Cunningham NR, Kashikar-Zuck S. Nonpharmacological treatment of pain in rheumatic diseases and other musculoskeletal pain conditions. Curr Rheumatol Rep 2013; 15:306. [PMID: 23307578 PMCID: PMC3566663 DOI: 10.1007/s11926-012-0306-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Pain is a complex phenomenon affected by biological, psychological, and social factors. Treatment of pain is most effective when using a multidisciplinary approach consisting of a careful selection of pharmacological and non-pharmacological interventions based upon disease factors, pain characteristics, psychological coping abilities, and lifestyle factors. In this review we focus on research-based evidence for non-pharmacological intervention including psychological intervention, physical exercise, patient education, and complementary approaches for pain management for patients with rheumatic diseases and common musculoskeletal pain conditions, such as low back pain. The vast majority of research studies on chronic pain conditions are focused on adults but pediatric studies are also reviewed wherever possible, to give the reader a more inclusive view of non-pharmacological approaches for pain management across the lifespan.
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Affiliation(s)
- Natoshia Raishevich Cunningham
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3026, USA.
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Beckwée D, Vaes P, Cnudde M, Swinnen E, Bautmans I. Osteoarthritis of the knee: why does exercise work? A qualitative study of the literature. Ageing Res Rev 2013; 12:226-36. [PMID: 23026409 DOI: 10.1016/j.arr.2012.09.005] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 09/17/2012] [Accepted: 09/21/2012] [Indexed: 12/19/2022]
Abstract
The effectiveness of exercise to reduce pain and improve functioning in osteoarthritis of the knee (OAk) is well substantiated. Underlying mechanisms are still under debate and better understanding of the pathways involved may contribute to more targeted treatment strategies. The present qualitative analysis of the literature aims to provide an overview of theoretical models that are put forward to explain the beneficial treatment effects of exercise in OAk. An inductive qualitative approach, based on the 'grounded theory' of Glaser and Straus, was used. Twenty-two studies emphasizing on exercise therapy for OAk, collected from three Cochrane reviews and nine guidelines of the Physiotherapy Evidence Database (PEDRO) published between 2000 and 2012, were included. The introduction and discussion parts of these papers were screened for explanations of exercise-induced benefits in OAk patients. Seventy-three key points were identified which were subdivided into 16 core theoretical concepts. Finally, 5 categories were formed: neuromuscular, peri-articular, intra-articular, psychosocial components, and general fitness and health. We referred to scientific evidence that was used in the included studies to describe and categorize the concepts. Future research on exercise in OAk should allow distinguishing the contribution of different potential pathways to the treatment effects.
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Lim CG, Lee SJ, Ko E, Lee KS. Effect of a Complex Exercise Program for the Lower Extremities on Quadriceps Activity and Pain of Elderly Patients with Knee Osteoarthritis: a Pilot Study. J Phys Ther Sci 2013. [DOI: 10.1589/jpts.25.249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Chae Gil Lim
- Department of Physical Therapy, Gachon University
| | - Sun-Ju Lee
- Department of Physical Therapy, Graduate School of Public Health and Social Welfare, Medicine and Science of Gachon University
| | - Eunhye Ko
- Professional Physical Therapy P.C.: 143-70 Sanford Ave., Flushing, NY 11355, USA
| | - Kang Sung Lee
- Department of Prosthetics and Orthotics, Hanseo University
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70
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Golightly YM, Allen KD, Caine DJ. A comprehensive review of the effectiveness of different exercise programs for patients with osteoarthritis. PHYSICIAN SPORTSMED 2012; 40:52-65. [PMID: 23306415 PMCID: PMC4077018 DOI: 10.3810/psm.2012.11.1988] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Exercise is recommended as a first-line conservative intervention approach for osteoarthritis (OA). A wide range of exercise programs are available and scientific evidence is necessary for choosing the optimal strategy of treatment for each patient. The purpose of this review is to discuss the effectiveness of different types of exercise programs for OA based on trials, systematic reviews, and meta-analyses in the literature. Publications from January 1997 to July 2012 were searched in 4 electronic databases using the terms osteoarthritis, exercise, exercise program, effectiveness, and treatment outcome. Strong evidence supports that aerobic and strengthening exercise programs, both land- and water-based, are beneficial for improving pain and physical function in adults with mild-to-moderate knee and hip OA. Areas that require further research include examination of the long-term effects of exercise programs for OA, balance training for OA, exercise programs for severe OA, the effect of exercise programs on progression of OA, the effectiveness of exercise for joint sites other than the knee or hip, and the effectiveness of exercise for OA by such factors as age, sex, and obesity. Efforts to improve adherence to evidence-based exercise programs for OA and to promote the dissemination and implementation of these programs are crucial.
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Affiliation(s)
- Yvonne M. Golightly
- Research Assistant Professor, Department of Epidemiology, University of North Carolina, Chapel Hill, NC,Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC,Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC
| | - Kelli D. Allen
- Associate Research Professor, Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC,Research Health Scientist, Health Services Research and Development Service, Durham Veterans Affairs Medical Center, Durham, NC
| | - Dennis J. Caine
- Professor, Department of Physical Education, Exercise Science and Wellness, University of North Dakota, Grand Forks, ND
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71
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Effects of weekly and fortnightly therapeutic exercise on physical function and health-related quality of life in individuals with hip osteoarthritis. J Orthop Sci 2012; 17:737-44. [PMID: 22918618 DOI: 10.1007/s00776-012-0292-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 08/01/2012] [Indexed: 02/09/2023]
Abstract
BACKGROUND Most previous studies on the effects of therapeutic exercise on osteoarthritis (OA) of the hip joint included participants with knee OA or postoperative participants. Moreover, although some systematic reviews recommend therapeutic exercise for hip OA, a consensus on the effective interventional frequency has not been reached. This study aimed to investigate the effects of therapeutic exercise performed at different frequencies on physical function and health-related quality of life in participants with hip OA. METHODS Individuals diagnosed with hip OA (36 women, age 42-79 years; 19 in 2009 and 17 in 2010) were recruited from the cooperating medical institutions. They were divided into two groups depending on the frequency of therapeutic exercise: fortnightly in 2009 (fortnightly group) and weekly in 2010 (weekly group). Participants in each group performed the same land-based and aquatic exercises on the same day for a total of ten sessions. Muscle strength of the lower extremity, "timed up and go" (TUG), time of one-leg standing with open eyes (TOLS), Harris Hip Score, and scores of the Medical Outcomes Survey Short Form-36 questionnaire, were measured before and after interventions. RESULTS The fortnightly group had no significant changes in lower-extremity muscle strength following intervention, but the strength of all muscles in the weekly group improved significantly after intervention. Further, in both groups, TUG and TOLS of the worse side of the hip joint significantly improved after interventions. CONCLUSIONS Weekly exercise improves muscle strength of the lower extremity and may therefore be an effective interventional technique for managing hip OA. In addition, in persons with hip OA, therapeutic exercise consisting of both land- and water-based exercises markedly improved physical function.
