Thermotherapy for treatment of osteoarthritis

Abstract

Osteoarthritis is a degenerative joint disease that affects mostly the weight‐bearing joints in the knees and hips. As the affected joint degenerates pain and restriction of movement often occur. Inflammation can also occur sometimes resulting in edema of the joint with OA. Treatment focuses on decreasing pain and improving movement. To determine the effectiveness of thermotherapy in the treatment of OA of the knee. The outcomes of interest were relief of pain, reduction of edema, and improvement of flexion or range of motion (ROM) and function. Two independent reviewers selected randomized and controlled clinical trials with participants with clinical and/or radiological confirmation of OA of the knee; and interventions using heat or cold therapy compared with standard treatment and/or placebo. Trials comparing head to head therapies, such as two different types of diathermy, were excluded. Randomized and controlled clinical trials including participants with clinical or radiographical confirmation of OA of the knee and interventions using heat or cold compared to standard treatment or placebo were considered for inclusion. Study results were extracted by two independent reviewers. Outcomes were continuous in nature (pain, strength, improvement) and were analyzed by weighted mean difference using a fixed effects model. Graphical data were used when table data were not available. Three randomized controlled trials, involving 179 patients, were included in this review. The included trials varied in terms of design, outcomes measured, cryotherapy or thermotherapy treatments and overall methodological quality. In one trial, administration of 20 minutes of ice massage, 5 days per week, for 3 weeks, compared to control demonstrated a clinically important benefit for knee OA on increasing quadriceps strength (29% relative difference). There was also a statistically significant improvement, but no clinical benefit in improving knee flexion ROM (8% relative difference) and functional status (11% relative difference). Another trial showed that cold packs decreased knee edema. Ice massage compared to control had a statistically beneficial effect on ROM, function and knee strength. Cold packs decreased swelling. Hot packs had no beneficial effect on edema compared with placebo or cold application. Ice packs did not affect pain significantly, compared to control, in patients with OA. More well designed studies with a standardized protocol and adequate number of participants are needed to evaluate the effects of thermotherapy in the treatment of OA of the knee. 熱療法治療退化性關節炎 退化性關節炎是影響身體負重的膝及髖關節，當退化時會造成疼痛及活動功能受限，偶而發炎造成退化性關節的腫脹。治療重點在減少疼痛及活動功能改善。 研究熱療法治療膝退化性關節炎的效果。結果指標為減少疼痛，減少關節腫脹及關節活動角度與功能改善。 兩位作者獨立進行臨床或X光診斷之膝退化性關節炎隨機對照試驗資料摘錄。比較熱療法或冷療法與標準方法或安慰劑，治療膝退化性關節炎的效果。排除例如直接比較兩種不同熱療方法之研究。 所有隨機對照試驗比較熱療法或冷療法與標準方法治療臨床或X光診斷之膝退化性關節炎的效果。 兩位作者獨立進行資料摘錄。連續性結果﹝疼痛、力量、進步﹞使用固定效應模型(fixedeffects model)及加權平均差異(weighted mean difference：WMD)來分析。如果表格資料不存在時則使用圖表資料 這項回顧包括了3個研究包含179例病患。各研究之設計、結果測量、熱療法或冷療法與研究的品質差異大。1篇研究3週，每週5天，每天20分鐘冰療法，比較控制組在四頭肌力量(相對增加29%)。另外在膝彎曲活動角度﹝相對增加8% ﹞與功能改善﹝相對增加11% ﹞有顯著差異，但臨床無幫助之改善。另1篇研究顯示冰敷減少膝關節腫脹。 冰療法比較控制組在膝彎曲活動角度、功能改善、力量增加有顯著差異。冰敷減少關節腫脹。熱療法比冷療法或安慰劑，無減少關節腫脹。冰敷比安慰劑無顯著減少關節疼痛。需良好設計及足夠樣本之研究以評估熱療法治療膝退化性關節炎的療效。 本摘要由林口長庚醫院余光輝翻譯。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。 熱療治療膝蓋退化性關節炎的效果有多好，到底有多安全？ 要回答這個問題，科學家們發現和分析三項研究。超過 170位退化性關節炎患者持續使用藥物，但也使用熱，冷或冰包布/毛巾加上按摩或不按摩或不治療。這些研究品質不高，但 Cochrane 回顧提供了今日我們所擁有最好的證據。 熱療是什麼，如何幫助膝退化性關節炎？ 退化性關節炎是關節炎最常見形式，會影響手，髖部，肩膀和膝蓋。在退化性關節炎，保護兩端骨頭的軟骨破損斷裂，導致疼痛和腫脹。熱療涉及應用熱或冷到關節來改善退化性關節炎的症狀，可以藉由包布紮，毛巾，蠟，其他等來完成。熱可透過改善循環和放鬆肌肉，而冷可麻痺疼痛，減少腫脹，收縮血管並阻止神經衝動到關節。熱療可用於復健計畫或在家裡。 熱療的效果有多好？ 一項研究表明，比起不治療，用冰按摩20分鐘，每週 5天共2週，可提高腿的肌肉力量，膝蓋運動範圍，減少步行50英尺時間。另一項研究表明，冰敷3天，每週 3天共3個星期改善疼痛的程度等同不治療。另一項研究表明，冷敷20分鐘 10個療程可減少腫脹勝過不治療。若是熱敷同一時間與劑量，對於腫脹也會有相同的效果勝過不治療。 安全性如何呢？...