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|Title: ||Osteoarthritis Year in Review: Rehabilitation and Outcomes|
|Authors: ||Davis, Aileen M|
|Keywords: ||Osteoarthritis, hip, knee, interventions, outcome, review|
|Issue Date: ||Jan-2012|
|Publisher: ||Osteoarthritis and Cartilage|
|Citation: ||Osteoarthritis and Cartilage. E-pub ahead of print available on line http://dx.doi.org/10.1016/j.joca.2012.01.006 15 January 2012.|
This review highlights seminal publications of rehabilitation interventions and outcomes in osteoarthritis (OA) of the hip or knee.
Medline, CINAHL, and Embase databases from September 2010 through August 2011 were
searched using the key words ‘osteoarthritis’, rehabilitation, physical therapy, exercise, and
outcome(s), limited to human and English. Rehabilitation intervention studies were included if they were randomized trials (RCT), systematic reviews or meta-analyses. Studies of surgical interventions were excluded unless they included evaluation of a rehabilitation intervention.
Outcome studies were included if they contributed methodologically to advancing outcome measurement. Reviews of measurement properties of outcomes were excluded. Eight
publications were selected and reviewed that relate to interventions evaluating manual therapy in hip or knee OA, tele-rehabilitation and performance and participation measures as outcomes.
Interventions: One systematic review of hip and knee OA, one meta-analysis of knee OA
provide limited support for the benefit of manual therapy with exercise for improving pain and function to a lesser extent in the short term (three months). Study quality overall was low. One high quality RCT in knee replacement of usual outpatient physiotherapy versus internet-based tele-rehabilitation based on a non-inferiority analysis demonstrated comparable
outcomes on WOMAC pain and function and performance measures.
Outcomes: Three studies demonstrated that observed performance measures such as timed walk tests and stair-climbing and timed-up-and-go measure concepts differ from self-report of 3 difficulty with physical function. Additionally, two studies showed differential times of recovery following TKR.
Two studies evaluated participation. One demonstrated the conceptual distinction of
activity limitations and participation and a second re-analyzed trial data from knee OA studies.
In one study, there were larger effects in combined activity/participation than for activity alone for arthroscopic lavage compared to intraarticular steroid and, in a second study, the effect was larger for activity with an advanced pharmacy intervention whereas the physiotherapy
intervention demonstrated a larger effect for activity/participation.
Conclusions: Interventions of manual therapy for hip and knee OA provided limited evidence of effectiveness. These studies are of limited quality due to lack of blinding and disclosure of cointervention.
Tele-rehabilitation may be a viable option to improve access to rehabilitation post
joint replacement for those in rural and remote areas. Data continue to support the need to include performance measures as well as patient reported outcomes in evaluating outcomes in OA. Additionally, measures of participation should be considered as core outcomes.|
|Appears in Collections:||UofT Faculty publications|
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