Effectiveness of Combined Physical Therapy and Balneotherapy Treatment on Knee Osteoarthritis

Öz

Objective: The purpose of this study is to evaluate the effects of hot pack (HP), transcutaneous electrical nerve stimulation (TENS) and short wave diathermia (SWD) physical therapy treatment combined with balneotherapy on pain, stiffness, and functional condition in patients with knee osteoarthritis compared to only physical therapy group.

Material and Methods: Thirty two patients (group 1: physical therapy + spa treatment) and 31 patients (group 2: physical therapy) with knee osteoarthritis were evaluated before (Day 0) and after (Day 10) treatment using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain, WOMAC stiffness, WOMAC functional status and WOMAC total scores.

Results: Statistically significant improvements were identified in the post-treatment WOMAC pain, WOMAC stiffness, WOMAC functional condition, and WOMAC total scores compared to the pre-treatment period in both group 1 and 2 (p<0.001). However, there was no statistically significant difference between the groups.

Conclusion: Both physical therapy with HP, TENS and SWD combined with balneotherapy and only physical therapy group have a positive effect on pain, stiffness, and functional status in patients with knee osteoarthritis. However, the two treatments were not superior to each other.

Anahtar Kelimeler

• Balneotherapy; Hot pack; Transcutaneous electrical nerve stimulation; Short wave diathermia; Knee osteoarthritis

DİZ OSTEOARTRİTİ TEDAVİSİNDE KOMBİNE FİZİK TEDAVİ VE KAPLICA TEDAVİSİNİN ETKİNLİĞİ

Öz

Amaç: Bu çalışmanın amacı diz osteoartritili hastalarda hot pack (HP), trankütanöz elektriksel sinir stimülasyonu (TENS) ve kısa dalga diatermi (KDD)’den oluşan fizik tedavi ile kombine kaplıca tedavisinin sadece fizik tedaviye göre ağrı, tutukluk ve fonksiyonel durum üzerine etkisini araştırmaktır.

Gereç ve Yöntemler: Diz osteoartriti olan 32 hastanın (Grup 1: fizik tedavi+kaplıca tedavisi alan hastalar) ve 31 hastanın (Grup 2: fizik tedavi alan hastalar ) tedavi öncesi (0.gün) ve tedavi sonrası (10.gün) Western Ontario and McMaster Universities Arthritis Index (WOMAC) ağrı, WOMAC tutukluk, WOMAC fonksiyonel durum ve WOMAC toplam skorları değerlendirildi.

Bulgular: Tedavi sonrası WOMAC ağrı, WOMAC tutukluk, WOMAC fonksiyonel durum ve WOMAC toplam skorlarında tedavi öncesi değerlere göre her iki grupta da istatistiksel olarak anlamlı gelişme saptandı (p<0.001). Ancak tedavi sonuçları arasında gruplar arası istatistiki olarak anlamlı fark saptanmadı.

Sonuç: Diz osteoartritli hastalarda hem HP, TENS ve KDD’den oluşan fizik tedavi hem de fizik tedavi ile kombine kaplıca tedavisi ağrı, tutukluk ve fonksiyonel durum üzerine etkilidir. Ancak iki tedavi grubunun birbirine üstünlüğü saptanmamıştır.

Anahtar Kelimeler

• Kaplıca tedavisi; Hot pack; Transkütanöz elektriksel sinir stimulasyonu; Kısa dalga diatermi; Diz osteoartriti

Kaynakça

1. 1. Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001;60(2):91-7.
2. 2. Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JWJ, Dieppe P et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003;62(12):1145-55.
3. 3. Fernandes L, Hagen KB, Bijlsma JWJ, Andreassen O, Christensen P, Conaghan PG et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis. 2013;72(7):1125-35.
4. 4. Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012;64(4):465-74.
5. 5. Wang SY. Physical therapy ınterventions for knee pain secondary to osteoarthritis. Ann Intern Med. 2012;157(9):632-44.
6. 6. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K et al. Development of criteria for the classification and reporting of osteoarthritis: Classification of osteoarthritis of the knee. Arthritis Rheum. 1986;29(8):1039-49.
7. 7. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494-503.
8. 8. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC : a health status instrument for measuring clinically-important patient-relevant outcomes following total hip or knee arthroplasty in osteoarthritis. J Rheumatol. 1988; 15(12):1833-40.

