The role of thermal balneotherapy in the treatment of obese patient with knee osteoarthritis

Abstract

Osteoarthritis (OA) is the most common form of arthritis clinically characterized by joint pain, functional limitation, and reduced quality of life. Several studies have shown a clear link between obesity and higher risk of knee OA. According to the multifactorial OA pathogenesis, the management of this condition requires a multidisciplinary approach. The objective of this study is to evaluate hydrokinesitherapy effects in thermal setting in obese patients with knee OA. Fifty-three patients were assessed for eligibility, of which 33 refused the treatment, while 10 patients dropped out after the enrollment for personal reasons or inability to adhere to the program. Ten patients (8 females, 2 males, mean age of 59.4 years) with obesity (range BMI 30-45 kg/m2) and knee OA (II-III grade of Kellgren-Lawrence scale) treated with hydrokinetic therapy in thermal water (two sessions per week for 8 consecutive weeks) completed the study. Primary outcome measure was pain (VAS). Secondary outcomes were clinical knee evaluation (range of motion-ROM, lower-limb muscle strength), WOMAC, and Lequesne Algofunctional Index. Patellar tendon and peri-articular soft tissue ultrasound evaluation and gait analysis at baseline (T0), at the end of treatment (T1), and at 6 months of follow-up (T2) were performed. Significant decrease on VAS pain during walking on a flat surface and going up/down stairs was reached from baseline at T1 (p = 0.0039; p = 0.0098) and was maintained at T2 (p = 0.00954) exclusively for VAS pain during walking on a flat surface. WOMAC score showed a significant reduction between T0 and T1 (p = 0.0137) and between T0 and T2 (p = 0.006438), as ROM evaluations. Kinematic path assessment did not show significant results in individual gait steps, except for the space-time variables of the average speed and the values of ground reaction force (GRF) obtained with force platforms. Hydrokinesitherapy in thermal environment in obese patients with knee OA may determine pain relief, joint function improvement, and walking speed increase until 6 months of follow-up.

How falls and fear of falling affect the performance of daily activities in individuals with knee osteoarthritis

“…In the present study, a direct correlation was found between total LI scores and a higher BMI (Masiero et al, 2018). In a study performed by Rosales Ade et al (2014) on 38 patients diagnosed with OA, it was found that weight loss improves patient functionality and performance of activities of daily living.…”

“…High BMI negatively affects the knee joints of patients by causing abnormal loading on knees and impairing joint bio-mechanisms. Obesity means more muscle strength is required to perform daily activities, which impairs physical functions (Masiero et al, 2018;Ng & Tan, 2013). A noticeable improvement in physical functioning can be achieved by including exercises that do not add force to the knee joint, and that are appropriate to the patients' abilities, and by implementing nutritional weight loss programs in educational initiatives targeting these patients.…”

“…The first section consisted of 24 items, including socio-demographic information (e.g., age, gender, education, profession, BMI, and whether the individual lived alone), and information on disease status (duration of OA, treatments relevant to OA, medications, auxiliary tools associated with gait, and falling experiences). BMI was divided into two categories: < 30 kg/m 2 and ≥ 30 kg/m 2 , in order to evaluate the possible relationship between obesity and functionality of patients (Masiero et al, 2018;Rosales Ade et al, 2014). The Ahlbäck radiological classification was used for staging knee OA in patients.…”

Short-wave diathermy in the clinical management of musculoskeletal disorders: a pilot observational study

“…It can be divided into superficial and deep treatment. Superficial heat therapy, which includes hot packs and thermal water, acts through skin contact (Masiero et al 2018). Deep heat therapy is generated by the interaction of electromagnetic waves with biological tissues (Laufer and Dar 2012).…”

Randomized controlled trial of aquatic exercise for treatment of knee osteoarthritis in elderly people

“…The prevalence of the disease is about 28% among the population over the age of 45 years, and people over 63 years are more prone to develop an accelerated form of the disease [2][3][4]. Patients typically have pain and stiffness in their knees and have a lower quality of life because of reduced physical activity [5,6]. Moreover, for patients in the end stage of the disease, surgery is a potential intervention [7].…”