Wiener Medizinische Wochenschrift

, Volume 163, Issue 9–10, pp 228–235

Osteoarthritis: physical medicine and rehabilitation—nonpharmacological management

themenschwerpunkt

Summary

Osteoarthritis (OA) is the most common joint disease, mainly affecting middle-aged and elderly persons. People with OA of the knee or hip experience pain and deconditioning that may lead to disability. Treatment goals include pain control, maximizing functional independence, and improving quality of life within the constraints imposed by both OA and comorbidities. Exercise is a core recommendation in all nonpharmacological guidelines for the management of patients with knee or hip OA; it is supposed to ameliorate pain and maybe function as well. Therapeutic ultrasound, neuromuscular as well as transcutaneous electrostimulation, pulsed magnetic field therapy, low-level laser therapy, thermal agents, acupuncture, and assistive devices such as insoles, canes, and braces can be used additionally in a multimodal therapeutic program. They may positively influence pain and function, mobility, and quality of life in patients suffering from OA of the lower limbs.

Keywords

Osteoarthritis Rehabilitation Exercise Physical modalities 

Arthrose: Physikalische Medizin und Rehabilitation – nichtmedikamentöses Management

Zusammenfassung

Arthrose ist eine degenerative Gelenkserkrankung, welche Menschen mittleren und höheren Alters betreffen kann. Eine Arthrose der Knie- und Hüftgelenke bedeutet meist nicht nur Schmerz und Bewegungseinschränkung, sondern eventuell auch den Verlust der Selbständigkeit. Daher ergeben sich die Therapieziele 1) Reduktion der Schmerzen, 2) Erhalt der Selbständigkeit und 3) Verbesserung der Lebensqualität. Eventuell vorhandene Begleiterkrankungen oder -umstände müssen in der Therapieplanung berücksichtigt werden. Alle Richtlinien zur nichtmedikamentösen Behandlung der Hüft- und Kniearthrose empfehlen durchwegs Bewegungstherapie zur Verbesserung von Schmerz und eventuell auch Funktion. Zusätzlich haben sich therapeutischer Ultraschall, neuromuskuläre Elektrostimulation, transkutane elektrische Nervenstimulation, Magnetfeldtherapie, Lasertherapie, Wärmebehandlungen und Akupunktur als effektiv erwiesen. Einlagenversorgung und die Verordnung von Hilfsmitteln wie Schienen oder Gehhilfen ergänzen das therapeutische Spektrum. Solch ein multimodales Management beeinflusst Schmerz, Funktion, Mobilität und Lebensqualität von PatientInnen mit Arthrose der unteren Extremitäten im positiven Sinne.

Schlüsselwörter

Arthrose Rehabilitation Übungs-, Trainingstherapie Physikalisch medizinische Maßnahmen 

