Efficacy of Aerobic Exercises For Osteoarthritis (part II): A Meta-analysis

Abstract

Objective: Osteoarthritis (OA) affects a large proportion of the population. Aerobic exercise has long been a rehabilitation intervention for treating patients with OA in efforts to decrease pain and improve functional status. The purpose of this meta-analysis was to examine the efficacy of aerobic exercise among individuals with OA.

Methods: A systematic review was conducted following a protocol of methods recommended by the Cochrane Collaboration. Eligible trials were identified by a literature search of Medline, Embase, and the Cochrane Controlled Trials Register. Twelve trials were included with 1363 patients undergoing various forms and combinations of aerobic physical activities including walking programmes, aquatic exercises, jogging in water, yoga and T'ai Chi.

Results: The overall results of this analysis indicate that various forms of aerobic exercise, such as a walking programme, jogging in water, yoga and T'ai Chi can have statistically significant effects on pain, joint tenderness, functional status, and respiratory capacity for patients with OA.

Conclusions: The most efficacious exercise regimen has yet to be determined but aerobic exercise in general is more beneficial for the OA patient than no exercise at all, and is superior or equivalent to strengthening exercises. The research indicates long-term effects need to be explored further, and combined behavioural strategies need to be studied to facilitate the sustainability of the beneficial effect of aerobic exercises.     

Use of ultrasound to increase effectiveness of isokinetic exercise for knee osteoarthritis

OBJECTIVE: To investigate the effects of ultrasound (US) in isokinetic muscle strengthening exercises on functional status of patients with knee osteoarthritis (OA). DESIGN: Effectiveness of isokinetic muscle strengthening exercises for treatment of periarticular soft tissue disorders was compared with and without pulsed and continuous US. SETTING: Outpatient exercise program in a Taiwan medical university hospital. PARTICIPANTS: One hundred twenty subjects with bilateral knee OA (Altman grade II). INTERVENTION: Subjects were randomized sequentially into 1 of 4 groups. Group I received isokinetic muscular strengthening exercises, group II received isokinetic exercise and continuous US, group III received isokinetic exercise and pulsed US treatment, and group IV was the control group. MAIN OUTCOME MEASURES: Therapeutic effects of isokinetic exercise were evaluated by changes in ambulation speed and the Lequesne index. In addition, changes in knee range of motion (ROM), visual analog scale for pain, and muscle peak torques during knee flexion and extension were compared. Compliance in each group was recorded. RESULTS: Each treated group had increased muscle peak torques and significantly reduced pain and disability after treatment and at follow-up. However, only patients in groups II and III had significant improvement in ROM and ambulation speed after treatment. Fewer participants in group III discontinued treatment due to knee pain during exercise. Patients in group III also showed the greatest increase in walking speed and decrease in disability after treatment and at follow-up. Gains in muscular strength in 60 degrees /s angular velocity peak torques were also noted in groups II and III. However, group III showed the greatest muscular strength gains with 180 degrees /s angular velocity peak torques after treatment and follow-up. CONCLUSIONS: US treatment could increase the effectiveness of isokinetic exercise for functional improvement of knee OA, and pulsed ultrasound has a greater effect than continuous US.     

Exercises for hand osteoarthritis: a systematic review of clinical practice guidelines and consensus recommendations

Background: Individuals with hand osteoarthritis (OA) often experience hand pain, joint stiffness and reduced grip strength, which affect performance of everyday functional tasks. There is a need to evaluate evidence-based rehabilitation strategies that aim to lessen the burden and improve the quality of life of people living with hand OA.

Objectives: Our objectives were to (1) identify guidelines and consensus recommendations on hand OA management to ascertain whether hand exercises are recommended as part of best practice; (2) identify the type and dosage of exercises recommended regarding frequency, intensity and duration and (3) provide a summary of exercise recommendations for the management of hand OA.

Methods: This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and was registered on Prospero (CRD42018086440). Seven published databases and 20 grey literature sources were searched (January 1997–January2019). Quality assessment was conducted with the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument and, using a narrative approach, evidence was synthesized based on the levels of evidence and strength of recommendations.