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72
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Semanik PA, Chang RW, Dunlop DD. Aerobic activity in prevention and symptom control of osteoarthritis. PM R 2012; 4:S37-44. [PMID: 22632701 DOI: 10.1016/j.pmrj.2012.02.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 02/13/2012] [Indexed: 11/15/2022]
Abstract
Almost 27 million adults in the United States experience some form of osteoarthritis (OA). An epidemic of arthritis-associated disability is expected in the United States during the next 2 decades, largely fueled by the aging population and the tremendous growth in the prevalence of knee OA. Regular physical activity (PA), particularly strengthening and aerobic activity, can reduce pain and improve function and health status among patients with knee and hip OA. The focus of this review is on the impact of aerobic activity on the progression and symptom control of OA. In general, both strengthening and aerobic exercise are associated with improvements in pain, perceived physical function, and performance measures for persons with lower limb OA, although comparisons of strengthening versus aerobic exercise on these outcomes are unusual. Structural disease progression in persons with established OA has been directly evaluated by a limited number of PA clinical trials for persons with knee OA, but these protocols focused on strength training exclusively. In healthy subjects, it appears that overall PA is beneficial, rather than detrimental, to knee joint health. Possibly the most important reason for engaging in PA is to prevent obesity, which independently has been associated with many serious chronic diseases, including the incidence and progression of OA. More research is needed to determine the optimal types and dosing of aerobic conditioning.
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Affiliation(s)
- Pamela A Semanik
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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73
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Tolerance of an aquatic power training program by older adults with symptomatic knee osteoarthritis. ARTHRITIS 2012; 2012:895495. [PMID: 23008770 PMCID: PMC3449099 DOI: 10.1155/2012/895495] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 08/09/2012] [Indexed: 01/22/2023]
Abstract
Objective. To determine the tolerance and feasibility of aquatic-based power training for improving lower limb muscle power, impairments, and mobility in adults with symptomatic knee OA. Participants. Twenty-nine adults, age 50 years and over, with symptomatic knee OA (ACR clinical criteria) and mobility limitation (400-meter walk time slower than median for sex and decade) completed 45-minute aquatic power training sessions twice weekly for 6 weeks. Main Outcome Measurements. Prospective outcomes included tolerance of the program, as well as change in stair climb power, 400-meter walk time, overall and knee-specific pain, activities of daily living (ADL), quality of life (QOL), and lower limb function at 6- and 12-week follow-up. Results. The training intensity required modification for 9 of the 29 participants. Lower limb muscle power, ADL, QOL, and overall pain were improved immediately and 6 weeks following completion (all P < 0.05). However, 400-meter walk times, and lower limb function did not differ from baseline. Conclusions. A 6-week aquatic rehabilitation program appears to be well tolerated by adults with symptomatic knee OA with mobility limitations and may result in improved lower limb muscle power, symptoms, ADL, and QOL. However, this intervention may have insufficient specificity or intensity for improving physical function.
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74
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Iversen MD. Managing Hip and Knee Osteoarthritis with Exercise: What is the Best Prescription? Ther Adv Musculoskelet Dis 2012; 2:279-90. [PMID: 22870454 DOI: 10.1177/1759720x10378374] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hip and knee osteoarthritis are common, chronic, and disabling. Therapeutic exercise is a component of all major rheumatologic society guidelines, yet the frequency, dose, duration, and therapeutic threshold for exercise are not clearly delineated. This review summarizes current studies of exercise for hip and knee osteoarthritis, discusses issues that influence the design, interpretation, and aggregation of results and how these factors impact the translation of data into clinical practice. A review of databases to identify current randomized controlled trials (2000 to present) of exercise to manage the symptoms of hip and knee osteoarthritis is discussed here. One study enrolling only hip patients was identified. Six studies of outcomes for individuals with hip or knee osteoarthritis and 11 studies of persons with knee osteoarthritis were found. Limited studies focus specifically on exercise for persons with hip osteoarthritis. Exercise is provided as a complex intervention combining multiple modes and provided in various settings under a range of conditions. Regardless of the variability in results and inherent biases in trials, exercise appears to reduce pain and improve function for persons with knee osteoarthritis and provide pain relief for persons with hip osteoarthritis. Given the complexity of exercise interventions and the specific issues related to study design, novel approaches to the evaluation of exercise are warranted.
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75
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Iwamoto J, Sato Y, Takeda T, Matsumoto H. Effectiveness of exercise for osteoarthritis of the knee: A review of the literature. World J Orthop 2012; 2:37-42. [PMID: 22474634 PMCID: PMC3302040 DOI: 10.5312/wjo.v2.i5.37] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 05/03/2011] [Accepted: 05/10/2011] [Indexed: 02/06/2023] Open
Abstract
Osteoarthritis (OA) of the knee is the most common type of arthritis and the major cause of chronic musculoskeletal pain and mobility disability in the elderly. The objective of this paper is to discuss the effectiveness of exercise for OA of the knee based on a review of the literature. We reviewed the relevant literature, i.e. systematic reviews and meta-analyses searched using PubMed. Muscle strengthening and aerobic exercises are effective in reducing pain and improving physical function in patients with mild to moderate OA of the knee.
