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Yuce S, Dzhavadov AA, Dikmen G, Ozden VE, Kocabey B, Parvizi J, Tozun R. Does Focused Gluteus Medius Muscle Stretching After Total Hip Arthroplasty Work? An Electromyographic Study. J Arthroplasty 2024:S0883-5403(24)00753-8. [PMID: 39053662 DOI: 10.1016/j.arth.2024.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The hypothesis of this randomized prospective study was that focused stretching of the gluteus medius muscle, in addition to generalized physical therapy, is likely to improve muscle reaction time and positively impact the return to function of the patient after primary total hip arthroplasty. METHODS We prospectively recruited 28 patients undergoing primary total hip arthroplasty from January 2021 to January 2023. The control group (13 patients) received a conventional rehabilitation protocol, while the intervention group (15 patients) received focused stretching exercises of the gluteus medius muscle in addition to the conventional rehabilitation protocol. Patients had preoperative and postoperative surface electromyography (sEMG) to assess muscle activity. RESULTS Patients in the intervention group after surgery had better muscle activation according to sEMG during walking and during one leg stance compared to the control group. Also, patients from the intervention group had better strength of the gluteus medius muscle after surgery, but this did not reach statistical significance. CONCLUSIONS The present prospective study demonstrated that implementation of focused gluteus medius muscle stretching results in statistically significantly higher muscle activation as measured by sEMG. The strength of the gluteus medius muscle is also higher as measured using a dynamometer, albeit not reaching statistical significance. Based on the findings of this sEMG study, it appears that focused stretching and strengthening of abductors muscles are beneficial.
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Affiliation(s)
- Selvi Yuce
- Department of Orthopedcis and Traumatology, Acıbadem Maslak Hospital, Istanbul, Turkiye
| | - Alisagib A Dzhavadov
- International Joint Centre (IJC), Acibadem Maslak Hospital, Istanbul, Turkiye; Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Goksel Dikmen
- International Joint Centre (IJC), Acibadem Maslak Hospital, Istanbul, Turkiye; Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkiye
| | - Vahit Emre Ozden
- International Joint Centre (IJC), Acibadem Maslak Hospital, Istanbul, Turkiye; Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkiye
| | - Burcu Kocabey
- Department of Orthopedcis and Traumatology, Acıbadem Maslak Hospital, Istanbul, Turkiye
| | - Javad Parvizi
- International Joint Centre (IJC), Acibadem Maslak Hospital, Istanbul, Turkiye; Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkiye
| | - Remzi Tozun
- Department of Orthopedcis and Traumatology, Acıbadem Maslak Hospital, Istanbul, Turkiye; International Joint Centre (IJC), Acibadem Maslak Hospital, Istanbul, Turkiye
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Centurião JHVM, Obara K, Silva CT, Paixão L, Silva MF, Dias JM, Cardoso JR. Effects of aquatic exercises in patients after total hip arthroplasty: A systematic review. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2043. [PMID: 37602930 DOI: 10.1002/pri.2043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/09/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) is a surgical procedure that can alter physical function and quality of life. OBJECTIVES The aim was to verify the effects of aquatic exercises compared with exercises on land, control or other modalities, in patients undergoing THA on the primary outcomes: self-reported physical function, quality of life and pain; and secondary outcomes: muscle strength, functional capacity and gait. DESIGN Systematic review that followed the PRISMA Statement and PROSPERO registered. The search was performed in the following databases: Web of Science, Embase, Medline, Cinahl, Lilacs, SPORTDiscus, Cochrane Library, Scopus, SciELO, and PEDro, from 1945 to 2022. The risk of bias assessment was performed using the Risk of Bias 2 (RoB2) from the Cochrane Collaboration. RESULTS Three randomized controlled trials (RCTs) were included, with a total of 364 participants. In the selection process, two publications from the same study were found. The RoB2 assessment classified one RCT as "high risk of bias" and the others as "low risk of bias". Therefore, the analysis of the results considered only studies with a low risk of bias. For the self-reported physical function outcome, evaluated by WOMAC, improvement was observed in favor of aquatic exercises, when started on the 14th postoperative day. Pain improved after 24th week postoperative, in favor of exercise (effect size between 0.2 and 0.4). Quality of life, verified only by one RCT, improved at each time point evaluated (effect size between 0.01 and 0.10). The functional capacity showed no difference between the groups. This was the first systematic review to assess the benefits of aquatic exercises specifically in THA and it was possible to infer that the exercises initiated after 14 days of postoperative are safer. The protocol should include proprioceptive, coordination, and resistance exercises. The session can last around 30 min and is held three times a week. CONCLUSION Decision making for treatment in the postoperative of THA may include aquatic exercises as a safe and efficacious alternative to improve self-reported physical function, pain, quality of life, and muscle resistance.
