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ĐÁNH GIÁ KẾT QUẢ ĐIỀU TRỊ THOÁI HÓA KHỚP GỐI BẰNG BÀI TẬP VẬN ĐỘNG KẾT HỢP VỚI SÓNG NGẮN TẠI BỆNH VIỆN CHỈNH HÌNH VÀ PHỤC HỒI CHỨC NĂNG CẦN THƠ NĂM 2022
Abstract
Đặt vấn đề: Thoái hóa khớp gối là kết quả của sự hao mòn và mất dần sụn khớp. Thường gặp nhất ở người cao tuổi. Bệnh có thể gây đau khớp, cứng khớp, giảm vận động, giảm chức năng sinh hoạt và chất lượng cuộc sống của bệnh nhân. Vật lý trị liệu-Phục hồi chức năng là một phương pháp điều trị bảo tồn hiệu quả, có khả năng giúp bệnh nhân cải thiện chức năng khớp gối. Mục tiêu nghiên cứu: Đánh giá kết quả điều trị thoái hóa khớp gối bằng bài tập vận động kết hợp với sóng ngắn tại Bệnh viện Chỉnh hình và Phục hồi chức năng Cần Thơ năm 2022. Đối tượng và phương pháp nghiên cứu: Nghiên cứu theo phương pháp tiến cứu. Thử nghiệm lâm sàng theo chiều dọc có so sánh trước và sau điều trị trên 30 bệnh nhân. Kết quả: Sau khi điều trị bằng các bài tâp vận động kết hợp với sóng ngắn, triệu chứng đau giảm (4,2 điểm), tăng tầm vận động chủ động và thụ động khớp gối (17,50), tăng sức mạnh cơ tứ đầu đùi (76,7% bậc 5, 23,3% bậc 4), tăng khả năng và đoạn đường đi bộ (73,4% đi bộ được trên 30 phút). Kết quả điều trị chung: sau điều trị mức độ tốt 50%, khá 33,3%. Tổng điểm trung bình tăng 6,1 điểm. Kết luận: Bài tập vận động khớp gối kết hợp với sóng ngắn trị liệu giúp làm thuyên giảm đau, cải thiện tầm vận động khớp gối, sức mạnh cơ tứ đầu đùi và tăng đáng kể quãng đường đi bộ ở bệnh nhân bị thoái hóa khớp gối.
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Objective
To develop an evidence‐based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA.
Methods
We identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind‐body, and pharmacologic therapies for OA. Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. A Voting Panel, including rheumatologists, an internist, physical and occupational therapists, and patients, achieved consensus on the recommendations.
Results
Based on the available evidence, either strong or conditional recommendations were made for or against the approaches evaluated. Strong recommendations were made for exercise, weight loss in patients with knee and/or hip OA who are overweight or obese, self‐efficacy and self‐management programs, tai chi, cane use, hand orthoses for first carpometacarpal (CMC) joint OA, tibiofemoral bracing for tibiofemoral knee OA, topical nonsteroidal antiinflammatory drugs (NSAIDs) for knee OA, oral NSAIDs, and intraarticular glucocorticoid injections for knee OA. Conditional recommendations were made for balance exercises, yoga, cognitive behavioral therapy, kinesiotaping for first CMC OA, orthoses for hand joints other than the first CMC joint, patellofemoral bracing for patellofemoral knee OA, acupuncture, thermal modalities, radiofrequency ablation for knee OA, topical NSAIDs, intraarticular steroid injections and chondroitin sulfate for hand OA, topical capsaicin for knee OA, acetaminophen, duloxetine, and tramadol.
Conclusion
This guideline provides direction for clinicians and patients making treatment decisions for the management of OA. Clinicians and patients should engage in shared decision‐making that accounts for patients’ values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.
Knee osteoarthritis (OA) is the most common musculoskeletal disease among old individuals which affects ability for sitting on the chair, standing, walking and climbing stairs. Our objective was to investigate the short and long-term effects of the most simple and the least expensive exercise protocols in combination to conventional conservative therapy for knee OA.
It was a single blind RCT study with a 12-months follow-up. Totally, 56 patients with knee OA were assigned into 2 random groups. The patients in exercise group received exercise for knee muscles in combination with non-steroid anti-inflammatory drugs (NSAIDs) and 10 sessions acupuncture and physiotherapy modalities. Non-exercise group received similar treatments except exercise program. The changes in patients' pain and functional status were evaluated by visual analog scale (VAS), knee and osteoarthritis outcome score (KOOS) questionnaire and functional tests (4 steps, 5 sit up, and 6 min walk test) before and after treatment (1 and 3 months after intervention), and 1 year later at the follow-up.