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Affiliation(s)
- Jun Iwamoto
- Jun Iwamoto, Tsuyoshi Takeda, Hideo Matsumoto, Institute for Integrated Sports Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo 160-8582, Japan
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76
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Robbins L, Kulesa MG. The state of the science in the prevention and management of osteoarthritis: experts recommend ways to increase nurses' awareness and knowledge of osteoarthritis. HSS J 2012; 8:151-8. [PMID: 23874256 PMCID: PMC3715627 DOI: 10.1007/s11420-012-9272-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Laura Robbins
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Marjorie G. Kulesa
- Department of Orthopaedic Surgery, Winthrop-University Hospital, 259 First Street, Mineola, NY 11501 USA
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77
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Juhl C, Lund H, Roos EM, Zhang W, Christensen R. A hierarchy of patient-reported outcomes for meta-analysis of knee osteoarthritis trials: empirical evidence from a survey of high impact journals. ARTHRITIS 2012; 2012:136245. [PMID: 22792458 PMCID: PMC3389647 DOI: 10.1155/2012/136245] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 04/05/2012] [Indexed: 12/12/2022]
Abstract
Objectives. To develop a prioritised list based on responsiveness for extracting patient-reported outcomes (PROs) measuring pain and disability for performing meta-analyses in knee osteoarthritis (OA). Methods. A systematic search was conducted in 20 highest impact factor general and rheumatology journals chosen a priori. Eligible studies were randomised controlled trials, using two or more PROs measuring pain and/or disability. Results. A literature search identified 402 publications and 38 trials were included, resulting in 54 randomised comparisons. Thirty-five trials had sufficient data on pain and 15 trials on disability. The WOMAC "pain" and "function" subscales were the most responsive composite scores. The following list was developed. Pain: (1) WOMAC "pain" subscale, (2) pain during activity (VAS), (3) pain during walking (VAS), (4) general knee pain (VAS), (5) pain at rest (VAS), (6) other composite pain scales, and (7) other single item measures. Disability: (1) WOMAC "function" subscale, (2) SF-36 "physical function" subscale, (3) SF-36 (Physical composite score), and (4) Other composite disability scores. Conclusions. As choosing the PRO most favourable for the intervention from individual trials can lead to biased estimates, using a prioritised list as developed in this study is recommended to reduce risk of biased selection of PROs in meta-analyses.
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Affiliation(s)
- Carsten Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
- Department of Physiotherapy, Copenhagen University Hospital, Gentofte, 2900 Hellerup, Denmark
| | - Hans Lund
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
| | - Ewa M. Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
| | - Weiya Zhang
- Academic Rheumatology, University of Nottingham, Nottingham NG5 1PB, UK
| | - Robin Christensen
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
- Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital, Frederiksberg, 2000 Frederiksberg, Denmark
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Affiliation(s)
- Alain Boussuges
- French Armed Forces Biomedical Research Institute, Brétigny sur Orge and UMR MD2, Aix-Marseilles University, Marseilles, France
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79
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Is water-based exercise training sufficient to improve physical fitness in the elderly? Eur Rev Aging Phys Act 2012. [DOI: 10.1007/s11556-012-0097-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Abstract
The research on the effects of aquatic exercise is a field that has grown rapidly in the last decade. The majority of the available literature is focused on the benefits of water-based exercise programs for people with rheumatologic disease and back pain; however, there is a lack of evidence reporting the effects of exercise performed in an aquatic medium for healthy elderly adults. The purpose of this study was to critically review the existing evidence of a potential relationship between water-based exercise and improvement of physical fitness in healthy elderly subjects. A systematic database search for manuscripts and a quality control were performed. A system of rating was defined. Aerobic, muscular strength, flexibility and body composition outcomes were then extracted. Nine studies were analyzed after the screening for eligibility: five randomized controlled trials (RCT), three randomized uncontrolled trials (UT) and one controlled trial (CT). Four RCT and two randomized UT were classified as high quality studies. One RCT, one randomized UT and one CT were considered low quality studies. Strong evidence supports the use of water-based exercise for the improvement of aerobic capacity and strength. Moderate evidence highlights the benefits on flexibility, and inconclusive evidence was found supporting the modification of body composition.
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80
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Esser S, Bailey A. Effects of exercise and physical activity on knee osteoarthritis. Curr Pain Headache Rep 2012; 15:423-30. [PMID: 21956792 DOI: 10.1007/s11916-011-0225-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Exercise is one of the most discussed and controversial nonpharmacologic management strategies for osteoarthritis (OA) of the knee. Health care providers and patients share varied and often pseudoscientific beliefs regarding the effects of exercise on knee OA formulated on outdated notions of the etiology, pathophysiology, and progression of the condition. Based on the contemporary literature, regular light to moderate physical activity has both preventive and therapeutic benefits for individuals with knee OA. Exercise regimens with strong evidence of benefit include those that focus on aerobic/cardiovascular conditioning and lower extremity strength training. Health care providers should confidently incorporate exercise recommendations into clinical management and offer patients evidence-based and individually tailored exercise prescriptions to help manage the painful and often disabling symptoms of this condition.
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Affiliation(s)
- Stephan Esser
- Harvard Medical School, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA 02114, USA
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81
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Kon E, Filardo G, Drobnic M, Madry H, Jelic M, van Dijk N, Della Villa S. Non-surgical management of early knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2012; 20:436-49. [PMID: 22037809 DOI: 10.1007/s00167-011-1713-8] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 10/06/2011] [Indexed: 12/24/2022]
Abstract
Conservative approach is usually the first choice for the management of the knee degeneration processes, especially in the phase of the disease recognized as early osteoarthritis (OA) with no clear lesions or associated abnormalities requiring to be addressed surgically. A wide spectrum of treatments is available, from non-pharmacological modalities to dietary supplements and pharmacological therapies, as well as minimally invasive procedures involving injections of various substances aiming to restore joint homeostasis and provide clinical improvement and possibly a disease-modifying effect. Numerous pharmaceuticals have been proposed, but since no therapy has shown all the characteristic of an ideal treatment, and side effects have been reported at both systemic and local level, the use of pharmacological agents should be considered with caution by assessing the risk/benefit ratio of the drugs prescribed. Both patients and physicians should have realistic outcome goals in pharmacological treatment, which should be considered together with other conservative measures. A combination of these therapeutic options is a more preferable scenario, in particular considering the evidence available for non-pharmacological management. In fact, exercise is an effective conservative approach, even if long-term effectiveness and optimal dose and administration modalities still need to be clarified. Finally, physical therapies are emerging as viable treatment options, and novel biological approaches are under study. Further studies to increase the limited medical evidence on conservative treatments, optimizing results, application modalities, indications, and focusing on early OA will be necessary in the future. Level of evidence IV.