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Affiliation(s)
- Julio Henric V M Centurião
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, Brazil
| | - Karen Obara
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, Brazil
| | - Carla T Silva
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, Brazil
| | - Luana Paixão
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, Brazil
| | - Mariana F Silva
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, Brazil
| | - Josilainne M Dias
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, Brazil
- Universidade Estadual de Mato Grosso do Sul, Campo Grande, Brazil
| | - Jefferson R Cardoso
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, Brazil
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Miyazaki S, Yamako G, Arakawa H, Sakamoto T, Kawaguchi T, Ito K, Chosa E. Weight-shifting-based robot control system improves the weight-bearing rate and balance ability of the static standing position in hip osteoarthritis patients: a randomized controlled trial focusing on outcomes after total hip arthroplasty. PeerJ 2023; 11:e15397. [PMID: 37214101 PMCID: PMC10199675 DOI: 10.7717/peerj.15397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
Background After a total hip arthroplasty (THA), standing and walking balance are greatly affected in the early stages of recovery, so it is important to increase the weight-bearing amount (WBA) on the operated side. Sometimes, traditional treatments may not be enough to improve WBA and weight-bearing ratio (WBR) on the operated side in a satisfactory way. To solve this problem, we came up with a new weight-shifting-based robot control system called LOCOBOT. This system can control a spherical robot on a floor by changing the center of pressure (COP) on a force-sensing board in rehabilitation after THA. The goal of this study was to find out how rehabilitation with the LOCOBOT affects the WBR and balance in a static standing position in patients with unilateral hip osteoarthritis (OA) who had a primary uncemented THA. Methods This randomized controlled trial included 20 patients diagnosed with Kellgren-Lawrence (K-L) grade 3 or 4 hip OA on the operative side and K-L grade 0 normal hip on the nonoperative side. We used the minimization method for allocation and randomly assigned patients to either the LOCOBOT group or the control group. As a result, 10 patient seach were randomly assigned to the LOCOBOT and control groups. Both groups received 40 min of rehabilitation treatment. Out of the 40 min, the LOCOBOT group underwent treatment for 10 min with LOCOBOT. The control group performed COP-controlled exercises on a flat floor instead of using LOCOBOT for 10 of the 40 min. All theoutcome measures were performed pre-THA and 11.9 ± 1.6 days after THA (12 days after THA). The primary outcome measure included WBR in the static standing position. Results After12 days of THA, the LOCOBOT group exhibited significantly higher mean WBR and WBA (operated side) values than the control group. Furthermore, the LOCOBOT group exhibited significantly lower mean WBA (non-operated side) and outer diameter area (ODA) values than the control group. From pre-THA to 12 days after THA, the LOCOBOT group exhibited a significant improvement in mean WBR and WBA (operated side). Moreover, the mean WBA (non-operated side) and ODA significantly decreased. From pre-THA to 12 days after THA, the control group showed a significant increase in total trajectory length and ODA. Conclusions The most important finding of this study was that patients were able to perform the LOCOBOT exercise as early as the second day after THA, and that WBR and ODA significantly improved by the 12th day after THA. This result demonstrated that the LOCOBOT effectively improves WBR in a short period of time after THA and is a valuable system for enhancing balance ability. This expedites the acquisition of independence in activities of daily living after THA and may contribute to optimizing the effectiveness of medical care.
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Affiliation(s)
- Shigeaki Miyazaki
- Rehabilitation Unit, University of Miyazaki Hospital, Miyazaki, Japan
| | - Go Yamako
- Department of Mechanical Engineering, Faculty of Engineering, University of Miyazaki, Miyazaki, Japan
| | - Hideki Arakawa
- Rehabilitation Unit, University of Miyazaki Hospital, Miyazaki, Japan
| | - Takero Sakamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tsubasa Kawaguchi
- Rehabilitation Unit, University of Miyazaki Hospital, Miyazaki, Japan
| | - Kirari Ito
- Department of Mechanical Engineering, Faculty of Engineering, University of Miyazaki, Miyazaki, Japan
| | - Etsuo Chosa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Konnyu KJ, Pinto D, Cao W, Aaron RK, Panagiotou OA, Bhuma MR, Adam GP, Balk EM, Thoma LM. Rehabilitation for Total Hip Arthroplasty: A Systematic Review. Am J Phys Med Rehabil 2023; 102:11-18. [PMID: 35302955 PMCID: PMC9464790 DOI: 10.1097/phm.0000000000002007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT We sought to determine the comparative benefits and harms of rehabilitation interventions for patients who have undergone elective, unilateral THA surgery for the treatment of primary osteoarthritis. We searched PubMed, Embase, The Cochrane Register of Clinical Trials, CINAHL, PsycINFO, Scopus, and ClinicalTrials.gov from January 1, 2005, through May 3, 2021. We included randomized controlled trials and adequately adjusted nonrandomized comparative studies of rehabilitation programs reporting performance-based, patient-reported, or healthcare utilization outcomes. Three researchers extracted study data and assessed risk of bias, verified by an independent researcher. Experts in rehabilitation content and complex interventions independently coded rehabilitation interventions. The team assessed strength of evidence. Large heterogeneity across evaluated rehabilitation programs limited conclusions. Evidence from 15 studies suggests that diverse rehabilitation programs may not differ in terms of risk of harm or outcomes of pain, strength, activities of daily living, or quality of life (all low strength of evidence). Evidence is insufficient for other outcomes. In conclusion, no differences in outcomes were found between different rehabilitation programs after THA. Further evidence is needed to inform decisions on what attributes of rehabilitation programs are most effective for various outcomes.
