1
|
Torstensen TA, Østerås H, LoMartire R, Rugelbak GM, Grooten WJA, Äng BO. High- Versus Low-Dose Exercise Therapy for Knee Osteoarthritis : A Randomized Controlled Multicenter Trial. Ann Intern Med 2023; 176:154-165. [PMID: 36689746 DOI: 10.7326/m22-2348] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The benefits of exercise in patients with knee osteoarthritis are well documented, but the optimal exercise dose remains unknown. OBJECTIVE To compare high-dose versus low-dose exercise therapy with regard to knee function, pain, and quality of life (QoL) in patients with long-term symptomatic knee osteoarthritis. DESIGN A Swedish and Norwegian multicenter randomized controlled superiority trial with multiple follow-ups up to 12 months after the intervention. (ClinicalTrials.gov: NCT02024126). SETTING Primary health care facilities. PATIENTS 189 patients with diagnosed knee osteoarthritis and a history of pain and decreased knee function were assigned to high-dose therapy (n = 98; 11 exercises; 70 to 90 minutes) or low-dose therapy (n = 91; 5 exercises; 20 to 30 minutes). INTERVENTION Patient-tailored exercise programs according to the principles of medical exercise therapy. Global (aerobic), semiglobal (multisegmental), and local (joint-specific) exercises were performed 3 times a week for 12 weeks under supervision of a physiotherapist. MEASUREMENTS The Knee Injury and Osteoarthritis Outcome Score (KOOS) was measured biweekly during the 3-month intervention period and at 6 and 12 months after the intervention. The primary end point was the mean difference in KOOS scores between groups at the end of the intervention (3 months). Secondary outcomes included pain intensity and QoL. The proportion of patients with minimal clinically important changes in primary and secondary outcomes was compared between groups. RESULTS Both groups improved over time, but there were no benefits of high-dose therapy in most comparisons. One exception was the KOOS score for function in sports and recreation, where high-dose therapy was superior at the end of treatment and at 6-month follow-up. A small benefit in QoL at 6 and 12 months was also observed. LIMITATION There was no control group that did not exercise. CONCLUSION The results do not support the superiority of high-dose exercise over low-dose exercise for most outcomes. However, small benefits with high-dose exercise were found for knee function in sports and recreation and for QoL. PRIMARY FUNDING SOURCE Swedish Rheumatic Fund.
Collapse
Affiliation(s)
- Tom Arild Torstensen
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden, and Holten Institute, Stockholm, Sweden (T.A.T.)
| | - Håvard Østerås
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, and Rosenborg Fysioterapiklinikk, Trondheim, Norway (H.Ø.)
| | - Riccardo LoMartire
- Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden (R.L.)
| | | | - Wilhelmus Johannes Andreas Grooten
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden, and Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden (W.J.A.G.)
| | - Björn Olov Äng
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden, Department of Research and Higher Education, Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden, and Department of Health and Welfare, Dalarna University, Falun, Sweden (B.O.Ä.)
| |
Collapse
|
2
|
Is Cervical Stabilization Exercise Immediately Effective in Patients with Chronic Neck Pain and Upper Cervical Spine Dysfunction? Randomized Controlled Trial. Life (Basel) 2022; 12:life12050714. [PMID: 35629381 PMCID: PMC9147665 DOI: 10.3390/life12050714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose: To compare the effectiveness of a single exercise session with manual therapy techniques in the segments of the upper cervical spine (C0−1, C1−2 and C2−3), against a single exercise session in patients with chronic neck pain and mobility deficits in the upper cervical spine. Methods: A single-blind randomized controlled trial was performed. Fifty-eight patients were recruited (29 for the manual therapy and exercise group and 29 for the exercise group) who presented chronic neck pain and upper cervical spine dysfunction. The exercise focused on the deep muscles. The manual therapy combined manipulations and mobilizations with these exercises. Cervical range of motion, flexion-rotation test, pressure pain threshold and pain intensity were measured by a blind evaluator before and after the intervention. Results: Compared to pre-intervention, after intervention, the exercise group was significantly lower in terms of the range of motion, flexion-rotation test, and pressure pain threshold (p < 0.05). The manual therapy and exercise group improved in upper cervical flexion, the flexion-rotation test and intensity of pain (p < 0.05). Conclusions: It may be necessary to normalize the mobility of the upper cervical spine before cervical stabilization training, in patients with chronic neck pain and mobility deficits in the upper cervical spine.
