Zusammenfassung
Hintergrund: Arthrose gehört zu den 10 häufigsten Erkrankungen in Europa und der gesamten Welt. Ihre Behandlung mit Physiotherapie wird empfohlen. Allerdings herrscht Unklarheit über die genauen Therapiemodalitäten.
Ziel: Betrachtung neuerer Arbeiten zum Thema und Identifizierung geeigneter Behandlungsmethoden bei Gonarthrose.
Methode: 23 randomisierte, kontrollierte Studien wurden auf ihre Ergebnisse und die verwendeten Therapiemethoden hin untersucht.
Ergebnisse: Verschiedene Behandlungsmethoden sind in der Lage, die Symptome der Gonarthrose zu lindern. Zu Trainings- und Physiotherapie wurden widersprüchliche Ergebnisse gefunden. Für Heimübungsprogramme lässt sich aufgrund fehlender Beschreibungen der Methodik keine verallgemeinernde Aussage treffen. Für eine kombinierte Intervention mit Trainingstherapie und Gewichtsreduzierung sowie die Verwendung von Tapes und Bandagen liegen einheitliche Ergebnisse vor, die eine Wirksamkeit der Therapieformen zeigen. Die einzelne Studie zu TENS zeigte eine Wirksamkeit unabhängig von der verwendeten Frequenz.
Schlussfolgerungen: Die Therapie von Kniearthrose durch Physiotherapie sollte aufgrund der vorliegenden Evidenz einen größeren Stellenwert als bisher erhalten. Weitere Forschung ist jedoch notwendig, um die Ergebnisse zu verifizieren.
Abstract
Background: Osteoarthritis is one of the ten most common diseases in Europe and throughout the world. Its treatment with physiotherapy is recommended. There is, however, no consensus concerning therapy modalities.
Objective: Investigating the results of newer studies concerning the topic and identification of appropriate treatment interventions in knee osteoarthritis.
Method: 23 randomized controlled trials were investigated in view of their results and the applied therapy methods.
Results: Different modalities of physical therapy are able to ease knee osteoarthritis symptoms. For exercise therapy and physiotherapy inconsistent results were detected. For home programs generalized evidence could not be found because of the lacking description of applied methods. For combined exercise therapy and weight loss as well as use of knee-tapes and bandages consistent results are on hand showing an effective treatment. The single study on TENS proved efficiency irrespective of employed frequency.
Conclusions: Due to the existing evidence knee osteoarthritis management with physiotherapy should play a more vital role than to date. However, more research is necessary to verify these results.
Schlüsselwörter
Gonarthrose - Methoden der Physiotherapie - Trainingstherapie
Key words
knee osteoarthritis - physiotherapy modalities - exercise therapy
Literatur
1
Altman R D, Brandt K, Hochberg M. et al .
Design and Conduct of Clinical Trials in Patients with Osteoarthritis: Recommendations from a task force of the Osteoarthritis Research Society.
Osteoarthritis and Cartilage.
1996;
4
217-243
2
Altman R D, Hochberg M C, Moskowitz R W. et al .
Recommendations for the medical management of osteoarthritis of the hip and knee. 2000 Update.
Arthritis & Rheumatism.
2000;
43
1905-1915
3
Van Baar M E, Dekker J, Oostendorp R A. et al .
The effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized clinical trial.
The Journal of Rheumatology.
1998;
25
2432-2439
4
Van Baar M E, Dekker J, Oostendorp R A. et al .
Effectiveness of exercise in patients with osteoarthritis of hip or knee: nine months’ follow up.
Annals of the Rheumatic Diseases.
2001;
60
1123-1130
5
Baker K R, Nelson M E, Felson D T. et al .
The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial.
The Journal of Rheumatology.
2001;
28
1655-1665
6
Bennell K L, Hinman R S, Metcalf B R. et al .
Efficacy of physiotherapy management of knee joint osteoarthritis: a randomised, double blind, placebo controlled trial.
Annals of the Rheumatic Diseases.
2005;
64
906-912
7
Brosseau L, MacLeay L, Robinson V. et al .
Intensity of exercise for the treatment of osteoarthritis.
Cochrane Database of Systematic Reviews.
2003;
2
CD004259
8
Cheng Y, Macera C A, Davis D R. et al .
Physical activity and self-reported, physician-diagnosed osteoarthritis: is physical activity a risk factor?.
Journal of Clinical Epidemiology.