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Affiliation(s)
- Kristin J. Konnyu
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Dan Pinto
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin
| | - Wangnan Cao
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Roy K. Aaron
- Department of Orthopaedic Surgery, Warren Albert Medical School of Brown University, Providence, Rhode Island; Orthopedic Program in Clinical/Translational Research, Warren Albert Medical School of Brown University, Providence, Rhode Island; Miriam Hospital Total Joint Replacement Center, Providence, Rhode Island
| | - Orestis A. Panagiotou
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Monika Reddy Bhuma
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Gaelen P. Adam
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Ethan M. Balk
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Louise M. Thoma
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Tang W, Flavell CA, Grant A, Doma K. The effects of exercise on function and pain following total hip arthroplasty: a systematic literature review and meta-analysis. PHYSICAL THERAPY REVIEWS 2022. [DOI: 10.1080/10833196.2022.2062967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Wilson Tang
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Carol Ann Flavell
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Andrea Grant
- Orthopaedic Research Institute of Queensland, Townsville, QLD, Australia
| | - Kenji Doma
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
- Orthopaedic Research Institute of Queensland, Townsville, QLD, Australia
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Fatoye F, Wright JM, Yeowell G, Gebrye T. Clinical and cost-effectiveness of physiotherapy interventions following total hip replacement: a systematic review and meta-analysis. Rheumatol Int 2020; 40:1385-1398. [PMID: 32451696 PMCID: PMC7371665 DOI: 10.1007/s00296-020-04597-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/04/2020] [Indexed: 12/22/2022]
Abstract
To examine the reported clinical and cost-effectiveness of physiotherapy interventions following total hip replacement (THR). A systematic review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). MEDLINE, CINAHL, AMED, Scopus, DARE, HTA, and NHS EED databases were searched for studies on clinical and cost-effectiveness of physiotherapy in adults with THR published up to March 2020. Studies meeting the inclusion criteria were identified and key data were extracted. Risk of bias was assessed using the Cochrane Risk of Bias Tool and a Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Data were summarised and combined using random-effect meta-analysis. A total of 1263 studies related to the aim of the review were identified, from which 20 studies met the inclusion criteria and were included in the review. These studies were conducted in Australia (n = 3), Brazil (n = 1), United States of America (USA) (n = 2), France (n = 2), Italy (n = 2), Germany (n = 3), Ireland (n = 1), Norway (n = 2), Canada (n = 1), Japan (n = 1), Denmark (n = 1), and United Kingdom (UK) (n = 1). The duration of follow-up of the included studies was ranged from 2 weeks to 12 months. Physiotherapy interventions were found to be clinically effective for functional performance, hip muscle strength, pain, and range of motion flexion. From the National Health Service perspective, an accelerated physiotherapy programme following THR was cost-effective. The findings of the review suggest that physiotherapy interventions were clinically effective for people with THR. However, questions remain on the pooled cost-effectiveness of physiotherapy interventions, and further research is required to examine this in patients with THR. Future studies are required to examine the cost-effectiveness of these interventions from patients, caregivers, and societal perspectives.Registration Prospero (ID: CRD42018096524).
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Affiliation(s)
- Francis Fatoye
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, 53 Bonsall Street, Manchester, M15 6GX, UK.
