Patients with osteoarthritis (OA) of the knee or hip who adhere to the recommended home physical therapy exercises and physically active lifestyle experience more improvement in pain, physical function, and self-perceived effect according to a study from researchers in The Netherlands. Research also shows that maintenance of exercise behavior and physically active lifestyle after discharge of physical therapy improves the long-term effectiveness of exercise therapy in patients with knee or hip OA. Details of the study are available online and will publish in the August print issue of Arthritis Care & Research, a journal of the American College of Rheumatology.
Individuals with OA of the hip or knee experience pain, reduced muscle strength, decreased range of joint motion, and joint instability. According to the World Health Organization (WHO) OA is one of the ten most disabling diseases in developed countries. Further WHO estimates state that 80% of those with OA have limitations in movement, and 25% cannot perform major daily life activities. Often OA patients are referred to physical therapy in order to reduce impairments and improve overall physical function to meet demands of daily living. Although exercise therapy has beneficial short-term effects, earlier research has shown that after discharge of exercise therapy the positive treatment effects decline over time and finally disappear in the long-term.
The Dutch research team conducted an observational follow-up study on 150 patients with OA of the hip and/or knee who were receiving exercise therapy. The study subjects were followed for 60 months to assess adherence to self-directed exercise (during and after prescribed physical therapy treatment period) on patient outcomes of pain, physical function, and self-perceived effect. Three forms of adherence, which is defined as the subject's behavior that corresponds to agreed recommendations by his or her physical therapist, were measured—adherence to home exercises, home activities, and increased physical activity. Researchers used a self-report questionnaire to measure participants' adherence to home exercise (e.g. muscle strengthening exercises) and activity (e.g. walking or cycling). Assessment of adherence started at baseline, and then took place again at 3, 15, and 60 months.
Patient outcomes of pain and physical function were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. The WOMAC scale ranges from best to worst, meaning lower scores represent less pain and improved physical function. Participants' physical performance was measured by the time (in seconds) it took to walk the distance of 5 meters with improvement in performance noted by a reduction in time to complete the walk.
Results show at the 3-month follow-up 57.8% of study subjects adhered to the recommended exercises and 53.8% to recommended activities. Adherence to exercise was significantly associated with a decrease in pain (-1.0 points on a scale from 0 to 20), and improvements in self-reported physical function (-2.3 points on a scale from 0 to 68) and physical performance (-0.29 seconds compared with the base-line time of 4.8 seconds to walk 5 meters (16 feet)). “Better adherence to home exercises and being more physically active improves the long-term effectiveness of exercise therapy in patients with OA of the hip and/or knee,” said lead study author, Martijn Pisters, M.Sc., PT.
A higher level of moderate or vigorous intensity physical activity was significantly associated with a decrease in pain, physical function and physical performance, as well as a positive self-perceived effect. The authors found that one hour per week more of physical activity at a moderate level resulted in an improvement in self-reported physical function of -0.24 on a scale from 0 to 68. During the physical therapy treatment period, the patients' physical activity increased by 1.5 hours of moderate or vigorous intensity physical activity per week. After the treatment period, physical activity declined by 0.5 and 1.3 hours respectively at the 15- and 60-month follow-up.
Additionally, researchers noted a decline in exercise adherence upon completion of physical therapy with only 44.1% of patients and 30.1% still exercising at the 15- and 60-month follow-up, respectively. Similarly, adherence to home activities decreased at the 15- and 60-month follow-up with only with 29.5% and 36%, respectively, of study subjects being adherent. “Future research should focus on how exercise behavior can be stimulated and maintained in the long term to improve outcomes for patients with OA,” concluded Mr. Pisters.
Article: "Exercise Adherence Improving Long-Term Patient Outcome in Patients with Osteoarthritis of the Hip and/or Knee." Martijn F. Pisters, Cindy Veenhof, Francois G. Schellevis, Jos W.R. Twisk, Joost Dekker, and Dinny H. De Bakker. Arthritis Care and Research; Published Online: March 16, 2010 (DOI: 10.1002/acr.20182); Print Issue Date: August 2010.
Showing posts with label physiotherapy news. Show all posts
Showing posts with label physiotherapy news. Show all posts
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PT Today : Souchard's global postural re-education relieves back pain
April 18, 2008 - Fox News( WEB PT )
PT News: Innovative Physical Therapy Relieves Back Pain
A person with chronic back pain is in too much discomfort to perform the exercise on his own. A physical therapist guides the process, stretching the muscles along the spinal column while the patient is in the specified positions.
There are two basic positions: standing up and lying down with the knees bent. While in each of these positions, the patient places his arms at his side and tries to open them wider and wider.
"The therapist helps you to find the level you're comfortable with, as you keep increasing the range of motion," Estol says.
When Back Pain Treatments Fail
Estol says medications and surgery for severe and chronic back pain typically have limited or no benefit.
That's why he decided to try the new method on 102 patients with chronic back pain associated with severe degenerative disc disease of the spine. Patients with degenerative disc disease can experience back pain so debilitating that they can't bend, stretch or, sometimes, even get out of a chair without help.
Five Months of Treatment
The participants had severe pain for an average of seven months; 82 had lower back pain and 20 had neck pain. About half were women.