The results showed that the patients with knee OA in exercise group had significant improvement in pain, disability, walking, stair climbing, and sit up speed after treatment at first and second follow-up when compared with their initial status and when compared with non-exercise group. At third follow up (1 year later) there was significant difference between groups in VAS and in three items of KOOS questionnaire in functional status.
Non aerobic exercises for muscles around knee can augment the effect of other therapeutic interventions like medical therapy, acupuncture, and modalities for knee OA.
Osteoarthritis (OA) is progressive joint disease characterized by joint inflammation and a reparative bone response and is one of the top five most disabling conditions that affects more than one-third of persons > 65 years of age, with an average estimation of about 30 million Americans currently affected by this disease. Global estimates reveal more than 100 million people are affected by OA. The financial expenditures for the care of persons with OA are estimated at a total annual national cost estimate of $15.5-$28.6 billion per year. As the number of people >65 years increases, so does the prevalence of OA and the need for cost-effective treatment and care. Developing a treatment strategy which encompasses the underlying physiology of degenerative joint disease is crucial, but it should be considerate to the different age ranges and different population needs. This paper focuses on different exercise and treatment protocols (pharmacological and non-pharmacological), the outcomes of a rehabilitation center, clinician-directed program versus an at home directed individual program to view what parameters are best at reducing pain, increasing functional independence, and reducing cost for persons diagnosed with knee OA.
Today, the most frequent chronic musculoskeletal disorder and the leading cause of disability in the elderly is osteoarthritis (OA). Approximately 43 million people in the United States and 15% of the world population are affected. Due to demographic changes, the incidence of OA is rapidly increasing, leading to an ascending socioeconomical and personal burden. Despite the exact cause of OA remains unknown, the pathogenic role of biomechanical dysfunction in OA is well established. For weight-bearing joints altered loading mechanisms, increased mechanical forces and changed biomechanics are significant contributing factors for initiation and progression of OA. Thus, OA is a disease of the whole joint, including muscles, tendons, ligaments, synovium and bone. This review focuses on the influence of biomechanics on the pathogenesis and progression of OA. We notably illustrate the pathological bioreactivity of soft tissues, subchondral bone and joint inflammation. Procedures, conservative or surgical, which actively alter the biomechanics of the lower limb, are promising strategies to treat symptoms as well as to influence disease progression in OA.
Degenerative musculoskeletal disorders are among the most frequent diseases occurring in adulthood, often impairing patients' functional mobility and physical activity. The aim of the present study was to investigate and compare the impact of three frequent degenerative musculoskeletal disorders--knee osteoarthritis (knee OA), hip osteoarthritis (hip OA) and lumbar spinal stenosis (LSS)--on patients' walking ability.
The study included 120 participants, with 30 in each patient group and 30 healthy control individuals. A uniaxial accelerometer, the StepWatch™ Activity Monitor (Orthocare Innovations, Seattle, Washington, USA), was used to determine the volume (number of gait cycles per day) and intensity (gait cycles per minute) of walking ability. Non-parametric testing was used for all statistical analyses.
Both the volume and the intensity of walking ability were significantly lower among the patients in comparison with the healthy control individuals (p < 0.001). Patients with LSS spent 0.4 (IQR 2.8) min/day doing moderately intense walking (>50 gait cycles/min), which was significantly lower in comparison with patients with knee and hip OA at 2.5 (IQR 4.4) and 3.4 (IQR 16.1) min/day, respectively (p < 0.001). No correlations between demographic or anthropometric data and walking ability were found. No technical problems or measuring errors occurred with any of the measurements.
Patients with degenerative musculoskeletal disorders suffer limitations in their walking ability. Objective assessment of walking ability appeared to be an easy and feasible tool for measuring such limitations as it provides baseline data and objective information that are more precise than the patients' own subjective estimates. In everyday practice, objective activity assessment can provide feedback for clinicians regarding patients' performance during everyday life and the extent to which this confirms the results of clinical investigations. The method can also be used as a way of encouraging patients to develop a more active lifestyle.
To establish the relationships between the range of joint motion (ROM) and disability in patients with osteoarthritis (OA) of the knee or hip. Two related issues were addressed: (1) the inter-relationships between ROMs of joint actions, and (2) the relationship between ROM and disability.
Data on 198 patients with OA of the knee or hip were used. The ROM was assessed bilaterally for the hip and knee, using a goniometer. Disability was assessed using a self-reporting method (questionnaire) and an observational method. Correlation and factor analysis were used to establish the inter-relationships between the ROMs of joint actions. Correlation and multiple regression analyses were carried out to establish the relationships between ROM and disability.