2000;
53
315-322
9
Cooper C, Snow S, McAlindon T E. et al .
Risk factors for the incidence and progression of radiographic knee osteoarthritis.
Arthritis & Rheumatism.
2000;
43
995-1000
10
Deyle G D, Henderson N E, Matekel R L. et al .
Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial.
Annals of Internal Medicine.
2000;
132
173-181
11
Deyle G D, Allison S C, Matekel R L. et al .
Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program.
Physical Therapy.
2005;
85
1301-1317
12
Fitzgerald G K, Oatis C.
Role of physical therapy in management of knee osteoarthritis.
Current Opinion in Rheumatology.
2004;
16
143-147
13
Foley N C, Bhogal S K, Teasell R W. et al .
Estimates of Quality and Reliability with the Physiotherapy Evidence-Based Database to Assess the Methodology of Randomized Controlled Trials of Pharmacological and Nonpharmacological Interventions.
Physical Therapy.
2006;
86
817-824
14
Fransen M, Crosbie J, Edmonds J.
Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial.
The Journal of Rheumatology.
2001;
28
156-164
15
Fransen M, McConnell S, Bell M.
Exercise for osteoarthritis of the hip or knee.
Cochrane Database of Systematic Reviews.
2003;
3
CD004286
16
Gelber A C, Hochberg M C, Mead L A. et al .
Joint Injury in Young Adults and Risk for Subsequent Knee and Hip Osteoarthritis.
Annals of Internal Medicine.
2000;
133
321-328
17 Gesundheitsbericht für Deutschland. Stuttgart; Metzler-Poeschel 1998
18
Haringsma R, Engels G I, Beekman A T. et al .
The criterion validity of the Center for Epidemiological Studies Depression Scale (CES-D) in a sample of self-referred elders with depressive symptomatology.
International Journal of Geriatric Psychiatry.
2004;
19
558-563
19
Heuts P H, Bie de R, Drietelaar M. et al .
Self-management in osteoarthritis of hip or knee: a randomized clinical trial in a primary healthcare setting.
The Journal of Rheumatology.
2005;
32
543-549
20
Hinman R S, Crossley K M, McConnell J. et al .
Efficacy of knee tape in the management of osteoarthritis of the knee: blinded randomised controlled trial.
British Medical Journal.
2003;
327
135
21
Huang M H, Lin Y S, Yang R C. et al .
A Comparison of Various Therapeutic Exercises on the Functional Status of Patients with Knee Osteoarthrosis.
Seminars in Arthritis and Rheumatism.
2003;
32
398-406
22
Huang M H, Yang R C, Lee C L. et al .
Preliminary results of integrated therapy for patients with knee osteoarthritis.
Arthritis Care & Research.
2005;
53
812-820
23
Hunter D J, Felson D T.
Osteoarthritis.
British Medical Journal.
2006;
332
639-642
24
Jordan K M, Arden N K, Doherty M. et al .
EULAR Recommendations 2003: An Evidence Based Approach to the Management of Knee Osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT).
Annuals of Rheumatic Diseases.
2003;
62
1145-1155
25
Law P P, Cheing G L.
Optimal stimulation frequency of transcutaneous electrical nerve stimulation on people with knee osteoarthritis.
Journal of Rehabilitative Medicine.
2004;
36
220-225
26
Lopez A D, Murray C C.
The global burden of disease, 1990 – 2020.
Nature Medicine.
1998;
4
1241-1243
27
Maher C G, Sherrington C, Herbert R D. et al .
Reliability of the PEDro Scale for Rating Quality of Randomized Controlled Trials.
Physical Therapy.
2003;
83
713-721
28
Mandell B F.
Whither arthroscopic treatment for osteoarthritis of the knee?.
Cleveland Clinical Journal of Medicine.
2003;
70
384-385
29
Mazzuca S A, Page M C, Meldrum R D. et al .
Pilot study of the effects of a heat-retaining knee sleeve on joint pain, stiffness, and function in patients with knee osteoarthritis.
Arthritis Care & Research.
2004;
51
716-721
30
McAlindon T, Felson D T.
Nutrition: risk factors for osteoarthritis.
Annuals of the Rheumatic Diseases.
1997;
56
397-400
31
McCarthy C J, Mills P M, Pullen R. et al .
Supplementing a home exercise programme with a class-based exercise programme is more effective than home exercise alone in the treatment of knee osteoarthritis.
Rheumatology.