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Affiliation(s)
- Elizaveta Kon
- Biomechanics Laboratory - III Clinic, Rizzoli Orthopaedic Institute, Via Di Barbiano,1/10, 40136, Bologna, Italy.
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82
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Honda T, Kamioka H. Curative and health enhancement effects of aquatic exercise: evidence based on interventional studies. Open Access J Sports Med 2012; 3:27-34. [PMID: 24198584 PMCID: PMC3781896 DOI: 10.2147/oajsm.s30429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to report on the health benefits and curative effects of aquatic exercise. METHODS We adopted the results of high-grade study designs (ie, randomized controlled trials and nonrandomized controlled trials), for which there were many studies on aquatic exercise. Aquatic exercise, in this study, means walking in all directions, stretching, and various exercises and conditioning performed with the feet grounded on the floor of a swimming pool. We excluded swimming. We decided to treat aquatic exercise, underwater exercise, hydrotherapy, and pool exercise as all having the same meaning. RESULTS Aquatic exercise had significant effects on pain relief and related outcome measurements for locomotor diseases. CONCLUSION Patients may become more active, and improve their quality of life, as a result of aquatic exercise.
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Affiliation(s)
- Takuya Honda
- Research Fellow of the Japanese Society for the Promotion of Science, Tokyo University of Agriculture, Tokyo, Japan
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83
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A randomized controlled trial to investigate the effects of water-based exercise to improve falls risk and physical function in older adults with lower-extremity osteoarthritis. Arch Phys Med Rehabil 2011; 93:27-34. [PMID: 21982325 DOI: 10.1016/j.apmr.2011.08.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 08/03/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the efficacy of a water-based exercise program specifically targeting balance to reduce falls risk and improve measures of balance and physical function in older adults with osteoarthritis (OA). DESIGN Randomized controlled trial. SETTING Community. PARTICIPANTS Persons (N=39; mean±SD age, 74±6y; 26 women) with mild to moderate OA and at risk for falling met study criteria, were measured at baseline, and were randomly assigned to the intervention (n=23) and control groups (n=16). INTERVENTIONS Water-based program (12wk, twice weekly; intervention group) or a time-matched computer training program (control group). MAIN OUTCOME MEASURE The primary outcome was the short-form Physiological Profile Assessment (PPA). Secondary outcomes included the Step Test, Timed Up and Go Test, Western Ontario and McMaster Universities OA Index (Likert 3.0 version), Arthritis Impact Measurement Scales 2, and Activity-specific Balance Confidence Scale. RESULTS No statistically significant between-group differences were found for any outcome measured (n=35; 4 lost to follow-up). Within-group analysis indicated that Step Test results improved significantly in both groups (mean change: control group, left leg, 2.07; 95% confidence interval, 3.19-.95; P=.002; intervention group, 2.14; 95% confidence interval, 3.20-1.08; P=.000). Two PPA item scores (reaction time, contrast sensitivity) improved significantly (86.83; 95% confidence interval, 9.86-163.79; P=.03; 1.43; 95% confidence interval, 2.35-.50; P=.005, respectively) in the control group, resulting in a lower falls risk score. CONCLUSIONS Water-based exercise did not reduce falls risk in our sample compared with attending a computer skills training class. Our study is, to our knowledge, the first to compare water-based exercise in this population with a control group that attended a time-dose-equivalent seated community-based activity. Whether gaining computer skills and going out into the community twice weekly is adequate stimulus to reduce falls risk in people with OA requires further investigation.
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84
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Balance dysfunction and falls in people with lower limb arthritis: factors contributing to risk and effectiveness of exercise interventions. Eur Rev Aging Phys Act 2011. [DOI: 10.1007/s11556-011-0086-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Abstract
Chronic musculoskeletal conditions in the lower extremities, particularly arthritis, and the chronic pain associated with them, are independent risk factors for falls, with approximately 50% of people with arthritis reporting one or more falls. Despite this, few studies have specifically addressed balance dysfunction, falls risk and falls incidence in people with arthritis. This review aimed to identify potential factors contributing to the increased risk of falls in people with lower limb osteoarthritis or rheumatoid arthritis and to summarise the evidence base for effective exercise interventions targeted to reduce their risk of falls. A systematic search of the literature was conducted in February 2010 and included the following databases: MEDLINE (Ovid), EMBASE, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine, Cochrane Library and PsycINFO. Only three studies that investigated exercise programmes for people with lower limb arthritis met all inclusion criteria, but none used falls as an outcome measure. To broaden the review, systematic reviews that assessed the effectiveness of exercise interventions for fall prevention in older people were also included. The presence of any form of lower limb arthritis and the associated consequences including pain, balance impairment, reduced muscle strength and reduced function are all associated with increased risk of falling. Due to the link between musculoskeletal pain and the increased risk of falls, further research needs to investigate which type of exercise programme will be effective in reducing the risk of falls in populations with arthritis in the lower limbs.