| | - J M Wright
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, 53 Bonsall Street, Manchester, M15 6GX, UK
| | - G Yeowell
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, 53 Bonsall Street, Manchester, M15 6GX, UK
| | - T Gebrye
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, 53 Bonsall Street, Manchester, M15 6GX, UK
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Papalia R, Campi S, Vorini F, Zampogna B, Vasta S, Papalia G, Fossati C, Torre G, Denaro V. The Role of Physical Activity and Rehabilitation Following Hip and Knee Arthroplasty in the Elderly. J Clin Med 2020; 9:jcm9051401. [PMID: 32397459 PMCID: PMC7291199 DOI: 10.3390/jcm9051401] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 12/15/2022] Open
Abstract
Hip and knee replacement is an effective treatment for symptomatic, end-stage hip and knee osteoarthritis, aiming to relieve pain and restore joint function. Several postoperative rehabilitation protocols and physical activities are proposed in routine clinical practice. However, their effect on clinical outcome and implant revision in patients undergoing joint replacement is still unclear. A systematic review of the literature was performed through a comprehensive search on online databases including Pubmed-Medline, Cochrane central, and Google scholar. We included all the available studies on postoperative physical activity and rehabilitation protocols after total knee and total hip arthroplasty in patients older than 65 years. The primary endpoint was to evaluate the effect of physical activity and rehabilitation on clinical outcome; the secondary outcome was to determine the effect on patients' quality of life (QoL) and implant survival. Although the heterogeneity of the rehabilitation protocols and outcome measures did not allow to draw definitive conclusions, most studies suggested that aquatic therapy, ergometer cycling, and fast-track protocols have a beneficial effect on muscle strength, gait speed, and main clinical scores after total hip arthroplasty. Similarly, enhanced rehabilitation protocols produced an improvement in primary and secondary outcomes after total knee arthroplasty.
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Affiliation(s)
- Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (S.C.); (F.V.); (B.Z.); (S.V.); (G.P.); (V.D.)
| | - Stefano Campi
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (S.C.); (F.V.); (B.Z.); (S.V.); (G.P.); (V.D.)
| | - Ferruccio Vorini
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (S.C.); (F.V.); (B.Z.); (S.V.); (G.P.); (V.D.)
| | - Biagio Zampogna
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (S.C.); (F.V.); (B.Z.); (S.V.); (G.P.); (V.D.)
| | - Sebastiano Vasta
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (S.C.); (F.V.); (B.Z.); (S.V.); (G.P.); (V.D.)
| | - Giuseppe Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (S.C.); (F.V.); (B.Z.); (S.V.); (G.P.); (V.D.)
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy;
| | - Guglielmo Torre
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (S.C.); (F.V.); (B.Z.); (S.V.); (G.P.); (V.D.)
- Correspondence: (G.T.)
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (R.P.); (S.C.); (F.V.); (B.Z.); (S.V.); (G.P.); (V.D.)
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Budib MB, Hashiguchi MM, Oliveira-Junior SAD, Martinez PF. Influência da reabilitação física sobre aspectos funcionais em indivíduos submetidos à artroplastia total de quadril: uma revisão sistemática. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2020. [DOI: 10.1590/1981-22562020023.190252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo: Avaliar, por meio de revisão sistemática, a influência do tratamento fisioterapêutico sobre a funcionalidade, amplitude de movimento articular e força muscular em pacientes submetidos à artroplastia total de quadril devido à osteoartrite. Métodos: A busca sistemática de ensaios clínicos randomizados e não randomizados foi conduzida utilizando os bancos de dados eletrônicos PubMed, Web of Science, PEDro, Cochrane, Clinical Trials e SciELO, com base nas estratégias de pesquisa recomendadas pelos itens de relatórios preferenciais para análises sistemáticas e metanálises (PRISMA). Resultados: Em geral, protocolos supervisionados por fisioterapeutas associados à realização de exercícios ativos da musculatura periarticular do quadril e de extensores de joelho têm propiciado importante prognóstico físico e funcional. Exercícios resistidos (dinâmicos e isométricos) de alta intensidade são mais eficazes para a funcionalidade. Para a força muscular e Amplitude de movimento (ADM), exercícios dinâmicos com 3 a 5 séries de 8 a 12 repetições com baixa e alta intensidade promoveram ganhos mais expressivos em relação a outras modalidades terapêuticas. Conclusões: As técnicas e os protocolos utilizados pela fisioterapia para o tratamento da ATQ são variados e possuem importante eficácia clínica comprovada na literatura.