Results: Eight guidelines and consensus recommendations were identified and included. Evidence from seven guidelines was rated between fair to high quality. Five out of seven guidelines recommended exercises for the management of hand OA. Limited information on exercise dosage (frequency, intensity and duration) was reported. Three strong and two weak recommendations for using different hand exercises were proposed in this systematic review.

Conclusion: Available guidelines and consensus recommendations on hand OA recommend exercises as part of current best practice for hand OA management. There is strong evidence to support the recommendation of strengthening, stretching and joint mobility exercises for the management of the hand OA. These recommended exercises, however, lacked specific details regarding the type and dosage (frequency, intensity and time) for optimal uptake, which therefore need to be established through research.     

Exercise in knee osteoarthritis: do treatment outcomes relate to bone marrow lesions? A randomized trial

Purpose: Exercise is effective for reducing knee osteoarthritis (OA) pain but effect sizes vary widely. Moreover, not all knee OA patients perceive beneficial effects. Tailoring specific exercises to subgroups of knee OA patients may increase effectivity. Bone marrow lesions (BMLs) have been suggested as a criterion to define such subgroups.

This study aimed to investigate whether BMLs’ presence/absence is related to treatment outcomes in a group of knee OA patients who exercised for 18 weeks.

Methods: Subjects with symptomatic knee OA started a strength or walking exercise program. BMLs’ presence at baseline was assessed. Pain was assessed before and after the intervention with the intermittent and constant osteoarthritis pain (ICOAP) questionnaire. Also the global perceived effect (GPE) on the patient’s complaints was rated.

Results: Thirty-five patients (strength (N?=?17) and walking (N?=?18)) were analyzed for BMLs. BMLs were present in 25 (71%) knees. Five (14%) patients dropped out and 19 (54%) improved (GPE ≥5). All dropouts had BMLs, but no difference was seen between dropouts and retainers (p?>?0.05). Pain scores did not differ between intervention groups (p?>?0.05) or between patients with BMLs and without BMLs (p?>?0.05).

Conclusions: Pain scores and GPE was not different between knee OA patients with and without baseline BMLs in this sample.

• Implications for Rehabilitation

• Both walking and strengthening exercises are effective means of improving pain in patients with knee osteoarthritis.

• In a relatively small sample, this study shows that the presence or absence of subchondral bone marrow lesions, as seen on magnetic resonance images, is not related to treatment outcomes.

     

等速训练改善关节活动度的初步观察

目的：探索等速训练在膝关节功能障碍康复治疗中的作用。方法：31例膝关节功能障碍患者,根据治疗方案分为3组：A组(等速训练,n=11),B组(常规治疗＆等张训练,n=9)和C组(常规治疗＆等速训练,n=11)。结果：A组关节活动度(ROM)扩大(18.3±8.8)°,B组(29.4±15.7)°,C组(55.9±26.1)°。结论：在膝关节功能障碍的康复治疗中速训练有助于扩大关节活动度。     

A comparison of two manual physical therapy approaches and electrotherapy modalities for patients with knee osteoarthritis: A randomized three arm clinical trial