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85
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Rodriguez D, Silva V, Prestes J, Rica RL, Serra AJ, Bocalini DS, Pontes FL. Hypotensive response after water-walking and land-walking exercise sessions in healthy trained and untrained women. Int J Gen Med 2011; 4:549-54. [PMID: 21887107 PMCID: PMC3160863 DOI: 10.2147/ijgm.s23094] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Indexed: 11/24/2022] Open
Abstract
Background: The aim of this study was to compare post-exercise hypotension after acute sessions of water-walking and land-walking in healthy trained and untrained women. Methods: Twenty-three untrained (n = 12) and trained (n = 11) normotensive women performed two walking sessions in water and on land at 40% of peak VO2 for 45 minutes. Systolic and diastolic blood pressure and mean arterial pressure were measured 15, 30, 45, and 60 minutes after the exercise sessions. Results: No differences were found between the groups for age and anthropometric parameters, but peak VO2 for the trained women (45 ± 8 mL/kg/minute) was higher than for the untrained women (31 ± 3 mL/kg/minute). No differences were found between the groups with regard to systolic and diastolic blood pressure and mean arterial pressure after water immersion. The heart rate in the trained group (62 ± 3 beats per minute [bpm]) was significantly lower (P < 0.05) than in the untrained group (72 ± 4 bpm) on land, and after water immersion, this difference disappeared (58 ± 5 bpm in the trained women and 66 ± 5 bpm in the untrained women). Sixty minutes after water-walking, systolic blood pressure (108 ± 8 mmHg vs 97 ± 3 mmHg), diastolic blood pressure (69 ± 5 mmHg vs 62 ± 5 mmHg), and mean arterial pressure (82 ± 6 mmHg vs 74 ± 4 mmHg) decreased significantly with rest in the untrained group, and no differences were found after land-walking. In the trained group, significant (P < 0.05) differences were found only for systolic blood pressure (110 ± 9 mmHg vs 100 ± 9 mmHg) after 60 minutes of water-walking; decreases in systolic blood pressure were found after 45 minutes (99 ± 7 mmHg) and 60 minutes (99 ± 6 mmHg) compared with rest (107 ± 5 mmHg) after land-walking. Conclusion: Single water-walking and land-walking sessions induced important hypotension following exercise. Additionally, walking performed in chest-deep water has a better effect on exercise-induced hypotension in untrained healthy women than walking at a similar intensity on land.
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86
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Batterham SI, Heywood S, Keating JL. Systematic review and meta-analysis comparing land and aquatic exercise for people with hip or knee arthritis on function, mobility and other health outcomes. BMC Musculoskelet Disord 2011; 12:123. [PMID: 21635746 PMCID: PMC3141607 DOI: 10.1186/1471-2474-12-123] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 06/02/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Aquatic and land based exercise are frequently prescribed to maintain function for people with arthritis. The relative efficacy of these rehabilitation strategies for this population has not been established.This review investigated the effects of aquatic compared to land based exercise on function, mobility or participants' perception of programs for people with arthritis. METHODS Medline, CINAHL, AMED and the Cochrane Central Register of Controlled Clinical Trials were searched up to July 2010. Ten randomised, controlled clinical trials that compared land to aquatic exercise for adults with arthritis were included. Study quality was assessed with the PEDro scale. Data relevant to the review question were systematically extracted by two independent reviewers. Standardised mean differences between groups for key outcomes were calculated. Meta-analyses were performed for function, mobility and indices that pooled health outcomes across multiple domains. RESULTS No differences in outcomes were observed for the two rehabilitation strategies in meta-analysis. There was considerable variability between trials in key program characteristics including prescribed exercises and design quality. Components of exercise programs were poorly reported by the majority of trials. No research was found that examined participant preferences for aquatic compared to land based exercise, identifying this as an area for further research. CONCLUSION Outcomes following aquatic exercise for adults with arthritis appear comparable to land based exercise. When people are unable to exercise on land, or find land based exercise difficult, aquatic programs provide an enabling alternative strategy.
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Affiliation(s)
- Stephanie I Batterham
- Department of Physiotherapy, Monash University Peninsula campus, McMahons Rd, Frankston, Australia
| | - Sophie Heywood
- The Melbourne Sports Medicine Centre, 4/250 Collins St, Melbourne, Australia
| | - Jennifer L Keating
- Department of Physiotherapy, Monash University Peninsula campus, McMahons Rd, Frankston, Australia
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88
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Kamioka H, Tsutani K, Mutoh Y, Okuizum H, Ohta M, Handa S, Okada S, Kitayuguchi J, Kamada M, Shiozawa N, Park SJ, Honda T, Moriyama S. A systematic review of nonrandomized controlled trials on the curative effects of aquatic exercise. Int J Gen Med 2011; 4:239-60. [PMID: 21556311 PMCID: PMC3085234 DOI: 10.2147/ijgm.s17384] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Indexed: 01/22/2023] Open
Abstract
Background: The objectives of this review were to integrate the evidence of curative effects through aquatic exercise and assess the quality of studies based on a review of nonrandomized controlled trials (nRCTs). Methods: Study design was a systematic review of nonrandomized controlled trials. Trials were eligible if they were nonrandomized clinical trials. Studies included one treatment group in which aquatic exercise was applied. We searched the following databases from 2000 up to July 20, 2009: MEDLINE via PubMed, CINAHL, and Ichushi-Web. Results: Twenty-one trials met all inclusion criteria. Languages included were English (N = 9), Japanese (N = 11), and Korean (N = 1). Target diseases were knee and/or hip osteoarthritis, poliomyelitis, chronic kidney disease, discomforts of pregnancy, cardiovascular diseases, and rotator cuff tears. Many studies on nonspecific disease (healthy participants) were included. All studies reported significant effectiveness in at least one or more outcomes. However results of evaluations with the TREND and CLEAR-NPT checklists generally showed a remarkable lack of description in the studies. Furthermore, there was the problem of heterogeneity, and we were therefore not able to perform a meta-analysis. Conclusion: Because there was insufficient evidence on aquatic exercise due to poor methodological and reporting quality and heterogeneity of nRCTs, we were unable to offer any conclusions about the effects of this intervention. However, we were able to identify problems with current nRCTs of aquatic exercise, and propose a strategy of strengthening study quality, stressing the importance of study feasibility as a future research agenda objective.
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Affiliation(s)
- Hiroharu Kamioka
- Faculty of Regional Environment Science, Tokyo University of Agriculture, Tokyo, Japan
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89
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Soto-Quijano DA, Grabois M. Hydrotherapy. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00134-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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90
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Valderrabano V, Steiger C. Treatment and Prevention of Osteoarthritis through Exercise and Sports. J Aging Res 2010; 2011:374653. [PMID: 21188091 PMCID: PMC3004403 DOI: 10.4061/2011/374653] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Accepted: 11/01/2010] [Indexed: 11/20/2022] Open
Abstract
Osteoarthritis (OA) is a degenerative joint disease with a high prevalence among older people. To date, the pathogenesis of the disease and the link between muscle function and OA is not entirely understood. As there is no known cure for OA, current research focuses on prevention and symptomatic treatment of the disorder. Recent research has indicated that muscle weakness precedes the onset of OA symptoms. Furthermore, several studies show a beneficial effect of land-based aerobic and strengthening exercises on pain relief and joint function. Therefore, current research focuses on the possibility to employ exercise and sports in the prevention and treatment of OA.