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Affiliation(s)
- Mariana Bogoni Budib
- Universidade Federal de Mato Grosso do Sul, Brasil; Universidade Federal de Mato Grosso do Sul, Brasil
| | | | | | - Paula Felippe Martinez
- Universidade Federal de Mato Grosso do Sul, Brasil; Universidade Federal de Mato Grosso do Sul, Brasil
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Wijnen A, Bouma SE, Seeber GH, van der Woude LHV, Bulstra SK, Lazovic D, Stevens M, van den Akker-Scheek I. The therapeutic validity and effectiveness of physiotherapeutic exercise following total hip arthroplasty for osteoarthritis: A systematic review. PLoS One 2018; 13:e0194517. [PMID: 29547670 PMCID: PMC5856403 DOI: 10.1371/journal.pone.0194517] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 03/05/2018] [Indexed: 01/08/2023] Open
Abstract
Objective To assess the therapeutic validity and effectiveness of physiotherapeutic exercise interventions following total hip arthroplasty (THA) for osteoarthritis. Data sources The databases Embase, MEDLINE, Cochrane Library, CINAHL and AMED were searched from inception up to February 2017. Eligibility criteria Articles reporting results of randomized controlled trials in which physiotherapeutic exercise was compared with usual care or with a different type of physiotherapeutic exercise were included, with the applied interventions starting within six months after THA. Only articles written in English, German or Dutch were included. Study appraisal Therapeutic validity (using the CONTENT scale) and risk of bias (using both the PEDro scale and the Cochrane Collaboration’s tool) were assessed by two researchers independently. Characteristics of the physiotherapeutic exercise interventions and results about joint and muscle function, functional performance and self-reported outcomes were extracted. Results Of the 1124 unique records retrieved, twenty articles were included. Only one article was considered to be of high therapeutic validity. Description and adequacy of patient selection were the least reported items. The majority of the articles was considered as having potentially high risk of bias, according to both assessment tools. The level of therapeutic validity did not correspond with the risk of bias scores. Because of the wide variety in characteristics of the physiotherapeutic exercise and control interventions, follow-up length and outcome measures, limited evidence was found on the effectiveness of physiotherapeutic exercise following THA. Conclusion The insufficient therapeutic validity and potentially high risk of bias in studies involving physiotherapeutic exercise interventions limit the ability to assess the effectiveness of these interventions following THA. Researchers are advised to take both quality scores into account when developing and reporting studies involving physiotherapeutic exercise. Uniformity in intervention characteristics and outcome measures is necessary to enhance the comparability of clinical outcomes between trials.
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Affiliation(s)
- Annet Wijnen
- University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Sjoukje E. Bouma
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Gesine H. Seeber
- University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Lucas H. V. van der Woude
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Sjoerd K. Bulstra
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Djordje Lazovic
- University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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The Hip Functional Retrieval after Elective Surgery May Be Enhanced by Supplemented Essential Amino Acids. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9318329. [PMID: 27110573 PMCID: PMC4823478 DOI: 10.1155/2016/9318329] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/22/2016] [Accepted: 03/06/2016] [Indexed: 11/25/2022]
Abstract
It is not known whether postsurgery systemic inflammation and plasma amino acid abnormalities are still present during rehabilitation of individuals after elective hip arthroplasty (EHA). Sixty subjects (36 females; age 66.58 ± 8.37 years) were randomized to receive 14-day oral EAAs (8 g/day) or a placebo (maltodextrin). At admission to and discharge from the rehabilitation center, serum C-reactive protein (CRP) and venous plasma amino acid concentrations were determined. Post-EHA hip function was evaluated by Harris hip score (HHS) test. Ten matched healthy subjects served as controls. At baseline, all patients had high CRP levels, considerable reduction in several amino acids, and severely reduced hip function (HHS 40.78 ± 2.70 scores). After treatment, inflammation decreased both in the EAA group and in the placebo group. Only EAA patients significantly improved their levels of glycine, alanine, tyrosine, and total amino acids. In addition, they enhanced the rate of hip function recovery (HHS) (from baseline 41.8 ± 1.15 to 76.37 ± 6.6 versus baseline 39.78 ± 4.89 to 70.0 ± 7.1 in placebo one; p = 0.006). The study documents the persistence of inflammation and plasma amino acid abnormalities in post-EHA rehabilitation phase. EAAs enhance hip function retrieval and improve plasma amino acid abnormalities.
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Effect of cycle ergometer and conventional exercises on rehabilitation of older patients with total hip arthroplasty: study protocol for randomized controlled trial. Trials 2015; 16:139. [PMID: 25873151 PMCID: PMC4397699 DOI: 10.1186/s13063-015-0647-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/12/2015] [Indexed: 11/16/2022] Open
Abstract