Collapse
|
3
|
Catapano M, Ahmed M, Breslow RG, Borg-Stein J. The aging athlete. PM R 2022; 14:643-651. [PMID: 35441493 DOI: 10.1002/pmrj.12814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/09/2022]
Abstract
Aging athletes, those 60 years and older, are a growing population of mature, active individuals who value sports and exercise participation throughout their lifespan. Although recommendations for younger and masters athletes have been extrapolated to this population, there remains a paucity of specific guidelines, treatment algorithms, and considerations for aging athletes. The benefits of living an active lifestyle must be weighed against the risks for unique cardiovascular, metabolic, and musculoskeletal injuries requiring diagnostic and therapeutic interventions. In this article, we review the unique cardiovascular and muscular physiology of aging athletes and how it influences the risk of specific medical conditions. We also discuss general prevention and treatment strategies. Finally, we identify areas of future research priorities and emerging treatments.
Collapse
Affiliation(s)
- Michael Catapano
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA.,Division of Sports Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marwa Ahmed
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA.,Division of Sports Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Joanne Borg-Stein
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA.,Division of Sports Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Krause F, Niederer D, Banzer W, Vogt L. Medical exercise and physiotherapy modes and frequency as predictors for a recurrence of chronic non-specific low back pain. J Back Musculoskelet Rehabil 2021; 34:665-670. [PMID: 33749637 DOI: 10.3233/bmr-200149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND A considerable part of patients with non-specific low back pain (LBP) suffer from a recurrence of symptoms after therapy cessation. OBJECTIVE The aim of this cohort study was to evaluate the predictive value of active and passive treatments and treatment modalities on a recurrence of low back pain after cessation of medically prescribed therapy. METHODS Patients with non-specific LBP from a health- and therapy-center were included. Treatments were monitored and categorized as active or passive. During one year after therapy cessation, patients were monitored to retrieve information about recurrence of symptoms. Patients were dichotomized (recurrence versus no recurrence). An ROC-Analysis was used to determine optimal cut-offs for relevant treatment characteristics' (passive versus active; frequency) impact on recurrence risk. The relative risk for a recurrence was calculated based on Chi2-test. RESULTS Data from 96 participants (56 females, 40 males, mean age 49 years, standard deviation 11 years) were analysed. A total of 34 participants had recurring LBP. The frequency of active treatment differed significantly between groups with or without recurrence (p< 0.05). A therapy frequency of 1.45 active treatments/week was a sensitive cut-off (sensitivity: 0.73) to discriminate the recurrence groups. Participants with an active therapy frequency of less than 1.45 treatments per week showed an 82% increased relative recurrence risk (RR: 1.824 (95%-CI: 1.077-3.087)). CONCLUSIONS The results empathize the importance of active treatments (i.e. exercise) in the therapy and (secondary) prevention of non-specific LBP. Less than 1.45 active treatment sessions/week increases the 1-year-risk of a recurrence by 82%. Performing at least two treatments sessions per week is therefore recommended.
Collapse
Affiliation(s)
- Frieder Krause
- Department of Sports Medicine and Exercise Physiology, Goethe-University Frankfurt, Germany
| | - Daniel Niederer
- Department of Sports Medicine and Exercise Physiology, Goethe-University Frankfurt, Germany
| | - Winfried Banzer
- Department of Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Goethe-University Frankfurt, Germany
| | - Lutz Vogt
- Department of Sports Medicine and Exercise Physiology, Goethe-University Frankfurt, Germany
| |
Collapse
|
5
|
Bruvoll M, Torstensen TA, Conradsson DM, Äng BO, Østerås H. Feasibility of high dose medical exercise therapy in patients with long-term symptomatic knee osteoarthritis. Physiother Theory Pract 2021; 38:1615-1623. [PMID: 33557676 DOI: 10.1080/09593985.2021.1885086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: High repetition high dose medical exercise therapy (MET) is a promising treatment for patients with musculoskeletal pain. However, little is known regarding the feasibility of MET in patients with symptomatic knee osteoarthritis (OA). The aim of this study was to investigate the feasibility of MET in patients with symptomatic knee pain with radiographic verified OA.Methods: Patients with symptomatic knee osteoarthritis were recruited to a group-based high repetitive high dose MET intervention for 12 weeks in a primary health care setting. Indicators of feasibility included processes (recruitment, program adherence, and exercise compliance), and scientific feasibility (safety and pain evaluated by using the Visual Analogue Scale (VAS)).Results: Out of 31 individuals with symptomatic knee OA, 29 (93%) were included in this study. A total of 26 patients (90%) completed the intervention and 83% reached an attendance rate of ≥30 treatments. No adverse events were reported, and a majority of the patients reported a pain intensity <30 mm (VAS) throughout the intervention period. The results showed a 70% reduction of median pain intensity between baseline (33 mm, IQR: 39), and post-assessment (10 mm, IQR: 25, P = .003).Conclusion: These findings support an overall positive feasibility of MET for patients with symptomatic knee OA. The results also demonstrated that achieving a high dose of exercises might be challenging for this population. Thus, individual variations in exercise dose may be a confounding factor when evaluating high dose MET in future clinical studies.