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Affiliation(s)
- Victor Valderrabano
- Orthopaedic Department, University of Basel, Spitalstr. 21, 4031 Basel, Switzerland
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91
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Bennell KL, Hinman RS. A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J Sci Med Sport 2010; 14:4-9. [PMID: 20851051 DOI: 10.1016/j.jsams.2010.08.002] [Citation(s) in RCA: 250] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 08/03/2010] [Accepted: 08/06/2010] [Indexed: 02/06/2023]
Abstract
Osteoarthritis (OA) is a chronic joint disease with the hip and knee being commonly affected lower limb sites. Osteoarthritis causes pain, stiffness, swelling, joint instability and muscle weakness, all of which can lead to impaired physical function and reduced quality of life. This review of evidence provides recommendations for exercise prescription in those with hip or knee OA. A narrative review was performed. Conservative non-pharmacological strategies, particularly exercise, are recommended by all clinical guidelines for the management of OA and meta-analyses support these exercise recommendations. Aerobic, strengthening, aquatic and Tai chi exercise are beneficial for improving pain and function in people with OA with benefits seen across the range of disease severities. The optimal exercise dosage is yet to be determined and an individualized approach to exercise prescription is required based on an assessment of impairments, patient preference, co-morbidities and accessibility. Maximising adherence is a key element dictating success of exercise therapy. This can be enhanced by the use of supervised exercise sessions (possibly in class format) in the initial exercise period followed by home exercises. Bringing patients back for intermittent consultations with the exercise practitioner, or attendance at "refresher" group exercise classes may also assist long-term adherence and improved patient outcomes. Few studies have evaluated the effects of exercise on structural disease progression and there is currently no evidence to show that exercise can be disease modifying. Exercise plays an important role in managing symptoms in those with hip and knee OA.
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Affiliation(s)
- Kim L Bennell
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Australia.
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92
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Rahmann AE. Exercise for people with hip or knee osteoarthritis: a comparison of land-based and aquatic interventions. Open Access J Sports Med 2010; 1:123-35. [PMID: 24198550 PMCID: PMC3781862 DOI: 10.2147/oajsm.s6941] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Expert opinion considers the referral of people with osteoarthritis (OA) for physiotherapy to be a core component of managing the functional disability and pain of the disease. Clinical guidelines for the physiotherapy management of people with OA focus on three main areas: exercise, pain relief, and specific manual therapy techniques. Land-based group and individual physiotherapy exercise programs, as well as manual therapy, have demonstrated a distinct benefit in favor of physiotherapy intervention. Similarly, both general and specific aquatic physiotherapy exercise programs have shown positive outcomes for people with OA. This review will focus primarily on therapeutic exercise to improve strength and fitness and reduce pain in people with hip or knee OA. An overview of the principles of hydrodynamics relevant to aquatic exercise is also included to facilitate an understanding of effective aquatic exercise programs. The issue of compliance with exercise programs will also be discussed. Clinicians will, therefore, gain an understanding of the benefits of land-based and aquatic exercise for people with OA.
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Affiliation(s)
- Ann E Rahmann
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
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93
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Nüesch E, Trelle S, Reichenbach S, Rutjes AWS, Tschannen B, Altman DG, Egger M, Jüni P. Small study effects in meta-analyses of osteoarthritis trials: meta-epidemiological study. BMJ 2010; 341:c3515. [PMID: 20639294 PMCID: PMC2905513 DOI: 10.1136/bmj.c3515] [Citation(s) in RCA: 430] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine the presence and extent of small study effects in clinical osteoarthritis research. DESIGN Meta-epidemiological study. DATA SOURCES 13 meta-analyses including 153 randomised trials (41 605 patients) that compared therapeutic interventions with placebo or non-intervention control in patients with osteoarthritis of the hip or knee and used patients' reported pain as an outcome. METHODS We compared estimated benefits of treatment between large trials (at least 100 patients per arm) and small trials, explored funnel plots supplemented with lines of predicted effects and contours of significance, and used three approaches to estimate treatment effects: meta-analyses including all trials irrespective of sample size, meta-analyses restricted to large trials, and treatment effects predicted for large trials. RESULTS On average, treatment effects were more beneficial in small than in large trials (difference in effect sizes -0.21, 95% confidence interval -0.34 to -0.08, P=0.001). Depending on criteria used, six to eight funnel plots indicated small study effects. In six of 13 meta-analyses, the overall pooled estimate suggested a clinically relevant, significant benefit of treatment, whereas analyses restricted to large trials and predicted effects in large trials yielded smaller non-significant estimates. CONCLUSIONS Small study effects can often distort results of meta-analyses. The influence of small trials on estimated treatment effects should be routinely assessed.
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Affiliation(s)
- Eveline Nüesch
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
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94
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Kim E, Kim T, Kang H, Lee J, Childers MK. Aquatic versus land-based exercises as early functional rehabilitation for elite athletes with acute lower extremity ligament injury: a pilot study. PM R 2010; 2:703-12. [PMID: 20598958 DOI: 10.1016/j.pmrj.2010.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 01/25/2010] [Accepted: 03/05/2010] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To compare outcomes between aquatic and land-based exercises during early-phase recovery from acute lower extremity ligament injuries in elite athletes. DESIGN A single-blinded, covariate adaptive randomized, controlled study. SETTING National training center for elite athletes. PARTICIPANTS Twenty-two athletes with isolated grade I or II ligament injury in ankles or knees were randomized into either an aquatic or land-based exercise group. INTERVENTIONS Early functional rehabilitation program (ranging, strengthening, proprioceptive training, and functional exercises) was performed in both groups. All exercises were identical except for the training environment. MAIN OUTCOME MEASUREMENTS Data were collected at baseline and at 2 and 4 weeks using a visual analog scale (VAS) for pain; static stability (overall stability index [OSI] level 5 and 3); dynamic stability (TCT), and percentage single-limb support time (%SLST). RESULTS Both groups showed decreases in VAS, OSI 5 and 3, and TCT, with a concomitant increase in %SLST at 2 and 4 weeks (P < .05). No significant differences were detected between the 2 groups in any of the outcome measures. However, the line graphs for VAS, OSI 3, TCT, and %SLST in the aquatic exercise group were steeper than those in the land-based exercise group indicating significant group by time interactions (P < .05). These data indicate that the aquatic exercise group improved more rapidly than the land-based exercise group. CONCLUSIONS For elite athletes with acute ligament sprains in the lower limb, aquatic exercises may provide advantages over standard land-based therapy for rapid return to athletic activities. Consequently, aquatic exercise could be recommended for the initial phase of a rehabilitation program.
