Non pharmacological knee osteoarthritis treatment

Osteoarthritis (OA) is a chronic disorder which mostly results with functional impairment and disability. The goal of the treatment program is to decrease pain and disability and to increase functional capacity and quality of life. One of the main parts of the treatment is nonpharmacological treatment modalities. These are weight loss, educational programs in modifying lifestyle and joint protective techniques, assistive devices, physical therapy (superficial and deep heat-cold applications, electrotherapeutic modalities, neuromuscular electrical stimulation), exercise and balneotherapy. Exercise therapy includes both aerobic exercise and strengthening programs. Choosing an appropriate exercise program depends on the patient's clinical evaluation and need. Although quadriceps muscle group is the primary stabilizer of knee joint, hamstring group exercises should also be recommended for a full performance. Progressive resistive exercise programs are found to have beneficial effects in pain and mobility. There are large evidence trials on the positive effects in the symptoms of OA of home-based exercise programs. Most of the studies reported the effectiveness of land-based exercises in knee OA patients. However aquatic exercises are another alternative for knee OA patients as it is safe, enjoyable and has no side effects. One of the widely used treatment option is balneotherapy and spa therapy. It was found to be effective on pain relief, functional capacity and quality of life parameters. Thermal action and chemical minerals play a significant role in its beneficial effect, however there is not an accepted clear concept about its mechanism. There is growing level of evidence about balneotherapy and spa therapy in the management of knee OA and it seems to take part in some of the treatment recommendations

Jumping into the deep-end: results from a pilot impact evaluation of a community-based aquatic exercise program

This multi-center quasi-experimental pilot study aimed to evaluate changes in pain, joint stiffness, physical function, and quality of life over 12 weeks in adults with musculoskeletal conditions attending ‘Waves’ aquatic exercise classes. A total of 109 adults (mean age, 65.2 years; range, 24–93 years) with musculoskeletal conditions were recruited across 18 Australian community aquatic centers. The intervention is a peer-led, 45 min, weekly aquatic exercise class including aerobic, strength, flexibility, and balance exercises (n = 67). The study also included a control group of people not participating in Waves or other formal exercise (n = 42). Outcomes were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and EuroQoL five dimensions survey (EQ-5D) at baseline and 12 weeks. Satisfaction with Waves classes was also measured at 12 weeks. Eighty two participants (43 Waves and 39 control) completed the study protocol and were included in the analysis. High levels of satisfaction with classes were reported by Waves participants. Over 90 % of participants reported Waves classes were enjoyable and would recommend classes to others. Waves participants demonstrated improvements in WOMAC and EQ-5D scores however between-group differences did not reach statistical significance. Peer-led aquatic exercise classes appear to improve pain, joint stiffness, physical function and quality of life for people with musculoskeletal conditions. The diverse study sample is likely to have limited the power to detect significant changes in outcomes. Larger studies with an adequate follow-up period are needed to confirm effects