A broad spectrum of physical therapy exercise programs provides symptom relief and functional benefit for patients with knee OA. Manual physical therapy, including tailored exercise programs provide relatively higher level benefit that persists to one year. It is currently unknown if there are important differences in the effects of different manual physical therapy techniques for patients with knee OA and there are virtually no studies comparing manual physical therapy and electrotherapy modalities. The aim of the study was to compare long-term results between three treatment groups (mobilization with movements [MWMs], passive joint mobilization [PJM], and electrotherapy) to determine which treatment is most effective in patients with knee OA. A single-blind randomized clinical trial with parallel design was conducted in patients with knee OA. Seventy-two consecutive patients (mean age 56.11 ± 6.80 years) with bilateral knee OA were randomly assigned to one of three treatment groups: MWMs, PJM, and electrotherapy. All groups performed an exercise program and received 12 sessions. The primary outcome measures of the functional assessment were the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and Aggregated Locomotor Function (ALF) test scores. The secondary outcome measures were pain level, measured using a pressure algometer and a visual analogue scale (VAS), range of motion (ROM), measured using a digital goniometer, and muscle strength, evaluated with a handheld dynamometer. Patients were assessed before treatment, after treatment and after 1 year of follow-up. Patients receiving the manual physical therapy interventions consisting of either MWM or PJM demonstrated a greater decrease in VAS scores at rest, during functional activities, and during the night compared to those in the electrotherapy group from baseline to after the treatment (p < 0.05). This improvement continued at the 1-year follow-up (p < 0.05). The MWMs and PJM groups also showed significantly improved WOMAC and ALF scores, knee ROM and quadriceps muscle strength compared to those in the electrotherapy group from baseline to 1-year follow-up (p < 0.05). In the treatment of patients with knee OA, manual physical therapy consisting of either MWM or PJM provided superior benefit over electrotherapy in terms of pain level, knee ROM, quadriceps muscle strength, and functional level.     

A RANDOMIZED TRIAL OF ISOKINETIC VERSUS ISOTONIC REHABILITATION PROGRAM AFTER ARTHROSCOPIC MENISCECTOMY

Background:

Although both isotonic and isokinetic exercises are commonly used in the rehabilitation of patients after arthroscopic meniscectomy no studies have compared their effect on strength recovery and functional outcomes.

Purpose:

The purpose of this study was to investigate the effects of two rehabilitation programs (isotonic and isokinetic) on muscle strength and functional performance after partial knee meniscectomy. A secondary purpose was to assess the correlation between isokinetic strength deficits and hop test performance deficits.

Methods:

Twenty male patients who underwent arthroscopic partial meniscectomy volunteered for the study. Both isotonic and isokinetic training were performed with the same equipment thereby blinding subjects to the mode of exercise. Main outcome measures were collected on the 14th and 33rd postoperative days and included isokinetic strength of the knee extensors and flexors, functional performance (single, triple, and vertical hopping) and the Lysholm questionnaire. Multivariate and univariate analyses of variance were used to assess the effects of the independent variables on the isokinetic variables, functional tests, and Lysholm score. Pearson''s correlation was used to assess the relationship between isokinetic strength deficits and functional performance deficits.

Results:

Isokinetic measures, functional tests, and the Lysholm score all increased between initial and final assessment (p≤0.003). However, there were no group or group*time effects on any of the outcome variables (p≥0.33). Functional tests were better predictors of isokinetic deficits in the 14^th compared to the 33^rd postoperative day.

Conclusion:

No differences were found in the outcomes of patients treated using an isokinetic and an isotonic protocol for rehabilitation after arthroscopic meniscectomy. More than half of patients did not meet the 90% criterion in the hop tests for safe return to sports five weeks after meniscectomy. There were correlations between the hop tests and isokinetic deficits two weeks after meniscectomy but not at the fifth week.

Level of evidence:

1b     

Limitations in activities in patients with osteoarthritis of the hip or knee: The relationship with body functions,comorbidity and cognitive functioning

Purpose. To determine the relationship between body functions, comorbidity and cognitive functioning on the one side and limitations in activities on the other, in elderly patients with osteoarthritis (OA) of the hip or knee.

Method. A cross-sectional cohort study was conducted in which 288 patients with hip or knee OA were included. Patients were recruited from rehabilitation centres and hospitals (Departments of Orthopedics, Rheumatology or Rehabilitation). Apart from demographic and clinical data, information about limitations in activities, body functions (pain, muscle strength, range of joint motion), comorbidity and cognitive functioning was collected by questionnaires and tests. Statistical analyses included univariate and stepwise multivariate regression analysis.