Background Total hip arthroplasty (THA) is an increasingly common treatment for older patients with hip osteoarthritis. The best strategy for a physiotherapy intervention for older people after THA is not clear in the literature. The purpose of this protocol study is to test the feasibility of undertaking a full trial clinical to evaluate the effect of ergometer cycling-associated conventional exercises on functional results and health-related quality of life (HRQOL) of older patients with THA. Methods/Design This study protocol is a prospective, single center, randomized controlled pilot clinical trial. Older patients (≥60 years) in the postoperative phase after primary unilateral THA for hip osteoarthritis will be consecutively recruited for this study and randomly allocated to 2 treatment groups. Group I will perform cycle ergometer and conventional exercises, and group II will perform only conventional exercises. The sessions will be conducted twice a week for 8 weeks. Assessments will be made at baseline (2 weeks postoperatively: the moment that the patients receive a referral for physical therapy, which will start after suture removal), after intervention (10 weeks postoperatively), and at 6 months of follow-up (24 weeks postoperatively). The primary outcomes are the function, evaluated using the Harris Hip Score (HHS) and the Short Physical Performance Battery (SPPB). The secondary outcome is HRQOL, measured using 2 evaluation instruments: the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Data collectors will be blinded and will not have contact with participants during the interventions. Discussion This randomized controlled trial will provide evidence regarding the effect of this exercise therapy on physical function and quality of life in older patients after THA. If our hypothesis is correct, both interventions will be effective, but the exercises on the cycle ergometer conferring better results in function, physical performance and quality of life. The study follows Consolidated Standards of Reporting Trials (CONSORT) guidelines, and the approval of the local ethics committee has been obtained. Trial registration ClinicalTrials.gov: NCT01622465 (14 June 2012)
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Lowe CJM, Davies L, Sackley CM, Barker KL. Effectiveness of land-based physiotherapy exercise following hospital discharge following hip arthroplasty for osteoarthritis: an updated systematic review. Physiotherapy 2015; 101:252-65. [PMID: 25724323 DOI: 10.1016/j.physio.2014.12.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 12/31/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Existing review required updating. OBJECTIVE To evaluate the effectiveness of physiotherapy exercise after discharge from hospital on function, walking, range of motion, quality of life and muscle strength, for patients following elective primary total hip arthroplasty for osteoarthritis. DESIGN Systematic review from January 2007 to November 2013. DATA SOURCES AMED, CINAHL, EMBASE, MEDLINE, Kingsfund Database, and PEDro. Cochrane CENTRAL, BioMed Central (BMC), The Department of Health National Research Register and Clinical Trials.gov register. Searches were overseen by a librarian. Authors were contacted for missing information. No language restrictions were applied. ELIGIBILITY CRITERIA Trials comparing physiotherapy exercise vs usual/standard care, or comparing two types of relevant exercise physiotherapy, following discharge from hospital after elective primary total hip replacement for osteoarthritis were reviewed. OUTCOMES Functional activities of daily living, walking, quality of life, muscle strength and joint range of motion. STUDY APPRAISAL Quality and risk of bias for studies were evaluated. Data were extracted and meta-analyses considered. RESULTS 11 trials are included in the review. Trial quality was mixed. Newly included studies were assessed as having lower risk of bias than previous studies. Narrative review indicates that physiotherapy exercise after discharge following total hip replacement may potentially benefit patients in terms of function, walking and muscle strengthening. LIMITATIONS The overall quality and quantity of trials, and their diversity, prevented meta-analyses. CONCLUSIONS Disappointingly, insufficient evidence still prevents the effectiveness of physiotherapy exercise following discharge to be determined for this patient group. High quality, adequately powered, trials with long term follow up are required.
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Affiliation(s)
- Catherine J Minns Lowe
- Physiotherapy Research Unit, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Hospital, Windmill Road, Headington, Oxford, UK.
| | - Linda Davies
- Physiotherapy Research Unit, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Hospital, Windmill Road, Headington, Oxford, UK
| | - Catherine M Sackley
- School of Rehabilitation Sciences, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Karen L Barker
- Physiotherapy Research Unit, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Hospital, Windmill Road, Headington, Oxford, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals NHS Trust, Oxford, UK
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Martins CN, Tarouco CP, Martin DG, Signori LU. Eletromiográfia do reto femoral em diferentes equipamentos proprioceptivos no meio aquático. REV BRAS MED ESPORTE 2014. [DOI: 10.1590/1517-86922014200401985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUÇÃO: A propriocepção é uma variável imprescindível para prevenção e reabilitação das lesões do joelho, podendo ser estimulada por diferentes equipamentos, os quais ainda não foram testados em meio aquático.OBJETIVO: Avaliar a atividade eletromiográfica (EMG) do músculo reto femoral de atletas no meio aquático frente a três diferentes equipamentos proprioceptivos (cama elástica, disco proprioceptivo e balancim).MÉTODOS: A amostra foi composta por dez jogadores de futsal profissional, sem histórico de lesões musculoesqueléticas (últimos três meses), com 23,1 (±1,5) anos e índice de massa corporal 25,2 (±0,5) kg/m². A aquisição do sinal EMG do reto femoral do membro dominante foi adquirido por eletrodos de superfície, aproximadamente 2,5 cm da posição distal do ponto motor. O nível da água foi ajustado individualmente (entre a região umbilical e o processo xifoide) e a temperatura mantida a 32 °C. As avaliações compreenderam o repouso, a contração voluntária máxima (CVM) antes e depois dos experimentos e os estímulos proprioceptivos (cama elástica, disco proprioceptivo e balancim) em apoio unipodal. Os dados (média ± erro padrão) foram comparados pelo teste-tpareado e pela ANOVA para medidas repetidas seguida de testeBonferrroni (post hoc).RESULTADOS: A EMG da CVM antes (221,0 ± 134 RMS/µVolts) e depois (243,0 ± 154,0 RMS/µVolts) foi semelhante (p = 0,129). No meio aquático, a cama elástica, o balancim e o disco apresentaram respectivamente 24,5 (±4,3), 33,9 (±4,3) e 32,5 (±6,7) %CVM. A atividade EMG do reto femoral na cama elástica foi 8% menor que o balancim e 9,5% que o disco proprioceptivo (p < 0,001).CONCLUSÃO: No meio aquático os equipamentos proprioceptivos promovem a ativação do reto femoral. Entretanto, a cama elástica apresenta menor atividade que o disco e o balancim, sugerindo-se que este equipamento deva ser utilizado no início da estimulação proprioceptiva.
