Efficacy of Paraffin Bath Therapy in Hand Osteoarthritis: A Single-Blinded Randomized Controlled Trial (2025)

Efficacy of Paraffin Bath Therapy in Hand Osteoarthritis: A Single-Blinded Randomized Controlled Trial Archives of Physical Medicine and Rehabilitation

Objective: To evaluate the efficacy of paraffin bath therapy on pain, function, and muscle strength in patients with hand osteoarthritis. Design: Prospective single-blinded randomized controlled trial. Setting: Department of physical medicine and rehabilitation in a university hospital. Participants: Patients with bilateral hand osteoarthritis (NZ56). Interventions: Patients were randomized into 2 groups with a random number table by using block randomization with 4 patients in a block. Group 1 (nZ29) had paraffin bath therapy (5 times per week, for 3-week duration) for both hands. Group 2 (nZ27) was the control group. All patients were informed about joint-protection techniques, and paracetamol intake was recorded. Main Outcome Measures: The primary outcome measures were pain (at last 48h) at rest and during activities of daily living (ADL), assessed with a visual analog scale (0e10cm) at 12 weeks. The secondary outcome measures were the Australian Canadian Osteoarthritis Hand Index (AUSCAN) and the Dreiser Functional Index (DFI), used for subjective functional evaluation, loss of range of motion (ROM), grip and pinch strength, painful and tender joint counts, and paracetamol intake. A researcher blind to group allocation recorded the measures for both hands at baseline, 3 weeks, and 12 weeks at the hospital setting. Results: At baseline, there were no significant differences between groups in any of the parameters (P>.05). After treatment, the paraffin group exhibited significant improvement in pain at rest and during ADL, ROM of the right hand, and pain and stiffness dimensions of the AUSCAN (P<.05). There was no significant improvement in functional dimension of the AUSCAN and the DFI (P>.05). The control group showed a significant deterioration in right hand grip and bilateral lateral pinch and right chuck pinch strength (P<.05), but there was no significant change in the other outcome measures. When the 2 groups were compared, pain at rest, both at 3 and 12 weeks, and the number of painful and tender joints at 12 weeks significantly decreased in the paraffin group (P<.05). Bilateral hand-grip strength and the left lateral and chuck pinch strength of the paraffin group were significantly higher than the control group at 12 weeks (P<.05). Conclusions: Paraffin bath therapy seemed to be effective both in reducing pain and tenderness and maintaining muscle strength in hand osteoarthritis. It may be regarded as a beneficial short-term therapy option, which is effective for a 12-week period. Archives of Physical Medicine and Rehabilitation 2013;94:642-9 ª 2013 by the American Congress of Rehabilitation Medicine

Comparison of efficacy of fluidotherapy and paraffin bath in hand osteoarthritis: A randomized controlled trial

Archives of Rheumatology, 2021

Objectives This study aims to compare the efficacy of paraffin bath therapy and fluidotherapy on pain, hand muscle strength, functional status, and quality of life (QoL) in patients with hand osteoarthritis (OA). Patients and methods This prospective randomized controlled study included 77 patients (8 males, 69 females; mean age: 63.1±10.3 years; range 39 to 88 years) with primary hand OA who applied between July 2017 and March 2018. The patients were randomized into two groups with the sealed envelope method: Paraffin bath therapy (20 min, one session per day, for two weeks) was applied for 36 patients whereas 41 patients received fluidotherapy for the same period. The pain severity of the patients, both at rest and during activities of daily living (ADL) within the last 48 hours was questioned and scored using Visual Analog Scale. Duruöz Hand Index (DHI) was used to evaluate hand functions. Gross grip strength was measured using Jamar dynamometer whereas fine grip strength was mea...

Supplementary_Material_3 – Supplemental material for The Ottawa Panel guidelines on programmes involving therapeutic exercise for the management of hand osteoarthritis