Results. Self-reported limitations in activities (Western Ontario and McMaster Universities Osteoarthritis Index) were significantly associated with pain, muscle strength knee extension, range of motion (ROM) hip flexion and morbidity count. Performance-based limitations in activities (timed walking test) were significantly associated with ROM (knee flexion, hip flexion and knee extension), muscle strength hip abduction, pain, cognitive functioning and age.

Conclusions. Self-reported limitations in activities in hip or knee OA are largely dependent on pain and to a lesser extent on range of joint motion, muscle strength and comorbidity. Performance-based limitations in activities are largely dependent on range of joint motion and muscle strength, and to a lesser extent on pain, cognitive functioning and other factors. These findings point to the role of body functions in limitations in activities in OA of the hip or knee. Although less important, comorbidity and cognitive functioning play a role as well.     

Comparative Study of Hamstring and Quadriceps Strengthening Treatments in the Management of Knee Osteoarthritis

[Purpose] Osteoarthritis (OA) of the knee is the most common form of joint disease. It is one of the major causes of impaired function that reduces quality of life (QOL) worldwide. The purpose of this study was to compare exercise treatments for hamstring and quadriceps strength in the management of knee osteoarthritis. [Subjects and Methods] Forty patients with OA knee, aged 50–65 years were divided into 2 groups. The first group (57.65±4.78 years) received hot packs and performed strengthening exercises for the quadriceps and hamstring, and stretching exercises for the hamstring. The second group (58.15±5.11 years) received hot packs and performed strengthening exercises for only the quadriceps, and stretching exercise for the hamstring. Outcome measures were the WOMAC (Western Ontario and McMaster Universities OA index questionnaire), Visual Analogue Scale (VAS) assessment of pain, the Fifty-Foot Walk Test (FWS), and Handheld dynamometry. [Results] There was a significant difference between the groups. The first group showed a more significant result than the second group. [Conclusion] Strengthening of the hamstrings in addition to strengthening of the quadriceps was shown to be beneficial for improving subjective knee pain, range of motion and decreasing the limitation of functional performance of patients with knee osteoarthritis.Key words: Strengthening, Stretching, Pain     

Exercise Therapy Is Effective for Improvement in Range of Motion,Function, and Pain in Patients With Frozen Shoulder: A Systematic Review and Meta-analysis

Objective(s)To determine (1) the effect of exercise therapy alone or in combination with other interventions compared with solely exercises and programs with or without exercises and (2) what kind of exercise therapy or combination with other interventions is most effective.Data SourcesPubMed, Web of Science and Cochrane Central Register of Controlled Trials.Study SelectionStudies were screened in a 2-phase approach by 2 independent reviewers (M.M. and L.M.). Reference lists of included studies and interesting systematic reviews were hand searched.Data ExtractionTwo independent reviewers (M.M. and L.M.) extracted information about origin, characteristics of study participants, eligibility criteria, characteristics of interventions, outcome measures and main results in a pre-defined template.Data SynthesisThirty-three studies were included in the qualitative and 19 in the meta-analysis. Preliminary evidence was found for supervised exercises to be more beneficial than home exercises for ROM and function. Multimodal programs comprising exercises may result in little to no difference in ROM compared to solely exercises. Programs comprising muscle energy techniques show little to no difference in ROM when compared with programs with other exercises. Adding stretches to a multimodal program with exercises may increase ROM. There is uncertain evidence that there is a difference between those programs regarding function and pain. Preliminary evidence was found for several treatment programs including exercises to be beneficial for improvement in both passive and active ROM, function, pain, and muscle strength. No studies used patient satisfaction as an outcome measure.ConclusionsROM, function, and pain improve with both solely exercises and programs with exercises, but for ROM and pain there was little to no difference between programs and for function the evidence was uncertain. Adding exercises improve active ROM compared with a program without exercises, whereas adding physical modalities has no beneficial effect. Muscle energy techniques are a beneficial type of exercise therapy for improving function compared with other types of exercise. Unfortunately, no conclusion can be drawn about the results in the long-term and most effective dose of exercise therapy.     