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Locher C, Pforr C. The Legacy of Sebastian Kneipp: Linking Wellness, Naturopathic, and Allopathic Medicine. J Altern Complement Med 2014; 20:521-6. [DOI: 10.1089/acm.2013.0423] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cornelia Locher
- Pharmacy Program, School of Medicine and Pharmacology, Centre for Optimization of Medicines, University of Western Australia, Crawley, Australia
| | - Christof Pforr
- Curtin Business School, Curtin University, Perth, Australia
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Okoro T, Ramavath A, Howarth J, Jenkinson J, Maddison P, Andrew JG, Lemmey A. What does standard rehabilitation practice after total hip replacement in the UK entail? Results of a mixed methods study. BMC Musculoskelet Disord 2013; 14:91. [PMID: 23496875 PMCID: PMC3606380 DOI: 10.1186/1471-2474-14-91] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 03/06/2013] [Indexed: 01/08/2023] Open
Abstract
Background There is evidence of prolonged poor function in patients following total hip replacement (THR). Studies of progressive resistance training (PRT) interventions to improve function are often compared to ‘standard’ practice which is not well defined. This study aimed to investigate ‘standard’ rehabilitation care in the UK after total hip replacement (THR) as well as determine whether PRT was part of ‘standard’ care. Methods After ethical approval, questionnaire item development about rehabilitation practice was guided by a focus group interview (after informed consent) with physiotherapists (n = 4; >5 years post-qualification) who regularly treated THR patients. An online questionnaire investigating the exercises prescribed and rehabilitation practice following THR was developed and sent to physiotherapists working in hospitals in the UK. The survey was performed from January to May 2011. The survey results were analysed (frequency (%) of responses) focusing on the exercises the physiotherapists considered important, as well as their use of PRT in prescribed regimes. Results 106 responses were obtained from physiotherapists in the UK. The survey respondents considered that the most important muscles to target in all phases of rehabilitation were the hip abductors (62.2%), followed by the quadriceps (16.9%), and other muscles (21%). Exercise type prescribed revealed no consensus, with weight bearing (42%), functional (45%) and Bed-based/Bridging/Postural exercises (13%) favoured. 83.7% were able to define the basis of progressive resistance training (PRT), but only 33% prescribed it. Conclusions Standard physiotherapy rehabilitation in the UK after THR is variable, and appears to rarely include PRT. This may be a factor in prolonged poor function in some patients after this common operation.
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Affiliation(s)
- Tosan Okoro
- School of Medical Sciences, Bangor University, Bangor, UK.
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Villalta EM, Peiris CL. Early aquatic physical therapy improves function and does not increase risk of wound-related adverse events for adults after orthopedic surgery: a systematic review and meta-analysis. Arch Phys Med Rehabil 2012; 94:138-48. [PMID: 22878230 DOI: 10.1016/j.apmr.2012.07.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/25/2012] [Accepted: 07/25/2012] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To investigate whether early postoperative aquatic physical therapy is a low-risk and effective form of physical therapy to improve functional outcomes after orthopedic surgery. DATA SOURCES Databases MEDLINE, CINAHL, AMED, Embase, and PEDro were searched from the earliest date available until October 2011. Additional trials were identified by searching reference lists and citation tracking. STUDY SELECTION Controlled trials evaluating the effects of aquatic physical therapy on adverse events for adults <3 months after orthopedic surgery. Two reviewers independently applied inclusion and exclusion criteria, and any disagreements were discussed until consensus could be reached. Searching identified 5069 potentially relevant articles, of which 8 controlled trials with 287 participants met inclusion criteria. DATA EXTRACTION A predefined data extraction form was completed in detail for each included study by 1 reviewer and checked for accuracy by another. Methodologic quality of included trials was assessed independently by 2 reviewers using the PEDro scale. DATA SYNTHESIS Pooled analyses were performed using random effects model with inverse variance methods to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs) (continuous outcomes) and risk difference and 95% CIs (dichotomous outcomes). When compared with land-based physical therapy, early aquatic physical therapy does not increase the risk of wound-related adverse events (risk difference=.01, 95% CI -.05 to .07) and results in improved performance of activities of daily living (SMD=.33, 95% CI=.07-.58, I(2)=0%). There were no significant differences in edema (SMD=-.27, 95% CI=-.81 to .27, I(2)=58%) or pain (SMD=-.06, 95% CI=-.50 to .38, I(2)=32%). CONCLUSIONS After orthopedic surgery aquatic physical therapy improves function and does not increase the risk of wound-related adverse events and is as effective as land-based therapy in terms of pain, edema, strength, and range of motion in the early postoperative period.