Collapse
Affiliation(s)
- Mona Bruvoll
- Faculty of Health and Social Sciences, Department of Neuromedicine and Movement Science, Physical Therapy Program, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tom Arild Torstensen
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.,Holten Institute, Stockholm, Sweden
| | - David Moulaee Conradsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.,Allied Health Professionals Function, Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Björn O Äng
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Research and Education, Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Håvard Østerås
- Faculty of Health and Social Sciences, Department of Neuromedicine and Movement Science, Physical Therapy Program, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
6
|
Smoak JB, Matthews JR, Vinod AV, Kluczynski MA, Bisson LJ. An Up-to-Date Review of the Meniscus Literature: A Systematic Summary of Systematic Reviews and Meta-analyses. Orthop J Sports Med 2020; 8:2325967120950306. [PMID: 32953923 PMCID: PMC7485005 DOI: 10.1177/2325967120950306] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/09/2020] [Indexed: 12/14/2022] Open
Abstract
Background: A large number of systematic reviews and meta-analyses regarding the meniscus
have been published. Purpose: To provide a qualitative summary of the published systematic reviews and
meta-analyses regarding the meniscus. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of all meta-analyses and systematic reviews regarding the
meniscus and published between July 2009 and July 2019 was performed with
PubMed, CINAHL, EMBASE, and the Cochrane database. Published abstracts,
narrative reviews, articles not written in English, commentaries, study
protocols, and topics that were not focused on the meniscus were excluded.
The most pertinent results were extracted and summarized from each
study. Results: A total of 332 articles were found, of which 142 were included. Included
articles were summarized and divided into 16 topics: epidemiology,
diagnosis, histology, biomechanics, comorbid pathology, animal models,
arthroscopic partial meniscectomy (APM), meniscal repair, meniscal root
repairs, meniscal allograft transplantation (MAT), meniscal implants and
scaffolds, mesenchymal stem cells and growth factors, postoperative
rehabilitation, postoperative imaging assessment, patient-reported outcome
measures, and cost-effectiveness. The majority of articles focused on APM
(20%), MAT (18%), and meniscal repair (17%). Conclusion: This summary of systematic reviews and meta-analyses delivers surgeons a
single source of the current evidence regarding the meniscus.
Collapse
Affiliation(s)
- Jason B Smoak
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - John R Matthews
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Amrit V Vinod
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Melissa A Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Leslie J Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| |
Collapse
|
7
|
McDonald M, Salisbury H. Physical Activity, Exercise, and Musculoskeletal Disorders in Sonographers. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319843883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maureen McDonald
- Department of Medical Imaging and Radiation Sciences, Jefferson College of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
- A. T. Still University, College of Graduate Health Studies, Doctor of Health Sciences Program, Mesa, AZ, USA
| | - Helen Salisbury
- A. T. Still University, College of Graduate Health Studies, Doctor of Health Sciences Program, Mesa, AZ, USA
| |
Collapse
|
8
|
Østerås H, Paulsberg F. The Effect of Medical Exercise Therapy on Pressure Sensitivity in Patients with Knee Osteoarthritis: A Cohort Pilot Study. Pain Ther 2019; 8:79-87. [PMID: 30929225 PMCID: PMC6514024 DOI: 10.1007/s40122-019-0121-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Indexed: 01/21/2023] Open
Abstract
Introduction While continued research into pain and exercise may address the underlying mechanisms, the mechanisms through which exercise may act are still poorly understood. The purpose of this study was to examine the effects of medical exercise therapy on pressure sensitivity in knee osteoarthritis patients, and to assess whether the decreased pain perception after medical exercise therapy can be explained by changes in pressure sensitivity. Methods We adopted acohort design in which 16 patients with long term pain were tested before and after 3 months of medical exercise therapy intervention. Pain was detected by visual analogue scale (VAS) and a digital pressure algometer, which also assessed pressure sensitivity. Function (Knee Osteoarthritis Outcome Score, KOOS), anxiety and depression (HAD) and kinesiophobia (Tampa Scale of Kinesiophobia, TSK) were also measured. Results The VAS showed a statistically significant reduction of perceived pain, from 5.19 (SD 2.04) to 4.12 (SD 2.09) from pre- to post-test (p < 0.05). There was no significant change in pressure algometry on either the painful side or the non-painful side. Conclusion As there were no significant correlations between the reduced pain perception and pressure sensitivity in knee osteoarthritis patients, we suggest that local knee pain does not necessarily alter generalized sensitivity. These findings should be further investigated in a randomized trial in the future. Trial Registration Clinicaltrials.gov, identifier NCT02905747.