9. 9. Tüzün EH, Eker L, Aytar A, Daşkapan A, Bayramoğlu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis Cartilage. 2005;13(1):28-33.
10. 10. Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet. 1997;349(9061):1269-76.
11. 11. Frost GJ. The spa as a model of an optimal healing environment. J Altern Complement Med. 2004;10(l):85-92.
12. 12. Gutenbrunner C, Bender T, Cantista P, Karagülle Z. A proposal for a worldwide definition of health resort medicine, balneology, medical hydrology and climatology. Int J Biometeorol. 2010;54(5):495-507.
13. 13. Forestier R, Desfour H, Tessier JM, Françon A, Foote AM, Genty C et al. Spa therapy in the treatment of knee osteoarthritis: a large randomised multicentre trial. Ann Rheum Dis. 2010;69(4):660-5.
14. 14. Yurtkuran M, Yurtkuran M, Alp A, Nasırcılar A, Bingöl Ü, Altan L et al. Balneotherapy and tap water therapy in the treatment of knee osteoarthritis. Rheumatol Int. 2006;27(1):19-27.
15. 15. Fioravanti A, Giannitti C, Bellisai B, Iacoponi F, Galeazzi M. Efficacy of balneotherapy on pain, function and quality of life in patients with osteoarthritis of the knee. Int J Biometeorol. 2012;56(4):583-90.
16. 16. Karagülle M, Karagülle MZ, Karagülle O, Dönmez A, Turan M. A 10-day course of SPA therapy is beneficial for people with severe knee osteoarthritis. Clin Rheumatol. 2007;26(12):2063-71.
17. 17. Kovács I, Bender T. The therapeutic effects of Cserkeszölö thermal water in osteoarthritis of the knee: A double blind, controlled, follow-up study. Rheumatol Int. 2002;21(6):218-21.
18. 18. Sherman G, Zeller L, Avriel A, Friger M, Harari M, Sukenik S. Intermittent balneotherapy at the Dead Sea area for patients with knee osteoarthritis. Isr Med Assoc J. 2009;11(2):88-93.
19. 19. Evcik D, Kavuncu V, Yeter A, Yigit I. The efficacy of balneotherapy and mud-pack therapy in patients with knee osteoarthritis. Joint Bone Spine. 2007;74(1):60-5.
20. 20. Cetin N, Aytar A, Atalay A, Akman MN. Comparing hot pack, short-wave diathermy, ultrasound, and TENS on isokinetic strength, pain, and functional status of women with osteoarthritic knees: a single-blind, randomized, controlled trial. Am J Phys Med Rehabil. 2008;87(6):443-51.
21. 21. Rutjes AW, Nüesch E, Sterchi R, Kalichman L, Hendriks E, Osiri M et al. Transcutaneous electrostimulation for osteoarthritis of the knee. Cochrane Database Syst Rev. 2009;(4):CD002823.
22. 22. Laufer Y, Dar G. Effectiveness of thermal and athermal short-wave diathermy for the management of knee osteoarthritis: A systematic review and meta-analysis. Osteoarthr Cartil. 2012;20(9):957-66.
23. 23. Cantarini L, Leo G, Giannitti C, Cevenini G, Barberini P, Fioravanti A. Therapeutic effect of spa therapy and short wave therapy in knee osteoarthritis: A randomized, single blind, controlled trial. Rheumatol Int. 2007;27(6):523-29.
24. 24. Sarsan A, Akkaya N, Özgen M, Yildiz N, Atalay NS, Ardic F. Comparing the efficacy of mature mud pack and hot pack treatments for knee osteoarthritis. J Back Musculoskelet Rehabil. 2012;25(3):193-9.
25. 25. Onat ŞŞ, Taşoğlu Ö, Özişler Z, Güneri FD, Özgirgin N. Balneotherapy in the treatment of knee osteoarthritis: a controlled study. Arch Rheumatol. 2015;30:292-7.