Treatment of Knee Osteoarthritis in Relation to Hamstring and Quadriceps Strength

[Purpose] To assess the effect of hamstring and quadriceps strengthening exercises on pain intensity, gait velocity, maximum isometric strength, and activities of daily living of patients with knee osteoarthritis (OA). [Subjects and Methods] A total of 20 patients with knee OA, 50 to 65 years of age (57.65 ± 4.78 years), received hot packs, strengthening exercises for the quadriceps and the hamstring muscles and stretching exercises for hamstring muscles. Outcome measures included: the Western Ontario and McMaster Universities OA index questionnaire (WOMAC) scores for assessing health status and health outcomes of knee OA; self-reported pain intensity scores, measured using a visual analogue scale; the 50 ft walk test (a measure of gait velocity and function); and handheld dynamometry (a tool used to measure maximum isometric strength of knee extension and flexion). [Results] There was a significant difference between pre- and post-intervention measures of pain intensity, 50 ft walk times, hamstring strength, and quadriceps strength. Significant differences in WOMAC measures were also observed in the subscales of pain, stiffness and physical function, as well as WOMAC total scores. [Conclusion] Strengthening the hamstring muscles in addition to strengthening the quadriceps muscles proved to be beneficial for perceived knee pain, range of motion, and decreasing the limitation of functional performance of patients with knee OA.Key words: Hamstring/quadriceps ratio, Knee pain, Osteoarthritis     

Effect of different exercise programs on non-specific chronic low back pain and disability in people who perform sedentary work

BackgroundThis study compared the short- and long-term effects of different exercise programs on lumbar muscle function, cross-sectional area of the multifidus muscle, functional disability and low back pain in people who perform sedentary work.MethodsA total of 70 volunteer women with sedentary occupations suffering from low back pain were randomized to either the lumbar stabilization exercise program group or the lumbar muscle strengthening exercise program group. All subjects entered the 20-week exercise programs. The measurement of the cross-sectional area of the multifidus muscle was executed by using an ultrasound system, isokinetic peak torque was measured applying an isokinetic dynamometer.FindingsThe results indicated that the 20-week exercise programs reduced low back pain and functional disability. Positive effects for the cross-sectional area of the multifidus muscle, functional disability and low back pain lasted for 4 weeks after the application of lumbar muscle strengthening exercise program and for 12 weeks after the application of lumbar stabilization exercise program. The lumbar muscle strength increased and lasted for 8 weeks after both exercise programs.InterpretationThe 20-week lumbar stabilization exercise and muscle strengthening exercise programs were efficacious in decreasing LBP and functional disability in people performing sedentary work, however the lumbar stabilization exercise program was more effective, and this effect lasted for 12 weeks after completion of the program.     

The effect of a foot gymnastic exercise programme on gait performance in older adults: A randomised controlled trial

Background.?Aged-related loss of ankle dorsiflexion range of motion (ROM) and toe plantarflexor strength play an important role in gait performance. Further, conventional strength, balance and gait training can significantly improve the lower extremity muscle power and functional abilities of older individuals. It remains unclear, however, whether training effects can be enhanced by augmenting ankle ROM and toe plantarflexor strength complementary to training.

Objective.?This study investigated the effect of physical exercise combined with foot gymnastics on the gait performance in older adults.

Methods.?Fifty-six independent living, older adults aged 66–91 years were randomly assigned to either foot gymnastics group (FG; n?=?28) or training group (TG; n?=?28). Further, 14 subjects were integrated as a control group (CG; n?=?14) (no exercise). The FG and TG completed the same training program consisting of aerobic exercises, progressive resistance strength training and stretching exercises twice per week for 12 weeks, whereas the FG performed additional foot gymnastic exercises at the end of the training session and a 10-min foot gymnastics home-program daily. Assessments included the Falls Efficacy Scale – International (FES-I), Expanded Timed Get-up-and-Go test (ETGUG), gait analysis and muscle power measurements of the knee and ankle joint at pre- and post-training.