Close inter-relationships were found between the ROMs of the same joint action of the lateral and contralateral joints; inter-relationships between ROMs of different joint actions were substantially weaker. Low ROMs were associated with high levels of disability, both self-reported and observed. Some 25% of the variation in disability levels could be accounted for by differences in ROM. In both knee and hip OA patients, flexion of the knee and extension and external rotation of the hip were found to be most closely associated with disability.
Restricted joint mobility, especially in flexion of the knee and extension and external rotation of the hip, appears to be an important determinant of disability in patients with OA.
Ageing-associated changes that affect articular tissues promote the development of osteoarthritis (OA). Although ageing and OA are closely linked, they are independent processes. Several potential mechanisms by which ageing contributes to OA have been elucidated. This Review focuses on the contributions of the following factors: age-related inflammation (also referred to as 'inflammaging'); cellular senescence (including the senescence-associated secretory phenotype (SASP)); mitochondrial dysfunction and oxidative stress; dysfunction in energy metabolism due to reduced activity of 5'-AMP-activated protein kinase (AMPK), which is associated with reduced autophagy; and alterations in cell signalling due to age-related changes in the extracellular matrix. These various processes contribute to the development of OA by promoting a proinflammatory, catabolic state accompanied by increased susceptibility to cell death that together lead to increased joint tissue destruction and defective repair of damaged matrix. The majority of studies to date have focused on articular cartilage, and it will be important to determine whether similar mechanisms occur in other joint tissues. Improved understanding of ageing-related mechanisms that promote OA could lead to the discovery of new targets for therapies that aim to slow or stop the progression of this chronic and disabling condition.
Osteoarthritis (OA) is a leading cause of musculoskeletal pain and disability. According to a study by Lawrence et al, an estimated 27 million Americans were living with OA in 2008. This number will continue to increase as the population of persons older than 65 years grows. Because of the increasing number of persons who have this chronic condition that causes pain and decreases function, the prevalence of this diagnosis in primary care and musculoskeletal clinics likely will increase. The reduction of pain and improvement in function should be goals of providers who treat these patients. Physical therapy (PT) is a commonly used treatment modality for persons with OA. Many treatment modalities are available within the scope of PT, including strength training, manual therapy, aquatic therapy, electrical stimulation, and balance and perturbation training. A review of the most recent and highest-quality literature regarding these modalities found that strength training, aquatic therapy, and balance and perturbation therapy were the most beneficial with respect to reducing pain and improving function. Evidence clearly indicates that electrical stimulation likely has very little impact on these variables, and evidence regarding manual therapy is equivocal. Literature reviewing prognostic indicators for persons with OA who will likely respond to PT reveal that persons with milder disease (ie, unilateral OA, symptoms for less than 1 year, and a 40-m self-paced walking test of less than 25.9 seconds) and those who have pain of 6 or greater on the numerical pain rating scale are likely to have better outcomes with PT, which suggests that earlier referral is preferable. Barriers to the acceptance of PT as a therapeutic treatment for OA include fatalistic patient and provider perspectives, inadequate analgesia, and a fear among some patients and providers that increased activity will lead to progression of their OA.
To determine the effect of quadriceps strength in individuals with knee osteoarthritis (OA) on loss of cartilage at the tibiofemoral and patellofemoral joints (assessed by magnetic resonance imaging [MRI]) and on knee pain and function.
We studied 265 subjects (154 men and 111 women, mean+/-SD age 67+/-9 years) who met the American College of Rheumatology criteria for symptomatic knee OA and who were participating in a prospective, 30-month natural history study of knee OA. Quadriceps strength was measured at baseline, isokinetically, during concentric knee extension. MRI of the knee at baseline and at 15 and 30 months was used to assess cartilage loss at the tibiofemoral and patellofemoral joints, with medial and lateral compartments assessed separately. At baseline and at followup visits, knee pain was assessed using a visual analog scale, and physical function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index.
There was no association between quadriceps strength and cartilage loss at the tibiofemoral joint. Results were similar in malaligned knees. However, greater quadriceps strength was protective against cartilage loss at the lateral compartment of the patellofemoral joint (for highest versus lowest tertile of strength, odds ratio 0.4 [95% confidence interval 0.2, 0.9]). Those with greater quadriceps strength had less knee pain and better physical function over followup (P<0.001).
Greater quadriceps strength had no influence on cartilage loss at the tibiofemoral joint, including in malaligned knees. We report for the first time that greater quadriceps strength protected against cartilage loss at the lateral compartment of the patellofemoral joint, a finding that requires confirmation. Subjects with greater quadriceps strength also had less knee pain and better physical function over followup.
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