References

  1. 1.
    Altman R, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthrits. Classification of osteoarthritis of the knee. Arthritis Rheum. 1986;29:1039–49.PubMedCrossRefGoogle Scholar
  2. 2.
    Altman R, Alarcon G, Appelrouth D, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991;34:505–14.PubMedCrossRefGoogle Scholar
  3. 3.
    Dreinhöfer K, Stucki G, Ewert T, et al. ICF core sets for osteoarthritis. J Rehabil Med. 2004;(Suppl 44):75–80.Google Scholar
  4. 4.
    Bellamy N. WOMAC osteoarthritis index. A user’s guide. London University of Western Ontario; 1995.Google Scholar
  5. 5.
    Klassbo M, Larsson E, Mannevik E. Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster Universities Oteoarthritis Index. Scand J Rheumatol. 2003;32:46–51.PubMedCrossRefGoogle Scholar
  6. 6.
    Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1:64–71.PubMedCrossRefGoogle Scholar
  7. 7.
    Binkley JM, Stratford PW, Lott SA, Riddle DL. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther. 1999;79:371–83.PubMedGoogle Scholar
  8. 8.
    Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16:137–62.PubMedCrossRefGoogle Scholar
  9. 9.
    Hochberg MC, Altman RD, April TK, et al. American college of rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthitis Care Res. 2012;64:465–74.CrossRefGoogle Scholar
  10. 10.
    Zhang W, Nuki G, Moskowitz RW, et al. OARSI recommendations for the management of hip and knee osteoarthritis Part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage. 2010;18:476–99.PubMedCrossRefGoogle Scholar
  11. 11.
    Roddy E, Zhang W, Doherty M, et al. Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee—the MOVE consensus. Rheumatology. 2005;44:67–73.PubMedCrossRefGoogle Scholar
  12. 12.
    Fransen M, Mc Connell S. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2009;CD007912.Google Scholar
  13. 13.
    Fransen M, Mc Connell S, Henandez-Molina G, et al. Exercise for osteoarthritis of the hip. Cochrane Database Syst Rev. 2009;CD007912.Google Scholar
  14. 14.
    Fransen M, McConnell S, Hernandez-Molina G, et al. Does land-based exercise reduce pain and disability associated with hip osteoarthritis? A meta-analysis of randomized controlled trials. Osteoarthritis Cartilage. 2010;18:613–20.PubMedCrossRefGoogle Scholar
  15. 15.
    Hernandez-Molina G, Reichenbach S, Zhang B, et al. Effect of therapeutic exercise for hip osteoarthritis: results of meta-analysis. Arthritis Rheumatism. 2008;59:1221–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Bartels EM, Lund H, Hagen KB, et al. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev. 2007;CD005523.Google Scholar
  17. 17.
    Mikesky AE, Mazzuca SA, Brandt KD, et al. Effects of strength training on the incidence and progression of knee osteoarthritis. Arthritis Rheum. 2006;55:690–9.PubMedCrossRefGoogle Scholar
  18. 18.
    O’Reilly SC, Jones A, Muir KR, et al. Quadriceps weakness in knee osteoarthritis: the effect on pain and disability. Ann Rheum Dis. 1998;57:588–94.CrossRefGoogle Scholar
  19. 19.
    Steultjens MP, Dekker J, van Baar ME, et al. Muscle strength, pain and disability in patients with osteoarthritis. Clin Rehabil. 2001;15:331–41.PubMedCrossRefGoogle Scholar
  20. 20.
    Foroughi N, Smith RM, Lange AK, et al. Progressive resistance training and dynamic alignment in osteoarthritis: a single-blind randomized controlled trial. Clin Biomech. 2011;26:71–7.CrossRefGoogle Scholar
  21. 21.
    Bennell K, Hunt M, Wrigley T, et al. Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomized controlled trial. Osteoarthritis Cartilage. 2010;18:621–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Gür H, Cakin N, Akova B, et al. Concentric versus combined concentric-eccentric isokinetic training: effects on functional capacity and symptoms in patients with osteoarthritis of the knee. Arch Phys Med Rehabil. 2002;83:308–16.PubMedCrossRefGoogle Scholar