Results.?No significant change in FES-I score occurred in either group. The FG showed a significant improvement of ankle ROM. There were significant time?×?group interactions in walking speed, step length, in several muscle power measurements and in ETGUG. The positive effects of gait parameters ranged between 1 and 11% and between 2 and 12%, of muscle power between 14 and 34% and 14 and 46% and of ETGUG were 10 and 8% for the FG and TG, respectively. The FG and TG did not differ significantly in their improvements. The CG showed a trend to deteriorations between 0 and??6% for gait parameters, between??4 and??14% for muscle power and 0% for ETGUG.

Conclusions.?The results of this study provide evidence of significant improvements in gait performance, muscle power and ETGUG after a conventional training program in independent living, older adults. However, there is no additional effect on physical performance after foot gymnastic exercises.     

The effect of a foot gymnastic exercise programme on gait performance in older adults: A randomised controlled trial

Abstract

Background. Aged-related loss of ankle dorsiflexion range of motion (ROM) and toe plantarflexor strength play an important role in gait performance. Further, conventional strength, balance and gait training can significantly improve the lower extremity muscle power and functional abilities of older individuals. It remains unclear, however, whether training effects can be enhanced by augmenting ankle ROM and toe plantarflexor strength complementary to training. Objective. This study investigated the effect of physical exercise combined with foot gymnastics on the gait performance in older adults.

Methods. Fifty-six independent living, older adults aged 66-91 years were randomly assigned to either foot gymnastics group (FG;n - 28) or training group (TG;n = 28). Further, 14 subjects were integrated as a control group (CG;n = 14) (no exercise). The FG and TG completed the same training program consisting of aerobic exercises, progressive resistance strength training and stretching exercises twice per week for 12 weeks, whereas the FG performed additional foot gymnastic exercises at the end of the training session and a 10-min foot gymnastics home-program daily. Assessments included the Falls Efficacy Scale - International (FES-I), Expanded Timed Get-up-and-Go test (ETGUG), gait analysis and muscle power measurements of the knee and ankle joint at pre- and post-training.

Results. No significant change in FES-I score occurred in either group. The FG showed a significant improvement of ankle ROM. There were significant time x group interactions in walking speed, step length, in several muscle power measurements and in ETGUG. The positive effects of gait parameters ranged between 1 and 11% and between 2 and 12%, of muscle power between 14 and 34% and 14 and 46% and of ETGUG were 10 and 8% for the FG and TG, respectively. The FG and TG did not differ significantly in their improvements. The CG showed a trend to deteriorations between 0 and -6% for gait parameters, between -4 and - 14% for muscle power and 0% for ETGUG.

Conclusions. The results of this study provide evidence of significant improvements in gait performance, muscle power and ETGUG after a conventional training program in independent living, older adults. However, there is no additional effect on physical performance after foot gymnastic exercises.     

The Role of Therapeutic Exercise in the Conflicting and Unstable Shoulder

Abstract

Context: The use of therapeutic exercise and manual therapy in rehabilitation of the unstable and conflicting shoulder (UCS) is widespread. In the literature, there are several electromyographical studies that have analysed the effect of specific physical exercises and clinical trials on the effectiveness of specific rehabilitative protocols. However, it has not been established yet what is the best intervention for these disorders.

Objective: In order to establish general recommendations for the treatment of UCS, we have reviewed the results of some electromyographical studies to identify the best exercises to recruit specifically the shoulder girdle muscles and some clinical trials that have proposed the utilisation of therapeutic exercise and manual therapy for UCS.

Methods: Review of the literature of the last 10 years. We have searched Pedro, Medline and the Cochrane Library for randomised clinical trials, systematic reviews and electromyographical studies on rehabilitative protocols based on therapeutic exercise and manual therapy.

Outcomes: It is common practice for clinicians to consider the involvement of patients with shoulder instability or impingement in a programme of exercises, before proceeding to a surgical intervention. Our analysis of the literature provides evidence of the efficacy of manual therapy associated with therapeutic exercises for decrease in pain, recovery of patient's strength and restoration of abilities.