"The patients had tried almost all combinations of treatments you could think of, including regular physical therapy, bed rest, anti-inflammatory medications, acupuncture, and epidural injections," Estol says. "Quite a few had already had surgery and others were scheduled for surgery when we treated them."
Importantly, three-fourths couldn't walk more than 10 blocks without stopping, he says. Thirty-five percent had pain so severe they couldn't walk more than five blocks and had to stop working or playing sports.
The treatment included two GPR sessions during the first week, then one session a week for an average of five months. Participants also practiced breathing techniques and were given a home exercise program.
Back Pain Relieved in Nearly All
The findings showed that 92 of the 102 people reported pain relief and were able to return fully to their daily activities.
For 85 percent of the patients, the improvement was noted after just three weeks of treatment. And after an average of almost two years, the pain has not recurred, Estol says.
Cautious Optimism
Other researchers at the meeting were cautiously optimistic.
Albert Lo, MD, PhD, assistant professor of neurology at Yale University in New Haven, Conn., and a moderator of the session at which the findings were presented, says a success rate of 90 percent in patients with chronic back pain "is very unusual and begs for further investigation."
"If the findings are reproducible in [future studies], GPR could be a very exciting adjunctive therapy for patients with chronic neck and back pain," he tells WebMD.
By Charlene Laino, reviewed by Michael W. Smith, MD
SOURCES: American Academy of Neurology 57th Annual Meeting, April 9-16, 2005, Miami Beach, Fla. Conrado Estol, MD, PhD, Neurologic Center for Treatment and Rehabilitation, Buenos Aires, Argentina. Albert Lo, MD, PhD, assistant professor of neurology, Yale University, New Haven, Conn
PT News: Innovative Physical Therapy Relieves Back Pain
An innovative physical therapy technique may relieve back pain even when all other treatments fail.
The technique, called Souchard's global postural re-education -- or GPR for short -- employs a series of gentle movements to realign spinal column joints and strengthen and stretch muscles that have become tight and weak from underuse.
"GPR corrects the patient's posture and decompresses the spinal canal," says Conrado Estol, MD, PhD, of the Neurologic Center for Treatment and Rehabilitation in Buenos Aires, Argentina. He presented his study at the American Academy of Neurology 57th Annual Meeting.
Return to Daily Activities
"In our study, nine in 10 people with chronic back pain due to disc disease significantly improved and were able to return to their usual daily activities -- usually within five months."
GPR can also help the 95 percent of adults who will suffer acute back pain injury at some point in their lives, he tells WebMD.
Developed in France, GPR is only now being introduced in the United States.
Patient, Therapist Work Together
A person with chronic back pain is in too much discomfort to perform the exercise on his own. A physical therapist guides the process, stretching the muscles along the spinal column while the patient is in the specified positions.
There are two basic positions: standing up and lying down with the knees bent. While in each of these positions, the patient places his arms at his side and tries to open them wider and wider.
"The therapist helps you to find the level you're comfortable with, as you keep increasing the range of motion," Estol says.
When Back Pain Treatments Fail
Estol says medications and surgery for severe and chronic back pain typically have limited or no benefit.
That's why he decided to try the new method on 102 patients with chronic back pain associated with severe degenerative disc disease of the spine. Patients with degenerative disc disease can experience back pain so debilitating that they can't bend, stretch or, sometimes, even get out of a chair without help.
Five Months of Treatment
The participants had severe pain for an average of seven months; 82 had lower back pain and 20 had neck pain. About half were women.
"The patients had tried almost all combinations of treatments you could think of, including regular physical therapy, bed rest, anti-inflammatory medications, acupuncture, and epidural injections," Estol says. "Quite a few had already had surgery and others were scheduled for surgery when we treated them."
Importantly, three-fourths couldn't walk more than 10 blocks without stopping, he says. Thirty-five percent had pain so severe they couldn't walk more than five blocks and had to stop working or playing sports.
The treatment included two GPR sessions during the first week, then one session a week for an average of five months. Participants also practiced breathing techniques and were given a home exercise program.
Back Pain Relieved in Nearly All
The findings showed that 92 of the 102 people reported pain relief and were able to return fully to their daily activities.
For 85 percent of the patients, the improvement was noted after just three weeks of treatment. And after an average of almost two years, the pain has not recurred, Estol says.
Cautious Optimism
Other researchers at the meeting were cautiously optimistic.
Albert Lo, MD, PhD, assistant professor of neurology at Yale University in New Haven, Conn., and a moderator of the session at which the findings were presented, says a success rate of 90 percent in patients with chronic back pain "is very unusual and begs for further investigation."
"If the findings are reproducible in [future studies], GPR could be a very exciting adjunctive therapy for patients with chronic neck and back pain," he tells WebMD.
By Charlene Laino, reviewed by Michael W. Smith, MD
SOURCES: American Academy of Neurology 57th Annual Meeting, April 9-16, 2005, Miami Beach, Fla. Conrado Estol, MD, PhD, Neurologic Center for Treatment and Rehabilitation, Buenos Aires, Argentina. Albert Lo, MD, PhD, assistant professor of neurology, Yale University, New Haven, Conn
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