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Affiliation(s)
- Eunkuk Kim
- Department of Sports Medicine and Science, National Training Center of Korea Olympic Committee, Seoul, Korea.
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95
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Dunlop DD, Semanik P, Song J, Sharma L, Nevitt M, Jackson R, Mysiw J, Chang RW. Moving to maintain function in knee osteoarthritis: evidence from the osteoarthritis initiative. Arch Phys Med Rehabil 2010; 91:714-21. [PMID: 20434608 DOI: 10.1016/j.apmr.2010.01.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 01/18/2010] [Accepted: 01/19/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To investigate the association between baseline physical activity and 1-year functional performance in adults with knee osteoarthritis (OA). DESIGN Prospective cohort study of knee OA development and progression with 1-year follow-up. SETTING Community. PARTICIPANTS Osteoarthritis Initiative public data on adults with knee OA (n=2274; age, 45-79y) who participated in functional performance assessments (timed 20-m walk and chair stand test) at baseline and 1-year follow-up. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE A good 1-year performance outcome (separately defined for walk time and chair stand measures) was improvement from baseline quintile or maintenance in the best quintile. RESULTS Almost 2 in 5 persons with radiographic knee OA improved or maintained high performance at 1 year. Physical activity measured by the Physical Activity Scale for the Elderly (PASE) was significantly associated with good walk rate and chair stand outcomes (odds ratio per 40 units PASE [95% confidence interval]=1.13 [1.13, 1.17] and 1.10 [1.05, 1.15], respectively), as were participation in sports/recreational activities (1.45 [1.23, 1.71] and 1.29 [1.09, 1.51], respectively) and lifestyle activities (1.11 [1.06, 1.16] and 1.09 [1.04, 1.14], respectively). An independent protective relationship for these physical activity measures approached significance after adjusting for sociodemographic and health factors. Older adults reported the least baseline physical activity and least frequent good 1-year outcomes. CONCLUSIONS These findings support public health recommendations to be physically active in order to preserve function for persons with knee OA. Physical activity messages should specifically target older adults whose low activity levels may jeopardize their ability to maintain functional performance.
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Affiliation(s)
- Dorothy D Dunlop
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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96
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Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P. OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 2010; 18:476-99. [PMID: 20170770 DOI: 10.1016/j.joca.2010.01.013] [Citation(s) in RCA: 1055] [Impact Index Per Article: 75.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 01/26/2010] [Accepted: 01/26/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To update evidence for available therapies in the treatment of hip and knee osteoarthritis (OA) and to examine whether research evidence has changed from 31 January 2006 to 31 January 2009. METHODS A systematic literature search was undertaken using MEDLINE, EMBASE, CINAHL, AMED, Science Citation Index and the Cochrane Library. The quality of studies was assessed. Effect sizes (ESs) and numbers needed to treat were calculated for efficacy. Relative risks, hazard ratios (HRs) or odds ratios were estimated for side effects. Publication bias and heterogeneity were examined. Sensitivity analysis was undertaken to compare the evidence pooled in different years and different qualities. Cumulative meta-analysis was used to examine the stability of evidence. RESULTS Sixty-four systematic reviews, 266 randomised controlled trials (RCTs) and 21 new economic evaluations (EEs) were published between 2006 and 2009. Of 51 treatment modalities, new data on efficacy have been published for more than half (26/39, 67%) of those for which research evidence was available in 2006. Among non-pharmacological therapies, ES for pain relief was unchanged for self-management, education, exercise and acupuncture. However, with new evidence the ES for pain relief for weight reduction reached statistical significance, increasing from 0.13 [95% confidence interval (CI) -0.12, 0.36] in 2006 to 0.20 (95% CI 0.00, 0.39) in 2009. By contrast, the ES for electromagnetic therapy which was large in 2006 (ES=0.77, 95% CI 0.36, 1.17) was no longer significant (ES=0.16, 95% CI -0.08, 0.39). Among pharmacological therapies, the cumulative evidence for the benefits and harms of oral and topical non-steroidal anti-inflammatory drugs, diacerhein and intra-articular (IA) corticosteroid was not greatly changed. The ES for pain relief with acetaminophen diminished numerically, but not significantly, from 0.21 (0.02, 0.41) to 0.14 (0.05, 0.22) and was no longer significant when analysis was restricted to high quality trials (ES=0.10, 95% CI -0.0, 0.23). New evidence for increased risks of hospitalisation due to perforation, peptic ulceration and bleeding with acetaminophen >3g/day have been published (HR=1.20, 95% CI 1.03, 1.40). ES for pain relief from IA hyaluronic acid, glucosamine sulphate, chondroitin sulphate and avocado soybean unsponifiables also diminished and there was greater heterogeneity of outcomes and more evidence of publication bias. Among surgical treatments further negative RCTs of lavage/debridement were published and the pooled results demonstrated that benefits from this modality of therapy were no greater than those obtained from placebo. CONCLUSION Publication of a large amount of new research evidence has resulted in changes in the calculated risk-benefit ratio for some treatments for OA. Regular updating of research evidence can help to guide best clinical practice.
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Affiliation(s)
- W Zhang
- Nottingham City Hospital, University of Nottingham, Nottingham, UK.
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97
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What Does the Cochrane Collaboration Say about Exercises for the Hip and Knee? Physiother Can 2010; 61:46. [PMID: 20145751 DOI: 10.3138/physio.61.1.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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98
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Becker BE. Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM R 2009; 1:859-72. [PMID: 19769921 DOI: 10.1016/j.pmrj.2009.05.017] [Citation(s) in RCA: 237] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 04/28/2009] [Accepted: 05/28/2009] [Indexed: 11/19/2022]
Abstract
The aquatic environment has broad rehabilitative potential, extending from the treatment of acute injuries through health maintenance in the face of chronic diseases, yet it remains an underused modality. There is an extensive research base supporting aquatic therapy, both within the basic science literature and clinical literature. This article describes the many physiologic changes that occur during immersion as applied to a range of common rehabilitative issues and problems. Because of its wide margin of therapeutic safety and clinical adaptability, aquatic therapy is a very useful tool in the rehabilitative toolbox. Through a better understanding of the applied physiology, the practitioner may structure appropriate therapeutic programs for a diverse patient population.