2018

Supplemental material, Supplementary_Material_3 for The Ottawa Panel guidelines on programmes involving therapeutic exercise for the management of hand osteoarthritis by Lucie Brosseau, Odette Thevenot, Olivia MacKiddie, Jade Taki, George A Wells, Paulette Guitard, Guillaume Léonard, Nicole Paquet, Sibel Z Aydin, Karine Toupin-April, Sabrina Cavallo, Rikke Helene Moe, Kamran Shaikh, Wendy Gifford, Laurianne Loew, Gino De Angelis, Shirin Mehdi Shallwani, Ala&#39; S Aburub, Aline Mizusaki Imoto, Prinon Rahman, Inmaculada C Álvarez Gallardo, Milkana Borges Cosic, Nina Østerås, Sabrina Lue, Tokiko Hamasaki, Nathaly Gaudreault, Tanveer E Towheed, Sahil Koppikar, Ingvild Kjeken, Dharini Mahendira, Glen P Kenny, Gail Paterson, Marie Westby, Lucie Laferrière and Guy Longchamp in Clinical Rehabilitation

… recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including …

Annals of the …, 2007

To develop evidence based recommendations for the management of hand osteoarthritis (OA). Methods: The multidisciplinary guideline development group comprised 16 rheumatologists, one physiatrist, one orthopaedic surgeon, two allied health professionals, and one evidence based medicine expert, representing 15 different European countries. Each participant contributed up to 10 propositions describing key clinical points for management of hand OA. Final recommendations were agreed using a Delphi consensus approach. A systematic search of Medline, Embase, CINAHL, Science Citation Index, AMED, Cochrane Library, HTA, and NICE reports was used to identify the best available research evidence to support each proposition. Where possible, the effect size and number needed to treat were calculated for efficacy. Relative risk or odds ratio was estimated for safety, and incremental cost effectiveness ratio was used for cost effectiveness. The strength of recommendation was provided according to research evidence, clinical expertise, and perceived patient preference. Results: Eleven key propositions involving 17 treatment modalities were generated through three Delphi rounds. Treatment topics included general considerations (for example, clinical features, risk factors, comorbidities), non-pharmacological (for example, education plus exercise, local heat, and splint), pharmacological (for example, paracetamol, NSAIDs, NSAIDs plus gastroprotective agents, COX-2 inhibitors, systemic slow acting disease modifying drugs, intra-articular corticosteroids), and surgery. Of 17 treatment modalities, only six were supported by research evidence (education plus exercise, NSAIDs, COX-2 inhibitors, topical NSAIDs, topical capsaicin, and chondroitin sulphate). Others were supported either by evidence extrapolated from studies of OA affecting other joint sites or by expert opinion. Strength of recommendation varied according to level of evidence, benefits and harms/costs of the treatment, and clinical expertise. Conclusion: Eleven key recommendations for treatment of hand OA were developed using a combination of research based evidence and expert consensus. The evidence was evaluated and the strength of recommendation was provided.

There Is Inadequate Evidence to Determine the Effectiveness of Nonpharmacological and Nonsurgical Interventions for Hand Osteoarthritis: An Overview of High-Quality Systematic Reviews

Physical Therapy, 2009

Background. Patients with hand osteoarthritis are commonly treated by health care professionals (allied to medicine). Practice should be informed by updated evidence from systematic reviews of randomized controlled trials.

The Turkish League Against Rheumatism Recommendations for the Management of Hand Osteoarthritis Under Guidance of the Current Literature and 2018 European League Against Rheumatism Recommendations

Archives of Rheumatology, 2020

Objectives: This study aims to explore the accordance to the 2018 European League Against Rheumatism (EULAR) recommendations for the management of hand osteoarthritis (OA) among the Turkish League Against Rheumatism (TLAR) expert panel and composition of TLAR recommendations for the management of hand OA under guidance of the current literature. Materials and methods: The TLAR convener designated an expert panel of 10 physicians experienced in hand OA for this process. The 2018 EULAR recommendations for the management of hand OA and the systematic review of the literature were sent to the expert panel via e-mails. The e-mail process which included Delphi round surveys was completed. The EULAR standard operational procedure Appraisal of Guidelines for Research and Evaluation II was followed. The level of agreement was calculated for each item and presented as mean, standard deviations, minimum and maximum and comparisons of 2018 EULAR recommendations were performed. Results: Five overarching principles and 10 recommendations were discussed. Revisions were held for the sixth, seventh, and ninth recommendations with lowest level of agreements. These recommendations were revised in accordance with suggestions from the experts and re-voted. The revised forms were approved despite the lack of statistically significant difference between these forms (p=0.400, p=0.451, p=0.496, respectively). Except for the ninth recommendation about surgery (p=0.008), no significant difference in level of agreements was observed between the EULAR and TLAR hand OA recommendations. The 11 th recommendation about paraffin bath was added. Conclusion: The optimal treatment of hand OA consists of personalized non-pharmacological (self-management, exercise, splint), pharmacological (topical non-steroidal anti-inflammatory drugs as the first choice), and interventional procedures (only for refractory cases) based on shared decision between the patient and physician. TLAR hand OA recommendations were created mainly based on the most recent literature and the last EULAR hand OA management recommendations, which are widely approved among the TLAR experts.