Conclusions: While the analysed studies are inconclusive, on the basis of the available data, we suggest some general rehabilitative principles for the treatment of the unstable and conflicting shoulder.     

Phase I evaluation of the television assisted prompting system to increase completion of home exercises among stroke survivors

Purpose.?Effective delivery of dysphagia exercises requires intensive repetition, yet many brain injury survivors demonstrate difficulty adhering to home programmes. The Television Assisted Prompting (TAP) system provides a novel method to deliver intensive in-home therapy prompts. Specific research questions compared the effectiveness of the TAP system to typical practice on programme adherence, satisfaction and caregiver burden.

Method.?A within-participant alternating treatment design with random assignment of treatment condition compared exercise programme adherence across TAP and typical practice delivery conditions, replicated across three participants. Data included quantitative programme completion rates, satisfaction survey reports and caregiver burden questionnaire results, as well as qualitative interview findings.

Results.?A large treatment effect was demonstrated for two participants; exercise programme completion rates increased by 6–17 times typical practice levels with the TAP system. TAP supported sustained practice over the course of the experiment for the third participant despite minimal differences between conditions. Participants reported high satisfaction and endorsed the TAP system. There was no significant change in caregiver burden.

Conclusion.?The TAP system provided a novel assistive tool to support home programme completion of intensive exercise regimens for clients with cognitive impairment and care providers with significant burden. Future research must ensure continued development of a reliable and intuitive system.     

Transcutaneous Electrical Nerve Stimulation and Interferential Current Combined with Exercise for the Treatment of Knee Osteoarthritis: A Randomised Controlled Trial

Interferential current (IFC) and transcutaneous electrical nerve stimulation (TENS) are forms of electrical stimulation frequently used to treat knee osteoarthritis (OA). The relative effectiveness of these two modalities is currently unknown. The purpose of this study was to evaluate the effects of IFC and TENS, when used in conjunction with exercise, on pain and function in patients with knee OA. Forty-six subjects with radiographically confirmed OA were randomly assigned to one of three groups: TENS and standardised exercises, IFC and exercises or exercises alone. An electrical stimulator was used to apply IFC or TENS at 80 Hz for 20 minutes. All groups had a standardised exercise programme. Treatment was applied twice per week for 4 weeks. Outcomes included a 10-point pain rating scale for pain intensity and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). A two-way repeated measures ANOVA performed on the pain assessment score showed a statistically significant effect of time (p < 0.001), but not of experimental group (p = 0.813) or interaction (p = 0.067). A similar result was obtained for WOMAC score (p < 0.001, p = 0.241 and p = 0.130 for time, group and interaction effects, respectively). All treatment protocols led to significant improvements in pain and function over time. Neither IFC nor TENS displayed significant additional effects over exercise alone.     

A qualitative analysis of a progressive resistance exercise programme for people with multiple sclerosis

Purpose. This qualitative study explored the perceptions of adults with multiple sclerosis about the positive and negative effects of a progressive resistance strengthening programme; and identified factors that might facilitate or create barriers to participation.

Methods. Seven women and two men (mean age 45.6 years, SD 10.7) with multiple sclerosis participated in a 10-week gymnasium based progressive resistance strengthening programme held twice a week. Participants were interviewed at the end of the programme. The recorded interviews were transcribed and then independently coded by three researchers. From these codes, the main themes emerged.

Results. Reports about the programme were very positive with physical, psychological and social benefits noted. Most participants said that they had less fatigue as a result of the programme. Few negative outcomes were reported and these were minor such as aches and pains. Key extrinsic factors for programme completion were the leaders' encouragement and knowledge of exercise; and the group aspect of the programme. Key intrinsic factors were enjoyment, determination, seeing the signs of progress, and a previously held positive attitude about the benefits of exercise.

Conclusions. The results of this study suggest that progressive resistance strength training is a feasible fitness option for some people with multiple sclerosis. Factors perceived to be important for programme completion suggest that choosing encouraging leaders with knowledge of exercise, and exercising in a group may contribute to programme success.