2004;
43
880-866
32
Messier S P, Loeser R F, Mitchell M N. et al .
Exercise and weight loss in obese older adults with knee osteoarthritis: a preliminary study.
Journal of the American Geriatrics Society.
2000;
48
1062-1072
33
Messier S P, Loeser R F, Miller G D. et al .
Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: The Arthritis, Diet, and Activity Promotion Trial.
Arthritis & Rheumatism.
2004;
50
1501-1510
34
Mikesky A E, Mazzuca S A, Brandt K D. et al .
Effects of strength training on the incidence and progression of knee osteoarthritis.
Arthritis Care & Research.
2006;
55
690-699
35
Moseley J B, O’Malley K, Petersen N J. et al .
A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee.
The New England Journal of Medicine.
2002;
347
81-88
36
Neogi T, Booth S L, Zhang Y Q. et al .
Low vitamin K status is associated with osteoarthritis in the hand and knee.
Arthritis & Rheumatism.
2006;
54
1255-1261
37
Pelletier J P, Martel-Pelletier J, Abramson S B.
Osteoarthritis, an Inflammatory Disease. Potential Implication for the Selection of New Therapeutic Targets.
Arthritis & Rheumatism.
2001;
44
1237-1247
38
Penninx B W, Messier S P, Rejeski W J. et al .
Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis.
Archives of Internal Medicine.
2001;
161
2309-2316
39
Petersson I F, Boegard T, Saxne T. et al .
Radiographic osteoarthritis of the knee classified by the Ahlback and Kellgren & Lawrence systems for the tibiofemoral joint in people aged 35 – 54 years with chronic knee pain.
Annuals of Rheumatic Diseases.
1997;
56
493-496
40
Petrella R J.
Is exercise effective treatment for osteoarthritis of the knee?.
Br J Sports Med.
2000;
34
326-331
41
Quilty B, Tucker M, Campbell R. et al .
Physiotherapy, including quadriceps exercises and patellar taping, for knee osteoarthritis with predominant patello-femoral joint involvement: randomized controlled trial.
The Journal of Rheumatology.
2003;
30
1311-1317
42
Rejeski W J, Focht B C, Messier S P. et al .
Obese, older adults with knee osteoarthritis: weight loss, exercise, and quality of life.
Health Psychololgy.
2002;
21
419-426
43
Roos E M, Dahlberg L.
Positive effects of moderate exercise on glycosaminoglycan content in knee cartilage: a four-month, randomized, controlled trial in patients at risk of osteoarthritis.
Arthritis & Rheumatism.
2005;
52
3507-3514
44
Sharma L, Cahue S, Song J. et al .
Physical Functioning over Three Years in Knee Osteoarthritis.
Arthritis & Rheumatism.
2003;
48
3359-3370
45
Sherrington C, Herbert R D, Maher C G. et al .
PEDro. A database of randomized trials and systematic reviews in physiotherapy.
Manual Therapy.
2000;
5
223-226
46
Srikanth V K, Fryer J L, Zhai G. et al .
A metaanalysis of sex differences prevalence, incidence and severity of osteoarthritis.
Osteoarthritis and Cartilage.
2005;
13
769-781
47 The European Health Report 2005. Public health action for healthier children and populations. Copenhagen; WHO Regional Office for Europe 2005
48
Thomas K S, Muir K R, Doherty M. et al .
Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial.
British Medical Journal.
2002;
325
752
49
Thorstensson C A, Roos E M, Petersson I F. et al .
Six-week high-intensity exercise program for middle-aged patients with knee osteoarthritis: a randomized controlled trial.
BMC Musculoskeletal Disorders.
2005;
6
27
50
Wai E K, Kreder H J, Williams J I.
Arthroscopic debridement of the knee for osteoarthrosis in patients fifty years of age or older: utilization and outcomes in the province of Ontario.
The Journal of Bone & Joint Surgery.
2002;
84
17-22
51 World Health Organization (WHO) .Obesity: preventing and managing the global epidemic: report of a WHO consultation. Geneva; WHO 2000
52
Wu C W, Morrell M R, Heinze E. et al .
Validation of American College of Rheumatology Classification Criteria for Knee Osteoarthritis Using Arthroscopically Defined Cartilage Damage Scores.
Seminars in Arthritis and Rheumatism.
2005;
35
197-201
Jörn Kiselev, B.Sc. PT
Kalckreuthstr. 17
10777 Berlin
eMail: j.kiselev@web.de