Collapse
Affiliation(s)
- Håvard Østerås
- Norwegian University of Science and Technology, Trondheim, Norway.
| | | |
Collapse
|
9
|
Dong X, Li K. The Association Between Musculoskeletal Symptoms and Traditional Chinese Medicine Use Among Chinese Older Adults in the Greater Chicago Area. Gerontol Geriatr Med 2018; 4:2333721418778179. [PMID: 30035189 PMCID: PMC6050610 DOI: 10.1177/2333721418778179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/29/2017] [Accepted: 09/14/2017] [Indexed: 11/16/2022] Open
Abstract
Older adults disproportionately experience musculoskeletal symptoms, which are associated with morbidity and mortality. Traditional Chinese medicine (TCM) is an important part of Chinese culture and for millennia have been used to maintain health. This article aims to examine the association between musculoskeletal symptoms and different subtypes of TCM usage. Data were collected through the Population Study of Chinese Elderly in Chicago (PINE) study, a community-engaged, epidemiological study of a U.S. Chinese population. Review of systems was used to measure musculoskeletal symptoms. TCM use was measured by using a 5-point scale. Logistic regression analyses were conducted to control for potential confounding factors. Of 3,157 Chinese, older adults aged 60 and older, the mean age was 72.8 (SD = 8.3) and 58.9% were female. Older adults with any musculoskeletal symptoms had greater utilization of overall TCM use (odds ratio [OR] = 2.10, 95% confidence interval [CI] = [1.76, 2.52]), especially massage therapy (OR = 3.41, 95% CI = [2.51, 4.63]), herbal (OR = 2.68, 95% CI = [2.28, 3.14]), and acupuncture (OR = 2.49, 95% CI = [1.87, 3.32]). However, there was no statistically significant association between the presence of musculoskeletal symptoms and Tai-Chi (OR = 1.18, 95% CI = [0.93, 1.50]). This study demonstrated that musculoskeletal symptoms among Chinese older adults were strongly associated with the use of TCM. Future research is needed to examine the effectiveness of TCM in treating musculoskeletal symptoms.
Collapse
Affiliation(s)
- XinQi Dong
- Rush University Medical Center, Chicago, IL, USA
| | - Ke Li
- Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
10
|
Torstensen TA, Grooten WJA, Østerås H, Heijne A, Harms-Ringdahl K, Äng BO. How does exercise dose affect patients with long-term osteoarthritis of the knee? A study protocol of a randomised controlled trial in Sweden and Norway: the SWENOR Study. BMJ Open 2018; 8:e018471. [PMID: 29730615 PMCID: PMC5942416 DOI: 10.1136/bmjopen-2017-018471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Osteoarthritis (OA) of the knee is characterised by knee pain, disability and degenerative changes, and places a burden on societies all over the world. Exercise therapy is an often-used modality, but there is little evidence of what type of exercise dose is the most effective, indicating a need for controlled studies of the effect of different dosages. Thus, the aim of the study described in this protocol is to evaluate the effects of high-dose versus low-dose medical exercise therapy (MET) in patients with knee OA. METHODS AND ANALYSIS This is a multicentre prospective randomised two-arm trial with blinded assessment and data analysis. We are planning to include 200 patients aged 45-85 years with symptomatic (pain and decreased functioning) and X-ray verified diagnosis of knee OA. Those eligible for participation will be randomly allocated to either high-dose (n=100) or low-dose (n=100) MET. All patients receive three supervised treatments each week for 12 weeks, giving a total of 36 MET sessions. The high-dose group exercises for 70-90 min compared with 20-30 min for the low-dose group. The high-dose group exercises for a longer time, and receives a greater number of exercises with more repetitions and sets. Background and outcome variables are recorded at inclusion, and outcome measures are collected after every sixth treatment, at the end of treatment, and at 6-month and 12-month follow-ups. Primary outcome is self-rated knee functioning and pain using the Knee Injury and Osteoarthritis Outcome Score (KOOS). The primary end point is at the end of treatment after 3 months, and secondary end points are at 6 months and 12 months after the end of treatment. ETHICS AND DISSEMINATION This project has been approved by the Regional Research Ethics Committees in Stockholm, Sweden, and in Norway. Our results will be submitted to peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER NCT02024126; Pre-results.