  23. 23.
    Jan MH, Lin JJ, Liau JJ, et al. Investigation of clinical effects of high- and low-resistance training for patients with knee osteoarthritis: a randomized controlled trial. Phys Ther. 2008;88:427–36.PubMedCrossRefGoogle Scholar
  24. 24.
    Roddy E, Zhang W, Doherty M. Aerobic walking or strengthening exercise for osteoarthritis of the knee? A systematic review. Ann Rheum Dis. 2005;64:544–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Dunlop DD, Semanik P, Song J, et al. Moving to maintain function in knee osteoarthritis: evidence from the osteoarthritis initiative. Arch Phys Med Rehabil. 2010;91:714–21.PubMedCrossRefGoogle Scholar
  26. 26.
    Fitzgerald GK, Piva SR, Gil AB, et al. Agility and perturbation training techniques in exercise therapy for reducing pain and improving function in people with knee osteoarthritis: a randomized clinical trial. Physical Therapy. 2011;91:452–69.PubMedCrossRefGoogle Scholar
  27. 27.
    Hall A, Maher C, Latimer J, et al. The effectiveness of Tai Chi for chronic musculoskeletal pain conditions: a systematic review and meta-analysis. Arthritis Rheum. 2009;61:717–24.PubMedCrossRefGoogle Scholar
  28. 28.
    Fitzgerald GK, White DK, Piva S, et al. Associations for change in physical and psychological factors and treatment response following exercise in knee osteoarthritis: an explorative study. Arthritis Care Res. 2012;64(11):1673–80.Google Scholar
  29. 29.
    American Geriatrics Society Panel on Exercise and Osteoarthritis. Exercise prescription for older adults with osteoarthritis pain: consensus practice recommendations. J Am Geriatr Soc. 2001;49:808–23.Google Scholar
  30. 30.
    Christensen R, Bartels EM, Astrup A, et al. Effect of weight reduction in obese patients with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2007;66:433–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Messier S, Loeser R, Miller G, et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis. Arthritis Rheum. 2008;50:1501–10.CrossRefGoogle Scholar
  32. 32.
    Anandacoomarasamy A, Leibman S, Smith G, et al. Weight loss in obese people has structure-modifying effects on medial but not on lateral knee articular cartilage. Ann Rheum Dis. 2012;71:26–32.PubMedCrossRefGoogle Scholar
  33. 33.
    Takahashi KA, Tonomura H, Arai Y, Terauchi R, Honjo K, Hiraoka N, Hojo T, Kunitomo T. Kubo Hyperthermia for the treatment of articular cartilage with osteoarthritis. Int J Hyperthermia. 2009;25:661–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Dougherty DR, Friedman JE, Schimizzi ME, Clark JE, Denegar CR Comstock BA, Kraemer WJ. Preferences for heat, cold, or contrast in patients with knee osteoarthritis affect treatment response. Clin Interv Aging. 2010;5:199–206.PubMedGoogle Scholar
  35. 35.
    Yildirim N, Filiz Ulusoy M, Bodur H. The effect of heat application on pain, stiffness, physical function and quality of life in patients with knee osteoarthritis. J Clin Nurs. 2010;19:1113–20.PubMedCrossRefGoogle Scholar
  36. 36.
    Palmieri-Smith RM, Thomas AC, Karvonen-Gutierrez C, Sowers M. A clinical trial of neuromuscular electrical stimulation in improving quadriceps muscle strength and activation among women with mild and moderate osteoarthritis. Phys Ther. 2010;90:1441–52.PubMedCrossRefGoogle Scholar
  37. 37.
    Monaghan B, Caulfield B, O’Mathúna DP. Surface neuromuscular electrical stimulation for quadriceps strengthening pre and post total knee replacement. Cochrane Database Syst Rev. 2010;CD007177.Google Scholar
  38. 38.
    Vavken P, Arrich F, Schuhfried O, Dorotka R. Effectiveness of pulsed electromagnetic field therapy in the management of osteoarthritis of the knee: a meta-analysis of randomized controlled trials. J Rehabil Med. 2009;41:406–11.PubMedCrossRefGoogle Scholar