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Okoro T, Lemmey AB, Maddison P, Andrew JG. An appraisal of rehabilitation regimes used for improving functional outcome after total hip replacement surgery. Sports Med Arthrosc Rehabil Ther Technol 2012; 4:5. [PMID: 22313723 PMCID: PMC3292973 DOI: 10.1186/1758-2555-4-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 02/07/2012] [Indexed: 11/29/2022]
Abstract
This study aimed to systematically review the literature with regards to studies of rehabilitation programmes that have tried to improve function after total hip replacement (THR) surgery. 15 randomised controlled trials were identified of which 11 were centre-based, 2 were home based and 2 were trials comparing home and centre based interventions. The use of a progressive resistance training (PRT) programme led to significant improvement in muscle strength and function if the intervention was carried out early (< 1 month following surgery) in a centre (6/11 centre-based studies used PRT), or late (> 1 month following surgery) in a home based setting (2/2 home based studies used PRT). In direct comparison, there was no difference in functional measures between home and centre based programmes (2 studies), with PRT not included in the regimes prescribed. A limitation of the majority of these intervention studies was the short period of follow up. Centre based program delivery is expensive as high costs are associated with supervision, facility provision, and transport of patients. Early interventions are important to counteract the deficit in muscle strength in the affected limb, as well as persistent atrophy that exists around the affected hip at 2 years post-operatively. Studies of early home-based regimes featuring PRT with long term follow up are needed to address the problems currently associated with rehabilitation following THR.
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Affiliation(s)
- Tosan Okoro
- School of Medical Sciences (SMS)/School of Sport Health and Exercise Science (SSHES), Bangor University, Penrallt Road, Bangor LL57 2AS, UK.
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Liebs TR, Herzberg W, Rüther W, Haasters J, Russlies M, Hassenpflug J. Multicenter Randomized Controlled Trial Comparing Early Versus Late Aquatic Therapy After Total Hip or Knee Arthroplasty. Arch Phys Med Rehabil 2012; 93:192-9. [DOI: 10.1016/j.apmr.2011.09.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 09/08/2011] [Accepted: 09/15/2011] [Indexed: 01/22/2023]
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Hawker GA, Mian S, Bednis K, Stanaitis I. Osteoarthritis year 2010 in review: non-pharmacologic therapy. Osteoarthritis Cartilage 2011; 19:366-74. [PMID: 21324369 DOI: 10.1016/j.joca.2011.01.021] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 01/15/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To highlight seminal publications in the past year on the topic of non-pharmacologic management of osteoarthritis (OA). DESIGN A systematic search of the PUBMED and Cochrane databases from September 2009 to September 2010 was conducted to identify articles reporting on studies examining the safety or efficacy of non-pharmacologic therapies in the management of OA. Non-pharmacologic therapies were those considered in the 2008 OARSI OA guidelines. Identified articles were reviewed for quality; those of highest quality and deemed to have greatest potential impact on the management of OA were summarized. RESULTS The search identified 117 unique articles. Of these, four studies were chosen to highlight. A nested two-stage trial found that traditional Chinese acupuncture (TCA) was not superior to sham acupuncture, but that the providers' style affected both pain reduction and satisfaction with treatment, suggesting that the analgesic benefits of acupuncture may be partially mediated by the acupuncturists' behavior. A systematic review found little evidence of a significant effect for electrostimulation vs sham or no intervention on pain in knee OA. A single-blinded trial of Tai Chi vs attention controls found that 12 weeks of Tai Chi was associated with improvements in symptoms and disability in patients with knee OA. A randomized trial of early ACL reconstructive surgery and rehabilitation vs structured rehabilitation alone in subjects with acute anterior cruciate ligament tears found that, at 24 months following randomization, all study participants had improved, suggesting that a strategy of structured rehabilitation followed acute ACL injury may preclude the need for surgical reconstruction. CONCLUSIONS High quality studies of the safety and efficacy of non-pharmacologic agents in the management of OA remain challenging due to difficulties with adequate blinding and appropriate selection of attention controls. High quality studies suggest modest, if any, benefit of many non-pharmacologic therapies over attention control or placebo, but a significant impact of both over no intervention at all.
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Affiliation(s)
- G A Hawker
- Canadian Osteoarthritis Research Program, Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON M5S 1B2, Canada.
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