Collapse
Affiliation(s)
- Tom Arild Torstensen
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Wilhelmus J A Grooten
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Allied Health Professionals Function, Functional area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Håvard Østerås
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Annette Heijne
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Allied Health Professionals Function, Functional area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Harms-Ringdahl
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Allied Health Professionals Function, Functional area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Björn Olov Äng
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- School of Education, Health and Social Sciences, Dalarna University, Falun, Sweden
- Center for Clinical Research Dalarna, Falun, Sweden
| |
Collapse
|
11
|
Manual therapy, exercise therapy or combined treatment in the management of adult neck pain - A systematic review and meta-analysis. Musculoskelet Sci Pract 2017; 31:62-71. [PMID: 28750310 DOI: 10.1016/j.msksp.2017.07.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/13/2017] [Accepted: 07/18/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Neck pain is a common and often disabling musculoskeletal condition. Two therapies frequently prescribed for its management are manual therapy (MT) and exercise therapy (ET), and combining these treatment approaches are common. OBJECTIVE To assess whether or not combined treatment consisting of MT and ET is more effective than either therapy alone in relieving pain and improving function in adult patients with grade I-II neck pain. DESIGN Systematic review with meta-analysis. METHODS A systematic search on EMBASE, MEDLINE, AMED, CENTRAL and PEDro were performed until June 2017. Randomized controlled trials with adult grade I-II neck pain patients were included if they investigated the combined effect of MT and ET to the same ET or MT alone, and reported pain intensity or disability on numerical scales. Quality of life was assessed as a secondary outcome. Quality of the included trials was assessed with the PEDro scale, and the quality of evidence was assessed with GRADE. RESULTS 1169 articles were screened, and 7 studies were included, all of which investigated the addition of ET to MT. Only very small and non-significant between group differences was found on pain intensity at rest, neck disability, and quality of life at immediate post-treatment, 6 months, and 12 months follow-up. The quality of evidence was moderate for pain-at-rest outcomes and moderate too low for neck disability and quality of life outcomes. CONCLUSION Combined treatment consisting of MT and ET does not seem to be more effective in reducing neck pain intensity at rest, neck disability or improving quality of life in adult patients with grade I-II neck pain, than ET alone.
Collapse
|
12
|
Østerås H, Paulsberg F, Olsen SE, Østerås B, Torstensen TA. Effects of medical exercise therapy in patients with hip osteoarthritis: A randomized controlled trial with six months follow-up. A pilot study. J Bodyw Mov Ther 2016; 21:284-289. [PMID: 28532870 DOI: 10.1016/j.jbmt.2016.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 06/24/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND & AIMS There is no consensus regarding what type of exercises, combination of exercises or exercise dosage is most effective in patients with long-term hip arthrosis. The goal of this study was to evaluate the effects of two different exercise programs related to dose-response relationships. METHOD Prospective randomized controlled clinical trial with 6 months follow where 33 participants were randomly assigned to either high repetitive, high dosage medical exercise therapy (MET) (n = 16) or low dosage exercise therapy (ET) (n = 17). Primary outcomes are pain using a visual analog scale (VAS) and function using a functional assessment questionnaire (WOMAC). RESULTS Patients were equal at baseline. Two patients (6%) dropped out during the treatment period. There were no difference between groups after end of treatment nor at 6 months follow up. However, there were significant differences within each exercise group at end of treatment. CONCLUSION In this pilot study, we were not able to show any difference between MET and ET. More research is needed with a larger patient population and a more extensive exercise period similar to other studies that are published regarding dose-response effects. Clinicaltrials.gov identifier: NCT01700933.
Collapse
Affiliation(s)
- Håvard Østerås
- Norwegian University of Science and Technology, Faculty of Health and Social Science, Trondheim, Norway.
| | | | | | - Berit Østerås
- Norwegian University of Science and Technology, Faculty of Health and Social Science, Trondheim, Norway
| | - Tom Arild Torstensen
- Holten Institute, Stockholm, Sweden and NVS Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|