Yoga Is Effective for Arthritis

introduction

Osteoarthritis(OA) is a degenerative joint disease characterized by breakdown or loss of cartilage due to wear and tear. Any joint can be affected by this disease particularly knee, hip and finger joints. Limited range of motion, swelling, pain and stiffness in the joints are the common symptoms of the disease. Based on studies, there is higher prevalence of hip osteoarthritis in elderly white populations of both women and men in United States compared to Asian.

However, population of Asia is more prone to knee osteoarthritis especially Chinese older women.

The differences between joint being affected may due to genetic or environmental factors. Other than ethnicity and race, risk factors for osteoarthritis includes old age and female sex.

There is no doubt that physiotherapist plays an important role in rehabilitation of patients suffering from various condition or disease such as strokes and osteoarthritis. As a physiotherapist, it is our duty to understand the essential information of the disease and choosing best intervention to improve patient’s condition.

Randomized Controlled Trials(RCTs) contribute high level of evidence because of the study design, validity and applicability to patient care.

By reading and understanding the RCTs, we can integrate the evidence obtained from the research into the clinical practice. It helps us to make informed clinical decisions along with our clinical experience and patient’s values and preferences. In this assignment, I summarized 6 RCTs related to treatment choices for patients having osteoarthritis. These RCTS scored at least 6 in Pedro scale that indicates high methodological quality.

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Summary of the RCTs

Yoga for managing knee osteoarthritis in older women Yoga exercise is effective in some of the musculoskeletal disease by promoting balance and healing of the body due to the breathing techniques, poses, strengthening and stretching exercise incorporated in the program.

To investigate the effectiveness and long-term effect of the yoga exercise in reducing disease symptoms of knee osteoarthritis, this study included 36 women with mean age of 72 years old as the prevalence of OA in older women. All participants were having symptoms diagnosed as knee OA for at least 6 months. All eligible participants didn’t practice yoga exercise previously and had no supervised exercise program during recruitment. Those having exercise contraindication, joint locking, chronic use of walking aids, knee surgery within 2 years and corticosteroid or hyaluronic acid injection within 6 months are excluded for this study.

The yoga exercise class was designed and conducted by certified yoga instructors who had experience in teaching older adults. Participants in treatment group and control group (after 8 weeks) were required to attend a 60 minutes class once per week and practiced 30 minutes of prescribed yoga exercise at home 4 times per week. The yoga program integrated static stretching, balance, and strength exercises with progressive series of poses.

These are some examples of poses: This study measured pain, stiffness and physical functions by using Western Ontario and McMaster Universities Arthritis Index (WOMAC). Short Physical Performance Battery (SPPB) was performed to evaluate gait speed, chair stand and balance of participants. Other measurements included Quality of life (QoL), sleep disturbance, functional status, and body mass index (BMI). All data were collected before, during and after yoga exercise program.

The significant findings of this study show that the yoga exercise was safe, feasible and acceptable for older female patients with knee OA. In this study, Yoga exercise show therapeutic benefits at 8 weeks in older women with knee OA which indicated by improvements in WOMAC pain and stiffness scale as well as in the SPPB scores. However, all participants recruited are older women, the effects of yoga exercise found in this study may not be applicable to men or younger patients.

A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis Exercises for improving muscle strength and endurance show effectiveness in pain reduction and physical function improvements for patients with osteoarthritis(OA). These exercises can be practiced either on the land or in the water. The aim of this study is to compare the effects of aquatic and land-based exercise in patients with knee OA. 79 patients with diagnosed primary knee OA were recruited and assigned randomly to aquatic exercise, land-based exercise or control group. The number of participants for each group were similar.

All participants allowed to continue their usual care for osteoarthritis. Those having inflammatory joint disease, cardiorespiratory problems, knee fracture, or hydrophobia were excluded as indicated in this study. The 50 minutes exercise lesson instructed by qualified student physiotherapist was carried out twice per week. Both aquatic and land-based exercise comprised of warm-up, resistance exercises, balance and stabilizing exercises, lower limb stretches and cool-down period. These are the examples of exercises: The primary measure of this study was pain, Knee Injury and Osteoarthritis Outcome Score questionnaire (KOOS), and in addition standing balance and strength.

Data were collected before and after 8 weeks of exercises, and after 3 months of follow-up with some measurement collected randomly in each exercise session. There is no significant difference between groups were detected for KOOS. By comparing pain reduction and muscle strength, land-based exercise shows slight improvement compared to aquatic exercise. Less adverse events reported from aquatic exercise compared to land-based exercise may due to the buoyancy force reduces weight bearing on the affected joint. This study may not be generalized for all patients with knee OA as the exercise programme is not individualized and most of the participants are female.

Effects of Phonophoresis of Piroxicam and Ultrasound on Symptomatic Knee Osteoarthritis Combination of the medication gel and ultrasound is known as phonophoresis. Ultrasound is used to enhance the absorption of Non-Steroid Anti-inflammatory Drugs(NSAIDs) through the skin to relieve pain and inflammation in musculoskeletal conditions. Topical administration of the NSAIDs has fewer side effects compared to oral NSAIDs. To determine the effectiveness of phonophoresis of piroxicam compared with ultrasound on symptomatic knee OA, 46 participants were recruited and assigned randomly to either ultrasound or phonophoresis group. All participants reported having pain more than 50mm in Visual Analogue Scale (VAS).