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Affiliation(s)
- Bruce E Becker
- Washington State University, National Aquatics and Sports Medicine Institute, Department of Rehabilitation Medicine, University of Washington School of Medicine, Spokane WA 99224, USA.
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99
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Kamioka H, Tsutani K, Okuizumi H, Mutoh Y, Ohta M, Handa S, Okada S, Kitayuguchi J, Kamada M, Shiozawa N, Honda T. Effectiveness of aquatic exercise and balneotherapy: a summary of systematic reviews based on randomized controlled trials of water immersion therapies. J Epidemiol 2009; 20:2-12. [PMID: 19881230 PMCID: PMC3900774 DOI: 10.2188/jea.je20090030] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The objective of this review was to summarize findings on aquatic exercise and balneotherapy and to assess the quality of systematic reviews based on randomized controlled trials. METHODS Studies were eligible if they were systematic reviews based on randomized clinical trials (with or without a meta-analysis) that included at least 1 treatment group that received aquatic exercise or balneotherapy. We searched the following databases: Cochrane Database Systematic Review, MEDLINE, CINAHL, Web of Science, JDream II, and Ichushi-Web for articles published from the year 1990 to August 17, 2008. RESULTS We found evidence that aquatic exercise had small but statistically significant effects on pain relief and related outcome measures of locomotor diseases (eg, arthritis, rheumatoid diseases, and low back pain). However, long-term effectiveness was unclear. Because evidence was lacking due to the poor methodological quality of balneotherapy studies, we were unable to make any conclusions on the effects of intervention. There were frequent flaws regarding the description of excluded RCTs and the assessment of publication bias in several trials. Two of the present authors independently assessed the quality of articles using the AMSTAR checklist. CONCLUSIONS Aquatic exercise had a small but statistically significant short-term effect on locomotor diseases. However, the effectiveness of balneotherapy in curing disease or improving health remains unclear.
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Affiliation(s)
- Hiroharu Kamioka
- Faculty of Regional Environment Science, Tokyo University of Agriculture, Tokyo, Japan.
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100
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Schencking M, Otto A, Deutsch T, Sandholzer H. A comparison of Kneipp hydrotherapy with conventional physiotherapy in the treatment of osteoarthritis of the hip or knee: protocol of a prospective randomised controlled clinical trial. BMC Musculoskelet Disord 2009; 10:104. [PMID: 19689824 PMCID: PMC2736923 DOI: 10.1186/1471-2474-10-104] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 08/19/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The increasing age of the population, especially in the western world, means that the prevalence of osteoarthritis is also increasing, with corresponding socioeconomic consequences. Although there is no curative intervention at present, in accordance with US and European guidelines, pharmacotherapeutic and non-pharmacological approaches aim at pain control and the reduction of functional restriction.It has been established that hydrotherapy for osteoarthritis of the hip or knee joint using serial cold and warm water stimulation not only improves the range of movement but also reduces pain significantly and increases quality of life over a period of up to three months. Weight reduction is important for patients with osteoarthritis of the hip or knee. In addition, conventional physiotherapy and exercise therapy have both been shown, at a high level of evidence, to be cost-effective and to have long-term benefits for pain relief, movement in the affected joint, and patient quality of life. METHODS/DESIGN The study design consists of a prospective randomised controlled three-armed clinical trial, which will be carried out at a specialist clinic for integrative medicine, to investigate the clinical effects of hydrotherapy on osteoarthritis of the knee or hip joint, in comparison with conventional physiotherapy.One hundred and eighty patients diagnosed with osteoarthritis of hip or knee will be randomly assigned to one of three intervention groups: hydrotherapy, physiotherapy, and both physiotherapy and hydrotherapy of the affected joint. In the first group, patients will receive Kneipp hydrotherapy daily, with water applied in the form of alternate cold and warm thigh affusions (alternating cold and warm water stimulation is particularly relevant to the knee and hip regions).Patients in the second group will receive physiotherapy of the hip or knee joint three times a week. Patients in the physiotherapy-hydrotherapy combination group will receive both joint-specific physiotherapy three times a week and alternate cold and warm thigh affusions every day. Follow-up assessments will be on three levels: clinical assessment by the investigator; subjective patient assessment consisting of a patient diary, and questionnaires on admission and at the end of the treatment phase; and a final telephone assessment by the external evaluation centre. Assessments will be made at baseline, after two weeks of inpatient treatment, and finally after a further ten weeks of follow-up. The primary outcome measure will be pain intensity of the affected joint in the course of inpatient treatment, judged by the patient and the investigator. Secondary outcomes include health-related quality of life and joint-specific pain and mobility in the course of the study. Statistical analysis of the results will be on an intention-to-treat basis. CONCLUSION This study methodology has been conceived according to the standards of the CONSORT recommendations. The results will contribute to establishing hydrotherapy as a non-invasive, non-interventional, reasonably priced, therapeutic option with few side effects, in the concomitant treatment of osteoarthritis of the hip or knee. TRIAL REGISTRATION TRIAL REGISTRATION NUMBER NCT 00950326.
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Affiliation(s)
- Martin Schencking
- Kneipp Clinic (Sebastianeum & Kneippianum) Bad Wörishofen, Kneippstrasse 08, D-86825 Bad Wörishofen, Germany
- Dept of Primary Care, University of Leipzig Medical School, Ph.-Rosenthal-Strasse 55, D-04103 Leipzig, Germany
| | - Adriane Otto
- Dept of Primary Care, University of Leipzig Medical School, Ph.-Rosenthal-Strasse 55, D-04103 Leipzig, Germany
| | - Tobias Deutsch
- Dept of Primary Care, University of Leipzig Medical School, Ph.-Rosenthal-Strasse 55, D-04103 Leipzig, Germany
| | - Hagen Sandholzer
- Dept of Primary Care, University of Leipzig Medical School, Ph.-Rosenthal-Strasse 55, D-04103 Leipzig, Germany
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