Lucie Pelland

EFFICACY OF STRENGTHENING EXERCISES FOR OSTEOARTHRITIS (PART I): A META-ANALYSIS

Abstract Objective: Osteoarthritis (OA) is highly prevalent among older adults and is associated with increased pain, loss of strength and joint range of motion (ROM), as well as to an overall decrease in functional status. Therapeutic strength exercises are recommended as part of the standard intervention programme for the patient with OA in an effort to control pain and improve functional and health status. The purpose of this meta-analysis is to review the strength and quality of evidence supporting the effectiveness of therapeutic strengthening exercises for improving a variety of measured outcomes relevant for OA. Methods: A systematic review was conducted, following a protocol of methods recommended by the Cochrane Collaboration. Trials were identified by a literature search of Medline, EMBASE, and the Cochrane Controlled Trials Register. Only randomised controlled trials using strengthening exercises as an intervention and treating clients with OA were eligible. Twenty-two trials were included with 2325 patients undergoing various forms strengthening exercises (e.g. isometric, isotonic, isokinetic, concentric, concentric/eccentric, dynamic). The exercises were implemented either in stand-alone format or in combination with other exercises, such as stretching and ROM. Interventions were either facility-based, home-based or a combination of the two. Results: Evidence is provided for the inclusion of strengthening exercises in the rehabilitation programme for the patient with OA. Improvements were found for strength, pain, function and quality of life (QOL). Important components of the exercise programme that influence outcome include: (i) the combination of joint-specific strengthening with general strength, flexibility and functional exercises; (ii) progression of the exercise programme; and (iii) level of client self-reliance to sustain the programme. There is no evidence that the type of strengthening (i.e. isometric, isotonic or isokinetic) has an important impact on programme outcome. However, evidence is provided that the control of pain may be a dominant mechanism by which strengthening exercise produces beneficial effects for the patient with OA. Conclusion: Strengthening exercises alone have some effects on improving pain and functional outcomes in clients with OA. However, in order to maximise the effectiveness of strengthening exercise for these clients, it is necessary to combine strengthening exercises with a more complete exercise programme including ROM, stretching, functional balance and aerobic exercises.

EFFICACY OF BALNEOTHERAPY FOR OSTEOARTHRITIS OF THE KNEE: A SYSTEMATIC REVIEW

Abstract Balneotherapys role in treating patients with arthritic disease is much debated. More common in treating patients with rheumatoid arthritis, balneotherapys efficacy for patients with osteoarthritis needs further exploration. Our systematic review included three randomized controlled trials examining the effects of various types of balneotherapy on osteoarthritis of the knee. Thermal water balneotherapy showed clinical benefit but no statistical significance for pain relief. Combination hot sulphur and Dead Sea baths were more statistically significant and clinically effective than single bath treatments for short-term measures of pain and function. A combination bath regime also had a significant effect on pain severity at onemonth follow-up. No significant long-term (three months) benefits were observed for pain or function. We conclude that balneotherapy in the form of combination baths has short-term benefits for pain relief and function, which suggests that balneotherapy may require a standard treatment regime for optimal efficacy.

Efficacy Of Thermotherapy For Rheumatoid Arthritis: A Meta-Analysis

Abstract Thermotherapy is a commonly used modality in treating rheumatoid arthritis (RA). Superficial moist-heat fomentations (hot packs) at different temperatures, cryotherapy (ice packs), paraffin wax baths and faradic baths have been used as different thermotherapy modalities. This meta-analysis included randomized (RCT) and controlled clinical trials (CCT), case-control and cohort studies of thermotherapy compared with control (no treatment) or active therapy (head-to-head studies). All the included studies (n=7) in this review were identified as RCTs. The results of this meta-analysis of thermotherapy for RA found that there was no significant effect for hot and ice-pack applications and faradic baths on objective measures of disease activity, including joint swelling, pain, medication intake, range of motion (ROM), grip strength, hand function or patient preference, compared with control (no treatment) or active therapy. However, there were positive results for paraffin wax baths combined with exercises for arthritic hands on objective measures of ROM, pinch function, grip function, pain on non-resisted motion compared with control (no treatment) after 4 consecutive weeks of treatment. Exercise alone, however, for arthritic hands yielded better improvement than wax baths combined with exercises for pain on non-resisted motion. There is no significant difference between wax and therapeutic ultrasound, or between wax and faradic bath combined with ultrasound for all the outcomes measured after 1, 2 or 3 week(s). The reviewers concluded that thermotherapy can be used as a palliative therapy, or as an adjunct therapy combined with exercises for RA patients, especially wax baths in the treatment of arthritic hands. These conclusions are limited by methodological considerations, such as the poor quality of trials.