Patients with knee pain causes other than OA, recent surgery, or allergic to piroxicam were excluded in this study. The non-drug coupling gel used in ultrasound group serves as a control while 0.5% piroxicam gel mixed with a standard coupling agent at a ratio of 4:11 by volume to be used in treatment group of phonophoresis. Procedure in both treatment group was similar. The continuous mode (1.0W/cm2 power and 1MHz frequency of US wave) was administrated using stroking technique, 5 times a week for 2 weeks. Neither therapist nor participant know the treatment administrated since the gels used were same in colour and odour.

Baseline data was collected from each participant. The outcome measure was collected before treatment and 2 days after last session of treatment. Pain as the primary outcome measure was assessed using VAS and pain component of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Stiffness and physical function subscales of WOMAC were recorded as secondary outcome measure. Phonophoresis with piroxicam was more effective than ultrasound alone indicated by significant difference in pain reduction between groups in this study. No significant between-group differences were observed for physical function of patients. In conclusion, phonophoresis wit

Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: A randomized clinical trial Manual therapy was performed by certified therapist to improve elasticity of the joint structures and soft tissues around joint while exercise therapy aims to increase muscle strength and joint motion. 109 patients with hip OA were recruited to compare the efficacy of manual therapy and exercise therapy.

The inclusion criteria:

• pain,
• pain,
• >15° of hip internal rotation and
• pain with hip internal rotation and morning stiffness of hip lasting more than 60 minutes

The exclusion criteria included symptoms in both hips, fear of manipulative therapy, severe cardiorespiratory disease and lack of knowledge about Dutch language. Both treatments were performed twice per week. Manual therapy started with stretching, followed by traction of hip joint and manipulative traction in each limited range.

Joint mobility, pain relief, walking ability, muscle strength and functions were included in exercise programme. Baseline data was similar. Measurements were taken before and after 5 weeks of treatment, and follow-up of 3 and 6 months. 6-point Likert scale was used as primary outcome measure to record the general perceived improvements after treatment. SF‐36 were used to assess the health-related quality of life.

Harris Hip Score was assessed to determine the pain, ROM, walking function and activities of daily life(ADL). A walking test with 80 metres distance and 7 turning points was performed to evaluate walking ability. Pain and stiffness were reported using VAS and joint ROM assessed using goniometer. Statistical analysis showed that manual therapy is more effective than exercise therapy as indicated by improvements in primary outcome measure. In conclusion, manual therapy is essential to treat hip OA by reducing joint stiffness and muscle tension.

The effectiveness of pulsed electrical stimulation in the management of osteoarthritis of the knee: results of a double-blind, randomized, placebo-controlled, repeated-measures trial. Electrotherapy is recommended as a short-term therapy based on clinical guideline as electrical stimulation interferences with polarization of receptor and thus reduces pain. This study was carried out to determine the role of pulsed electrical stimulation(PES) in pain reduction for the management of the knee OA.

70 participants with diagnosed knee OA were recruited. The volunteer with contraindications to electrical stimulation, coexisting inflammatory arthropathies, schedule total knee replacement surgery during the study period or insufficient knowledge of English was excluded.   A commercial Transcutaneous Electrical Nerve Stimulation (TENS) is modified to deliver PES in pulsed, asymmetrically biphasic, exponentially decreasing waveform with a frequency of 100 Hz and pulse width of 4 msec. Both placebo and treatment devices looked similar and not detectable by participants since PES used was subsensory.

Participants were asked to wear the devices for 7 hours daily for 26 weeks, overnight was preferred. Changes in pain score assessed by VAS was the primary outcome measure in this study. Other measurements taken included pain, stiffness and function subscales in WOMAC, quality of life in SF-36, global perceived effect and physical activity. Both groups show improvements in pain reduction as indicated by VAS. There is no significant between-group difference was found for VAS or WOMAC. From this study, we concluded that subsensory PES was similar to placebo. Participants allowed to continue the usual care for OA, the treatment or placebo may be effective due to usual treatment received by participants.

Exercise combined with continuous passive motion or slider board therapy compared with exercise only: a randomized controlled trial of patients following total knee arthroplasty. Total knee replacement is a surgical procedure could be performed to patients with intolerable pain due to osteoarthritis. Early mobilization following (TKR) is required to regain full range of motion(ROM) of knee which related to functional activities.

This study was conducted to compare the effectiveness of continuous passive motion(CPM) or slider board therapy(SB) combined with exercise or exercise alone in achieving maximum ROM within 6 months after primary TKR. Both CPM and slider board were designed to improve ROM but slider board costs less than CPM. 120 participants were assigned randomly to 3 groups and were examined preoperatively, during discharge, 3 and 6 months following TKR.

Measurements taken included knee ROM, completion of Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The statistical analysis of this study shows no significant difference were observed between groups for all measurements taken. Regardless of the treatment received, the patient who received TKR will have improvements in pain, function or quality of life.