  39. 39.
    Ay S, Evcik D. The effects of pulsed electromagnetic fields in the treatment of knee osteoarthritis: a randomized, placebo-controlled trial. Rheumatol Int. 2009;29:663–6.PubMedCrossRefGoogle Scholar
  40. 40.
    Gremion G, Gaillard D, Leyvraz PF, Jolles BM. Effect of biomagnetic therapy versus physiotherapy for treatment of knee osteoarthritis: a randomized controlled trial. BMJ Rehabil Med. 2009;41:1090–5.CrossRefGoogle Scholar
  41. 41.
    Ryang We S, Koog YH, Jeong KI, Wi H. Effects of pulsed electromagnetic field on knee osteoarthritis: a systematic review. Rheumatology (Oxford). 2012 Apr 13. Epub ahead of print.Google Scholar
  42. 42.
    Rutjes AW, Nüesch E, Sterchi R, Jüni P. Therapeutic ultrasound for osteoarthritis of the knee or hip. Cochrane Database Syst Rev. 2010;CD003132.Google Scholar
  43. 43.
    Ulus Y, Tander B, Akyol Y, Durmus D, Buyukakincak O, Gul U, Canturk F, Bilgici A, Kuru O. Therapeutic ultrasound versus sham ultrasound for the management of patients with knee osteoarthritis: a randomized double-blind controlled clinical study. Int J Rheum Dis. 2012;15:197–206.PubMedCrossRefGoogle Scholar
  44. 44.
    Yang PF, Li D, Zhang SM, Wu Q, Tang J, Huang LK, Liu W, Xu XD, Chen SR. Efficacy of ultrasound in the treatment of osteoarthritis of the knee. Orthop Surg. 2011;3:181–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Tascioglu F, Kuzgun S, Armagan O, Ogutler G. Short-term effectiveness of ultrasound therapy in knee osteoarthritis. J Int Med Res. 2010;38:1233–42.PubMedCrossRefGoogle Scholar
  46. 46.
    Loyola-Sánchez A, Richardson J, MacIntyre NJ. Efficacy of ultrasound therapy for the management of knee osteoarthritis: a systematic review with meta-analysis. Osteoarthritis Cartilage. 2010;18:1117–26.PubMedCrossRefGoogle Scholar
  47. 47.
    Köybaşi M, Borman P, Kocaoğlu S, Ceceli E. The effect of additional therapeutic ultrasound in patients with primary hip osteoarthritis: a randomized placebo-controlled study. Clin Rheumatol. 2010;29:1387–94.PubMedCrossRefGoogle Scholar
  48. 48.
    Rutjes AW, Nüesch E, Sterchi R, Kalichman L, Hendriks E, Osiri M, Brosseau L, Reichenbach S, Jüni P. Transcutaneous electrostimulation for osteoarthritis of the knee. Cochrane Database Syst Rev. 2009;CD002823.Google Scholar
  49. 49.
    Vance CG, Rakel BA, Blodgett NP, DeSantana JM, Amendola A, Zimmerman MB, Walsh DM, Sluka KA. Effects of transcutaneous electrical nerve stimulation on pain, pain sensitivity, and function in people with knee osteoarthritis: a randomized controlled trial. Phys Ther. 2012;92:898–910.PubMedCrossRefGoogle Scholar
  50. 50.
    Pietrosimone BG, Saliba SA, Hart JM, Hertel J, Kerrigan DC, Ingersoll CD. Effects of transcutaneous electrical nerve stimulation and therapeutic exercise on quadriceps activation in people with tibiofemoral osteoarthritis. J Orthop Sports Phys Ther. 2011;41:4–12.PubMedGoogle Scholar
  51. 51.
    Alfredo PP, Bjordal JM, Dreyer SH, Meneses SR, Zaguetti G, Ovanessian V, Fukuda TY, Junior WS, Martins RÁ, Casarotto RA, Marques AP. Efficacy of low level laser therapy associated with exercises in knee osteoarthritis: a randomized double-blind study. Clin Rehabil. 2012;26:523–33.PubMedCrossRefGoogle Scholar
  52. 52.
    Hegedus B, Viharos L, Gervain M, Gálfi M. The effect of low-level laser in knee osteoarthritis: a double-blind, randomized, placebo-controlled trial. Photomed Laser Surg. 2009;27:577–84.PubMedCrossRefGoogle Scholar
  53. 53.
    Perlman AI, Ali A, Njike VY, Hom D, Davidi A, Gould-Fogerite S, Milak C, Katz DL. Massage therapy for osteoarthritis of the knee: a randomized dose-finding trial. PLoS One. 2012;7(2):e30248.PubMedCrossRefGoogle Scholar
