Physical Therapy in Persons With Osteoarthritis

Abstract

Osteoarthritis (OA) is a leading cause of musculoskeletal pain and disability. According to a study by Lawrence et al, an estimated 27 million Americans were living with OA in 2008. This number will continue to increase as the population of persons older than 65 years grows. Because of the increasing number of persons who have this chronic condition that causes pain and decreases function, the prevalence of this diagnosis in primary care and musculoskeletal clinics likely will increase. The reduction of pain and improvement in function should be goals of providers who treat these patients. Physical therapy (PT) is a commonly used treatment modality for persons with OA. Many treatment modalities are available within the scope of PT, including strength training, manual therapy, aquatic therapy, electrical stimulation, and balance and perturbation training. A review of the most recent and highest-quality literature regarding these modalities found that strength training, aquatic therapy, and balance and perturbation therapy were the most beneficial with respect to reducing pain and improving function. Evidence clearly indicates that electrical stimulation likely has very little impact on these variables, and evidence regarding manual therapy is equivocal. Literature reviewing prognostic indicators for persons with OA who will likely respond to PT reveal that persons with milder disease (ie, unilateral OA, symptoms for less than 1 year, and a 40-m self-paced walking test of less than 25.9 seconds) and those who have pain of 6 or greater on the numerical pain rating scale are likely to have better outcomes with PT, which suggests that earlier referral is preferable. Barriers to the acceptance of PT as a therapeutic treatment for OA include fatalistic patient and provider perspectives, inadequate analgesia, and a fear among some patients and providers that increased activity will lead to progression of their OA.

How Do Physical Therapists Treat People with Knee Osteoarthritis, and What Drives Their Clinical Decisions? A Population-Based Cross-Sectional Survey

“…5 Physical therapy (PT) plays an important role in the treatment of knee osteoarthritis symptoms. 6 Current evidence from randomized controlled trials (RCTs) has suggested that the most effective individual PT treatment modalities for knee osteoarthritis are cardiovascular or strengthening exercise and education (e.g., instructions on physical exercises and weight loss). [7][8][9][10] However, in clinical practice, physical therapists most often use a combination of two or more interventions when treating people with knee osteoarthritis.…”

The effects of horse-riding simulator exercise on balance in elderly with knee osteoarthritis

“…Osteoarthritis causes severe pain in elderly patients who have a low threshold for pain and high disability scores, thereby resulting in a low quality of life, increased risk of falls, and poor balance ability1, 2, 6 ) . In the present study, the static, dynamic, and functional balance abilities of osteoarthritis patients who undertook horseback riding exercises on exercise equipment were measured using a FRT and SFBBS.…”

“…As osteoarthritis causes severe pain and functional disorders, in general, the clinical treatment is focused on pain management and amelioration of related disorders. The treatments include muscle strength training, electrical stimulation, manual therapy, aquatic therapy, balance therapy, and pharmacotherapy6 ) .…”

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“…R. Brakke и соавт. (2012) отмечают, что большую вероятность возникновения положительного ответа на применение методов физиотерапии для лечения остеоартроза имеют пациенты с легкими формами заболевания (одностороннее поражение, наличие клинической симптоматики менее 1 года, тест 40-метровой ходьбы менее 29,5 сек) и оценкой боли по 10-ти балльной шкале в 6 баллов [10].…”