Aquatic exercise for the treatment of knee and hip osteoarthritis

Land-based versus pool-based exercise for people awaiting joint replacement surgery of the hip or knee: results of a randomized controlled trial

OBJECTIVE

To compare the preoperative effects of multidimensional land-based and pool-based exercise programs for people awaiting joint replacement surgery of the hip or knee.

DESIGN

Randomized, single-blind, before-after trial.

SETTING

Physiotherapy gymnasium and hydrotherapy pool.

PARTICIPANTS

Patients awaiting elective hip or knee joint replacement surgery.

INTERVENTIONS

Land-based (n=40) or pool-based exercise program (n=42). Each 6-week program included an education session, twice-weekly exercise classes, and an occupational therapy home assessment.

MAIN OUTCOME MEASURES

Participants were assessed immediately before and after the 6-week intervention, then 8 weeks later. Primary outcomes were pain and self-reported function (Western Ontario and McMaster Universities Osteoarthritis Index) and patient global assessment. Secondary outcomes were performance-based measures (timed walk and chair stand) and psychosocial status (Medical Outcomes Study 36-Item Short-Form Health Survey mental component score). Pain was also measured before and after each exercise class on a 7-point verbal rating scale.

RESULTS

Although both interventions were effective in reducing pain and improving function, there were no postintervention differences between the groups for the primary and secondary outcomes. However, the pool-based group had less pain immediately after the exercise classes.

CONCLUSIONS

While our multidimensional exercise-based interventions appeared to be effective in reducing disability in those awaiting joint replacement surgery of the hip or knee, there were no large differences in the postintervention effects of the interventions. However, pool-based exercise appeared to have a more favorable effect on pain immediately after the exercise classes.

Hydrotherapy after total hip arthroplasty: a follow-up study

The aim of the study was to evaluate the subjective functional outcome of total hip arthroplasty (THA) in patients who underwent hydrotherapy (HT) 6 months after discharge. A prospective randomized study was performed on 70 elderly inpatients with recent THA, who completed a rehabilitation program. After randomization, 33 of them were treated in conventional gyms (no-hydrotherapy group=NHTG) and 31 received HT (hydrotherapy group=HTG). Interviews with the Western-Ontario MacMasters Universities Osteoarthritis Index (WOMAC) were performed at admission, at discharge and 6 months later. Kruskal-Wallis, Mann-Whitney and Wilcoxon tests were applied for statistical analysis. Both groups improved. Pain, stiffness and function were all positively affected. Statistical analysis indicated that WOMAC sub-scales were significantly lower for all patients treated with HT. The benefits at discharge still remained after 6 months. We conclude that HT is recommended after THA in a geriatric population.

THE EFFECT OF PHYSICAL TRAINING ON THE LOCOMOTOR APPARATUS IN ELDERLY PEOPLE

Physiological changes taking place on the locomotive apparatus as a result of aging, such as muscular mass loss, body balance loss, reduced bone mass and osteoarthrosis cause limitations to the daily activities of elderly people, compromising their quality of life and making them weaker and dependent. Aged people who regularly practice physical activities have a higher level of functional independence and a better quality of life than the sedentary ones. This article addresses the key physiological changes with aging and provides a review of current literature about the effects of physical exercises on the locomotive apparatus of elderly individuals, specifying the best ways to prescribe physical exercises to this age group.

[Evidence-based physiotherapeutic strategies for musculoskeletal pain]

Inflammatory rheumatic disorders usually progress towards morphologic and functional deficits and thus cause substantial impairment of physical health. Amongst the therapeutic options physiotherapeutic strategies are essential and are often required to maintain the individual's quality of life. Because of the large variety of physiotherapeutical approaches, differentiated clinical examination is needed in order to implement physiotherapeutics in a treatment plan that is based on pathophysiologic and regeneration-specific aspects. The article presents a current overview of evidence-based physiotherapeutic strategies for musculoskeletal pain reduction in daily practice.

Treadmill training for the treatment of gait disturbances in people with Parkinson's disease: a mini-review

This report reviews recent investigations of the effects of treadmill training (TT) on the gait of patients with Parkinson's disease. A literature search identified 14 relevant studies. Three studies reported on the immediate effects of TT; over-ground walking improved (e.g., increased speed and stride length) after one treadmill session. Effects persisted even 15 min later. Eleven longer-term trials demonstrated feasibility, safety and efficacy, reporting positive benefits in gait speed, stride length and other measures such as disease severity (e.g., Unified Parkinson's Disease Rating Scale) and health-related quality of life, even several weeks after cessation of the TT. Long-term carryover effects also raise the possibility that TT may elicit positive neural plastic changes. While encouraging, the work to date is preliminary; none of the identified studies received a quality rating of Gold or level Ia. Additional high quality randomized controlled studies are needed before TT can be recommended with evidence-based support.

Depression and osteoarthritis

Depression is significant among patients with arthritis and musculoskeletal illnesses. However, the impact of depression on osteoarthritis has not been extensively studied. This article highlights the close links between these 2 prevalent chronic conditions, and the associated individual and societal burden. Results from a large clinical trial of depressed older patients with arthritis showed that a focused, collaborative depression care intervention not only decreased depression but also improved arthritis-associated outcomes, such as pain severity and arthritis-related limitations in daily activities. Relative to patients given usual care, patients receiving intervention also reported better health status and higher quality of life. Analyses of the depression interventions uncovered a reciprocal interrelation between depression and pain. Higher severity of either depression or pain decreased the benefits of systematic depression treatment and was associated with worse pain and depression outcomes. Current approaches to management of depression and arthritis do not reflect readily-available evidence-based treatment. A pilot study using a combined approach to address both depression and pain problems among elderly patients with depression and osteoarthritis suggested that benefits for depression, pain, and functional outcomes are strengthened by providing both pain and depression care management. An integrated depression and pain program using evidenced-based pharmacologic and nonpharmacologic treatments is needed to achieve optimal depression and pain outcomes. Currently, a randomized trial is under way to evaluate effectiveness of a combined pain and depression intervention using pharmacologic and nonpharmacologic therapies. Key intervention components in these 2 innovative and integrated depression and pain programs can guide clinicians to treat both depression and pain with more focus and intensity.