  54. 54.
    Lund H, Henriksen M, Bartels EM, Danneskiold-Samsøe B, Bliddal H. Can stimulating massage improve joint repositioning error in patients with knee osteoarthritis? J Geriatr Phys Ther. 2009;32:111–6.PubMedCrossRefGoogle Scholar
  55. 55.
    Manheimer E, Cheng K, Linde K, Lao L, Yoo J, Wieland S, van der Windt DA, Berman BM, Bouter LM. Acupuncture for peripheral joint osteoarthritis. Cochrane Database Syst Rev. 2010;CD001977.Google Scholar
  56. 56.
    Suarez-Almazor ME, Looney C, Liu Y, Cox V, Pietz K, Marcus DM, Street RL Jr. A randomized controlled trial of acupuncture for osteoarthritis of the knee: effects of patient-provider communication. Arthritis Care Res. 2010;62:1229–36.CrossRefGoogle Scholar
  57. 57.
    Lu TW, Wei IP, Liu YH, Hsu WC, Wang TM, Chang CF, Lin JG. Immediate effects of acupuncture on gait patterns in patients with knee osteoarthritis. Chin Med J. 2010;123:165–72.PubMedGoogle Scholar
  58. 58.
    Jones A, Silva PG, Silva AC, Colucci M, Tuffanin A, Jardim JR, Natour J. Evaluation of immediate impact of cane use on energy expenditure during gait in patients with knee osteoarthritis. Gait Posture. 2012 Mar;35(3):435–9.PubMedCrossRefGoogle Scholar
  59. 59.
    Moe RH, Fernandes L, Osterås N. Daily use of a cane for two months reduced pain and improved function in patients with knee osteoarthritis. J Physiother. 2012;58(2):128.PubMedCrossRefGoogle Scholar
  60. 60.
    Jones A, Silva PG, Silva AC, Colucci M, Tuffanin A, Jardim JR, Natour J. Impact of cane use on pain, function, general health and energy expenditure during gait in patients with knee osteoarthritis: a randomised controlled trial. Ann Rheum Dis. 2012;71:172–9.PubMedCrossRefGoogle Scholar
  61. 61.
    Simic M, Bennell KL, Hunt MA, Wrigley TV, Hinman RS. Contralateral cane use and knee joint load in people with medial knee osteoarthritis: the effect of varying body weight support. Osteoarthritis Cartilage. 2011;19:1330–7.PubMedCrossRefGoogle Scholar
  62. 62.
    Fang MA, Heiney C, Yentes JM, Harada ND, Masih S, Perell-Gerson KL. Clinical and spatiotemporal gait effects of canes in hip osteoarthritis. PM R. 2012;4:30–6.PubMedCrossRefGoogle Scholar
  63. 63.
    Hinman RS, Bowles KA, Metcalf BB, Wrigley TV, Bennell KL. Lateral wedge insoles for medial knee osteoarthritis: effects on lower limb frontal plane biomechanics. Clin Biomech (Bristol, Avon). 2012 Jan;27(1):27–33.CrossRefGoogle Scholar
  64. 64.
    Nester CJ, Richards JD, Kim WY, Johnson DS, Jari S, Laxton P, Tyson SF. A comparison of the biomechanical effects of valgus knee braces and lateral wedged insoles in patients with knee osteoarthritis. Gait Posture. 2012 Aug 21. Epub ahead of print.Google Scholar
  65. 65.
    Hurley ST, Hatfield Murdock GL, Stanish WD, Hubley-Kozey CL. Is there a dose response for valgus unloader brace usage on knee pain, function, and muscle strength? Arch Phys Med Rehabil. 2012;93:496–502.PubMedCrossRefGoogle Scholar
  66. 66.
    Sato E, Sato T, Yamaji T, Watanabe H. Effect of the WISH-type hip brace on functional mobility in patients with osteoarthritis of the hip: evaluation using the timed up & go test. Prosthet Orthot Int. 2012;36:25–32.PubMedCrossRefGoogle Scholar
  67. 67.
    Pinto D, Robertson MC, Hansen P, et al. Cost-effectiveness of non-pharmacologic, nonsurgical interventions for hip and/or knee osteoarthritis: a systematic review. Value Health. 2012;15:1–12.PubMedCrossRefGoogle Scholar
  68. 68.
    www.aaos.org.Google Scholar
  69. 69.
    www.awmf.org.Google Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  1. 1.Abteilung für Physikalische Medizin und RehabilitationHerz Jesu KrankenhausViennaAustria
  2. 2.Universitätsklinik für Physikalische Medizin und RehabilitationMUW, AKH WienViennaAustria

Personalised recommendations