Effects of hydrotherapy in Knee Osteoarthritis

knee osteoarthritis: is the most common form of joint disease and most often affects the knee. OA of the knee causes patients severe discomfort and a reduced ability to work . Anti-inflammatory drugs used to treat the symptoms of this disorder usually have various sideeffects.When drugs are not adequately effective, replacement surgery is often recommended . Patients with chronic pain increasingly seek alternative methods for pain relief.

1- Short- and Long-Term Effects of Spa Therapy in Knee Osteoarthritis Authors: Antonella Fioravanti, MD Francesca Iacoponi, PhD Barbara Bellisai, MD Luca Cantarini, PhD Mauro Galeazzi, MD

Objective To assess both the short- and long-term effectiveness of spa therapy in patients with primary knee osteoarthritis in a prospective, randomized, single-blinded, controlled trial. Design Eighty outpatients were enrolled in this study; 40 patients were treated with a combination of daily local mud packs and bicarbonatesulfate mineral bath water from the spa center of Rapolano Terme (Siena,Italy) for 2 wks, and 40 patients continued regular, routine ambulatorycare. Patients were assessed at baseline time; after 2 wks; after 3, 6, and 9 mos after the beginning of the study and were evaluated by Visual Analog Scale for spontaneous pain, Lequesne index, Western Ontario and McMaster Universities Index for gonarthrosis, Arthritis Impact Measurement Scale-1, and symptomatic drug consumption.

Results We observed a significant improvement of all evaluated parameters at the end of the cycle of spa therapy, which persisted throughout the whole of the follow-up period, whereas in the control group no significant differences were noted. This symptomatic effect was confirmed by the significant reduction of symptomatic drug consumption.Tolerability of spa therapy seemed to be good, with light and transitory side effects.

Conclusions The results from our study confirm that the beneficial effects of spa therapy in patients with knee osteoarthritis lasts over time, with positive effects on the painful symptomatology and a significant improvement on functional capacities. Spa therapy can represent a useful backup to pharmacologic treatment of knee osteoarthritis or a valid alternative for patients who do not tolerate pharmacologic treatments.

Aquatic Physical Therapy for Hip and Knee Osteoarthritis: Results of a Single-Blind Randomized Controlled Trial Rana S Hinman, Sophie E Heywood, Anthony R Day

Background and Purpose Aquatic physical therapy is frequently used in the management of patients with hip and knee osteoarthritis (OA), yet there is little research establishing its efficacy for this population. The purpose of this study was to evaluate the effects of aquatic physical therapy on hip or knee OA. Subjects A total of 71 volunteers with symptomatic hip OA or knee OA participated in this study. Methods The study was designed as a randomized controlled trial in which participants randomly received 6 weeks of aquatic physical therapy or no aquatic physical therapy. Outcome measures included pain, physical function, physical activity levels, quality of life, and muscle strength.

Water temperature = 34 degree c Duration = 45 – 60 minutes

Allow them to practice once. THE TIMED UP & GO TEST 1. Patient is in a seated position. 2. Place a visible object 8 feet away from the patient. 3. Have the patient get up and walk around the object and sit back down. Allow them to practice once. Then time them 3 times.

Results The intervention resulted in less pain and joint stiffness and greater physical function, quality of life, and hip muscle strength. Totals of 72% and 75% of participants reported improvements in pain and function,respectively, compared with only 17% (each) of control participants. Benefits were maintained 6 weeks after the completion of physical therapy, with 84% of participants continuing independently.

Discussion and Conclusion Compared with no intervention, a 6-week program of aquatic physical therapy resulted in significantly less pain and improved physical function, strength, and quality of life. It is unclear whether the benefits were attributable to intervention effects or a placebo response.

3- Hydrotherapy Versus Conventional Land-Based Exercise for the Management of Patients With Osteoarthritis of the Knee: A Randomized Clinical Trial Luciana E Silva, Valeria Valim, Ana Paula C Pessanha, Leda M Oliveira, Samira Myamoto, Anamaria Jones, Jamil Natour

Background and Purpose This study was designed to evaluate the effectiveness of hydrotherapy in subjects with osteoarthritis (OA) of the knee compared with subjects with OA of the knee who performed land-based exercises. Subjects and Methods Sixty-four subjects with OA of the knee were randomly assigned to 1 of 2 groups that performed exercises for 18 weeks: a water-based exercise group and a land-based exercise group. The outcome measures included a visual analog scale (VAS) for pain in the previous week, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), pain during gait assessed by a VAS at rest and immediately following a 50-foot (15.24-m) walk test (50FWT), walking time measured at fast and comfortable paces during the 50FWT, and the Lequesne Index. Measurements were recorded by a blinded investigator at baseline and at 9 and 18 weeks after initiating the intervention.

Results The 2 groups were homogenous regarding all parameters at baseline. Reductions in pain and improvements in WOMAC and Lequesne index scores were similar between groups. Pain before and after the 50FWT decreased significantly over time in both groups. However, the water-based exercise group experienced a significantly greater decrease in pain than the land-based exercise group before and after the 50FWT at the week-18 follow-up.

Discussion and Conclusion Both water-based and land-based exercises reduced knee pain and increased knee function in participants with OA of the knee. Hydrotherapy was superior to landbased exercise in relieving pain before and after walking during the last follow-up. Water-based exercises are a suitable and effective alternative for the management of OA of the knee.

Intermittent Balneotherapy at the Dead Sea Area for Patients with Knee Osteoarthritis Gilad Sherman*, Lior Zeller MD1, Avital Avriel MD1, Michael Friger PhD2, Marco Harari MD4 and Shaul Sukenik MD1,3

Background Balneotherapy, traditionally administered during a continuous stay at the Dead Sea area, has been shown to be effective for patients suffering from knee osteoarthritis. Objectives To evaluate the effectiveness of an intermittent regimen of balneotherapy at the Dead Sea for patients with knee osteoarthritis.

Methods Forty-four patients with knee osteoarthritis were included in a prospective randomized single-blind controlled study. The patients were divided into two groups: a treatment group (n=24), which were treated twice weekly for 6 consecutive weeks in a sulfur pool heated to 35–36°C, and a control group (n=20) treated in a Jacuzzi filled with tap water heated to 35–36°C. Participants were assessed by the Lequesne index of osteoarthritis severity, the WOMAC index, the SF-36 quality of health questionnaire, VAS scales for pain (completed by patients and physicians), and physical examination.

Results A statistically significant improvement, lasting up to 6 months, was observed in the treatment group for most of the clinical parameters. In the control group the only improvements were in the SF-36 bodily pain scale at 6 months, the Lequesne index at 1 month and the WOMAC pain score at the end of the treatment period. Although the patients in the control group had milder disease, the difference between the two groups was not statistically significant. Conclusions Intermittent balneotherapy appears to be effective for patients with knee osteoarthritis.

Thank you Prepared by: Nourah Al-Howimel