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02.04.2018 13:54:52
What is the best conservative therapy for patients with knee pain and knee osteoarthritis? Possible options include physical therapy, movement training, propioception, aerobics, aquatics, muscle building, tai chi, massage, orthotics, taping, electrostimulation, pulsed electromagnetic fields, ultrasound or even diathermy. These methods have been explored by researchers in a meta-analysis of available literature for their efficacy and their side effects. Shi-Yi Wang and colleagues from the University of Minnesota in Minneapolis have published the analysis in the Annals of Internal Medicine.
Physical therapy and physiotherapy are ahead
The review of 193 studies from the English-language literature showed that the greatest scientific evidence currently exists for the physical therapy measures used by physiotherapists. A total of 84 randomized controlled trials demonstrated a beneficial effect on knee pain, joint function and degree of disability for 13 different types of physical therapy. Significantly weaker was the scientific evidence in the study of the effects of aerobics, aquatic exercises, muscle building or ultrasound. On the one hand, there were fewer studies on these procedures; on the other hand, the reported effects were less pronounced in alleviating pain or improving function than in physical therapy. The authors also provide an estimate of the level of scientific evidence for each procedure. For example, the scientific evidence for massage is weak, as only 3 studies with 162 participants could be evaluated. However, knee and leg massage improved all three areas of action (pain, disability, function) "clinically meaningful".
Most knee pain had women
When the data from the studies were pooled, the patient characteristics showed that 70% of the patients with knee problems were women. On average, they were overweight with a BMI of 29 on average. 52% also had additional pharmacological therapy with analgesics.
Where the advantages of each procedure lay
When looking at the strengths and weaknesses of the individual procedures, it became clear that the physical therapies had a favorable effect on all tested areas. A long-term effect of physical therapy was documented in 7 of these studies. Equally good effects on pain, disability, and functionality were not found in the studies of aerobic or water-based exercises. Here, for example, only degree of disability or function improved. Water training in direct comparison with aerobics seemed to be associated with less knee pain at the end of the study (p-value 0.044).
Also, the intensity of the exercises and the attitude of the patients was important
The researchers pointed out that their meta-analysis does not allow comparative statements on the frequency of the procedures used, their duration and their intensity. However, they point out that the patient characteristics and thus also the motivated attitude of the patients to the therapy had an influence on the success. Thus, they found that a high adherence to therapy, in terms of the number of courses attended, was associated with a better knee outcome. For example, both in muscle building and in aerobics, the patients with the highest adherence had the best result. Thus, the attitude of the patient to a conservative therapy seems to be at least as crucial as the type of measures used.
Side effects without consistent pattern
Side effects were reported in the studies only a few, but very different. Mainly skin irritations have been noted in taping and electrostimulation, swelling in diathermy and exercise training or in the use of insoles. There were no proven side effects that would have been disproportionately frequent and thus came as a reason for a frequent treatment discontinuation in question.
How common are knee problems?
Knee pain is one of the common health problems. 28% of over-45s and 37% of over-65s in the United States report having knee problems. In Germany, about 10% of the population is regularly plagued by knee pain.
