The Effect of Local Heat and Cold Therapy on the Intraarticular and Skin Surface Temperature of the Knee

Objective. To evaluate the effects of local application of ice chips, ligno-paraffin, short-wave diathermy, and nitrogen-cold air on skin and intraarticular temperature. \ud Methods. Forty-two healthy subjects were divided into 4 treatment groups. A temperature probe was inserted into the knee joint cavity and another placed on the overlying skin, and changes in temperature over 3 hours, by treatment group, were recorded. \ud Results. The mean skin surface temperature dropped from 27.9°C to 11.5°C after application of ice chips, and from 28.8°C to 13.8°C after application of cold air. The mean intraarticular temperature decreased from 31.9°C to 22.5°C and from 32.9°C to 28.8°C, respectively, after these 2 treatments. Short-wave diathermy increased skin temperature by 2.4°C; intraarticular temperature was increased only 1.4°C by short-wave diathermy. Treatment with ligno-paraffin increased the skin surface temperature 8.9°C; the temperature in the joint cavity was increased 3.5°C. \ud Conclusion. The use of short-wave diathermy and superficial heat packs in the treatment of patients with arthritis may potentially cause harm by increasing intraarticular temperature. This may have major implications regarding treatment policy for patients with arthritis

Reproduceerbaarheid van een Functionele Capaciteits Evaluatie bij mensen met beginnende artrose van heup en / of knie

De Isernhagen Work Systems Functionele Capaciteits Evaluatie (IWS FCE) is een performance-based test met goede psychometrische kenmerken bij gezonden en bij mensen met lage rugklachten. Doel: bepalen van de twee-daagse reproduceerbaarheid van de IWS FCE en analyseren van mogelijke bronnen van variantie bij mensen met artrose

No adverse physiological responses to infrared whole body hyperthermia in patients with rheumatoid arthritis and ankylosing spondylitis compared to healthy subjects

PURPOSE: Since about ten years a new modality for whole body hyperthermia, a compact and userfriendlyinfrared (IR) 'sauna' has become available. Patients with musculoskeletal disorders report positive effects.RELEVANCE: Until now hardly any research was done in this field. Therefore in this study the short-termphysiological and clinical effects in healthy subjects and patients with Rheumatoid Arthritis (RA) andAnkylosing Spondylitis (AS) were investigated. SUBJECTS: 17 RA patients (3 male, 14 female), 19 AS patients (12 male, 7 female) and 21 healthy subjects (11 male, 10 female) with a mean age (sd) of 47 (13), 45 (10) and 45 (7) years respectively were included in the study.METHODS AND MATERIALS: Patients with RA or AS and healthy subjects were treated with whole-body hyperthermia by means of a 30 minutes stay in a IR sauna cabin at an adjusted temperature of 55°C. Before and directly after the sauna treatment in both RA and AS patient groups pain and stiffness and were measured on a 10 centimetres Visual Analogue Scale. Besides that in all groups body weight was measured before and after treatment. Additionally during the treatment heart rate, systolic and diastolic blood pressure, skin surface and core temperature were continuously monitored. Also general wellbeing during and after treatment was investigated. RESULTS: Pain and stiffness improved significantly duringtreatment; mean between 40% and 60%. The mean weight loss during treatment due to transpiration was significant (p<0.001) in all groups, but it was significantly higher (p<0.001) in healthy subjects (-0.5 kg) than in patients (both RA and AS -0.3 kg). During treatment mean heart rate, skin and core temperature increased significantly p<,0.001) in all groups, while blood pressures showed small but significant declines. No significant differences between groups were observed. On average all subjects felt comfortable during and especially after treatment. CONCLUSION: Infra red whole body hyperthermia has statistically significant positive direct effects upon pain and stiffness in RA as well as in AS patients. Looking at the physiological effects, RA and AS patients do not respond differently from age and gender matched healthy controls

A system of networks and continuing education for physical therapists in rheumatology: a feasibility study

PURPOSE: To evaluate the feasibility of regional physical therapy networks including continuing education in rheumatology. The aim of these networks was to improve care provided by primary care physical therapists by improving specific knowledge, technical and communicative skills and the collaboration with rheumatologists. METHODS: In two regions in The Netherlands continuing education (CE) programmes, consisting of a 5-day postgraduate training course followed by bimonthly workshops and teaching practices, were organised simultaneously. Network activities included consultations, newsletters and the development of a communication guideline. Endpoint measures included the participation rate, compliance, quality of the CE programme, teaching practices, knowledge, network activities, communication, number of patients treated and patient satisfaction. RESULTS: Sixty-three physical therapists out of 193 practices (33%) participated in the project. They all completed the education programmes and were formally registered. All evaluations of the education programmes showed positive scores. Knowledge scores increased significantly directly after the training course and at 18 months. A draft guideline on communication between physical therapists and rheumatologists was developed, and 4 newsletters were distributed. A substantial proportion of physical therapists and rheumatologists reported improved communication at 18 months. The mean number of patients treated by physical therapists participating in the networks increased significantly. Patients' satisfaction scores within the networks were significantly higher than those from outside the networks at 18 months. CONCLUSIONS: Setting up a system of networks for continuing education for physical therapists regarding the treatment of patients with rheumatic diseases is feasible. Further research will focus on the effectiveness of the system and its implementation on a larger scale

Arbeidsparticipatie en Arbeidscapaciteit bij Beginnende Artrose van Heup en Knie

Artrose is een degeneratieve aandoening van het kraakbeen, waarbij ook de andere structuren in de gewrichten betrokken zijn. De aandoening kan leiden tot beperkingen in het dagelijks functioneren. De huidige kennis betreffende de effecten van artrose op arbeidsparticipatie is onvolledig. In de literatuur zijn slechts enkele studies gevonden met een adequate opzet, die geldige conclusies over dit effect opleverden. In dit onderzoek wordt de arbeidsparticipatie van mensen met beginnende artrose beschreven bij de baseline meting van de CHECK-studie (Cohort Heup En Cohort Knie)