Spa therapy and knee osteoarthritis: A systematic review

Wang

Arch Orthop Trauma Surg

2018

ObjectiveThe study aimed to evaluate the role of lateral-wedge insoles in pain reduction and functional improvement among patients with medial knee osteoarthritis.Materials and methodsThree databases including Pubmed, Embase, and Web of science were searched from inception until October 2017 for studies investigating the role of lateral-wedge treatment in pain relief and functional recovery among patients with knee osteoarthritis. Eligible studies were pooled using fixed effect model or random-effects model based on Cochrane Q statistic and I2 test. Moreover, subgroup analysis stratified by research area was performed, and sensitivity analysis was further designed to evaluate the strength of the meta-analysis.ResultsTen studies with a total of 938 patients, of which 478 patients received lateral-wedge insoles and 460 patients were set as control, were included in the meta-analysis. The pooled statistics did not show significant improvement in knee pain (SMD = − 0.21, 95% CI − 0.50, 0.08; P = 0.16) and knee function (SMD = 0.22, 95% CI − 0.27, 0.70; P = 0.38) in lateral-wedge insoles treatment group compared with controls. However, subgroup analysis based on research area revealed a favorable outcome toward Asian patients who received lateral-wedge insoles in pain reduction when compared with control group. (SMD = − 0.88, 95% CI − 1.59, − 0.17; P = 0.02). No significant improvement was observed among patients in USA and other areas. Sensitivity analysis showed unchanged results when we omitted each study. No significant publication bias was observed among the included studies.ConclusionThough for young Asian patients within normal BMI, to some extent, the lateral-wedge insoles seems to be helpful. However, there was no evidence to demonstrate the relationship between race and role of lateral-wedge insoles on pain reduction. All in all, based on current data, lateral-wedge insoles appear to be ineffective at attenuating knee pain and function improvement.

Section: Introductionmentioning

confidence: 99%

Ineffectiveness of lateral-wedge insoles on the improvement of pain and function for medial knee osteoarthritis: a meta-analysis of controlled randomized trials

Wang

Arch Orthop Trauma Surg

2018

BMC Complement Altern Med

“…The last OARSI recommendation include spa therapy but restricted spa treatment to a subgroup of patients with generalized OA with comorbidities because of a lack of evidence [ 7 ]. Spa therapy effect is well known on pain, physical function [ 14 , 15 ] and symptomatic drug consumption [ 16 ]. Short and long-term efficacy (up to 9 months) were demonstrated [ 16 ] on painful symptomatology and functional capacities in knee osteoarthritis people.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of self-management exercise program with spa therapy for behavioral management of knee osteoarthritis: research protocol for a quasi-randomized controlled trial (GEET one)

Gay

Guiguet‐Auclair

Pereira

et al. 2018

BackgroundOsteoarthritis (OA) is not limited to joint pain and stiffness, which can lead to disability; it is also linked to comorbidities such as overweight, obesity and fears and beliefs related to the pathology. The knee OA population appears more affected by these risk factors and has a lower physical activity (PA) level than the general population. The key challenge for OA treatment is increasing the PA level to decrease the risk factors.MethodsWe aim to perform a prospective, multicentric, quasi-randomized controlled trial with an alternate-month design (1-month periods). People aged 50–75 years old with symptomatic knee OA (stage I-IV Kellgren and Lawrence scale) with low and moderate PA level will be included in 3 spa therapy resorts. The experimental arm will receive 5 self-management exercise sessions (1.5 h each; education, aerobics, strength training, range of motion) + an information booklet + 18 sessions (1 h each) of spa therapy treatment (STT). The active comparator arm will receive an information booklet + 18 sessions of STT. The primary outcome will be a change at 3 months in PA level (International Physical Activity Questionnaire short form score). Secondary outcomes will be function (WOMAC) pain (numerical scale), anxiety/depression (HAD), fears and beliefs about OA (KOFBeQ) and arthritis self-efficacy (ASES). The barriers to and facilitators of regular PA practice will be assessed by using specific items specifically designed for the study because of lack of any reference scale.DiscussionThe study could demonstrate the impact of a self-management exercise program associated with spa therapy in the medium term by increasing PA level in people with OA. A benefit for ameliorating fears and beliefs and anxiety/depression and improving self-efficacy will also be analysed. The findings could offer new prospects while establishing best clinical practice guidelines for this population.Trial registrationClinicalTrials.gov NCT02598804 (November 5, 2015).Electronic supplementary materialThe online version of this article (10.1186/s12906-018-2339-x) contains supplementary material, which is available to authorized users.

“…These might include synthetic reagents that produce H 2 S or alternatively, natural H 2 S sources, such as sulfurous mineral waters. A few recent randomized clinical trials and systematic reviews have found evidence supporting beneficial effects of balneotherapy using this kind of waters [36,37,38]. In this context, our results might also contribute to the understanding of the mechanisms responsible for these positive effects, which at present have not been fully elucidated [39].…”

Section: Discussionmentioning

confidence: 75%

Long-term effects of hydrogen sulfide on the anabolic-catabolic balance of articular cartilage in vitro

et al. 2017

Healthy cartilage maintenance relies on an equilibrium among the anabolic and catabolic processes in chondrocytes. With the onset of osteoarthritis (OA), increased interleukin (IL)-1β levels induce an inhibition of the synthesis of extracellular matrix (ECM) proteins, as well as an increase in proteases. This eventually leads to a predominance of the catabolic phenotype and the progressive loss of articular cartilage. Hydrogen sulfide (HS) is a small gaseous molecule recognized as the third endogenous gasotransmitter. When administered exogenously, it has shown anti-inflammatory and anti-catabolic properties in several in vitro and in vivo models. Here, OA cartilage disks were co-cultured in vitro with IL-1β (5 ng/ml) and NaSH or GYY4137 (200 or 1000 μM) for 21 days. The ability of these two HS-producing compounds to avoid long term extracellular matrix (ECM) destruction was evaluated. We used a glycosaminoglycan (GAG) quantification kit histology and immunohistochemistry (IHC) to evaluate matrix proteins degradation and matrix metalloproteinases (MMP) abundance. Through the GAGs quantification assay, safranin O (S-O) and toluidine blue (TB) stains, and keratan/chondroitin sulfate (KS/ChS) IHCs it was shown that co-stimulation with HS-forming reagents effectively avoided GAGs destruction. Both Masson's trichrome (MT) stain and collagen (col) type II IHC, as well as aggrecan (agg) IHC demonstrated that not only were these proteins protected but even promoted, their abundance being higher than in the basal condition. Further, stains also demonstrated that positivity in the inter-territorial and intra-cellular for the different matrix components were rescued, suggesting that NaSH and GYY4137 might also have pro-anabolic effects. In addition, a clear protective effect against the increased MMPs levels was seen, since increased MMP3 and 13 levels were subsequently reduced with the co-stimulation with sulfide compounds. In general, GYY4137 was more effective than NaSH, and increasing the dose improved the results. This study demonstrates that HS anti-catabolic effects, which had been previously proven in short-term (24-48 h) in vitro cellular models, are maintained over time directly in OA cartilage tissue.