P05.31. Development of a manualized protocol of massage therapy for clinical trials in osteoarthritis

BMC Complementary and Alternative Medicine, 2012

Background: Clinical trial design of manual therapies may be especially challenging as techniques are often individualized and practitioner-dependent. This paper describes our methods in creating a standardized Swedish massage protocol tailored to subjects with osteoarthritis of the knee while respectful of the individualized nature of massage therapy, as well as implementation of this protocol in two randomized clinical trials. Methods: The manualization process involved a collaborative process between methodologic and clinical experts, with the explicit goals of creating a reproducible semi-structured protocol for massage therapy, while allowing some latitude for therapists' clinical judgment and maintaining consistency with a prior pilot study. Results: The manualized protocol addressed identical specified body regions with distinct 30-and 60-min protocols, using standard Swedish strokes. Each protocol specifies the time allocated to each body region. The manualized 30-and 60-min protocols were implemented in a dual-site 24-week randomized dose-finding trial in patients with osteoarthritis of the knee, and is currently being implemented in a three-site 52-week efficacy trial of manualized Swedish massage therapy. In the dose-finding study, therapists adhered to the protocols and significant treatment effects were demonstrated.

Comparison of two Traditional Spa Therapy Regimens in Patients with Knee Osteoarthritis

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin, 2002

Ziel der Studie: Vergleich der Wirkungen zweier verschiedener traditioneller Kurortbehandlungsregimes bei Patienten mit Knieosteoarthritis auf Kniefunktion und Schmerzen. Methodik: Alle Patienten mit nachgewiesener Knieosteoarthritis, die im Badeort Sandikli eine traditionelle Kur (8-tägig) durchführten, wurden um eine Teilnahme an der Studie gebeten. 49 Patienten stimmten der Teilnahme nach entsprechender Aufklärung zu und wurden in die folgenden Behandlungsgruppen eingeteilt: Gruppe I (n = 24) erhielt je ein Thermalwasserbad (39 8C, 20 min) und ein Peloidbad (45 8C, 20 min) pro Tag; Gruppe II (n = 25) erhielt zwei Thermalwasserbäder (39 8C, 20 min) pro Tag. Hauptzielparameter war der Lequesne-Index für Kniebeschwerden. Sekundäre Zielparameter waren Schmerzintensität (VAS), 10-Meter-Gehzeit, Dauer von drei Kniebeugen und Zeit für das Herauf-und Herabgehen von 10 Treppenstufen. Diese Parameter wurden von einem nicht verblindeten Untersucher zu Beginn und am Ende der Therapiephase erhoben. Ergebnisse: In beiden Gruppen fand sich eine signifikante (p < 0,001) Verbesserung des Lequesne-Knie-Index (Gruppe I: 49,3 %; Gruppe II: 31,3 %). Die Verbesserung war in Gruppe I signifikant stärker als in Gruppe II (p < 0,001). Die Schmerzangaben in der VAS verringerten sich in beiden Gruppen (Gruppe I: 37,3; Gruppe II: 30,1 %). Diese Reduktion war in Gruppe I signifikant stärker als in Gruppe II (p = 0,003). Auch die anderen drei Parameter zeigten signifi-Abstract Purpose: To compare the effects of two different traditional spa therapy regimens for knee osteoarthritis (OA) on function and pain. Patients and Methods: Patients with knee osteoarthritis staying in a spa hotel in Sandõklõ Spa for traditional spa therapy (8 days) were asked to be included in the study. Total of 49 patients gave informed consent consisting two groups based on treatment regimens as follows: Group I (n = 24) had a thermal water bath and a peloid bath per day; Group II (n = 25) had two thermal mineral water baths per day. The primary outcome measure was Lequesne's knee severity index. Secondary measures were pain intensity (visual analogue scale), 10 meters walking time, 3 times squatting down and up time and 10 stairs stepping up and down time. An unblinded observer carried out all assessments at the beginning and at the end of the spa therapy. Results: In both groups, improvements were found in Lequesne's Knee Index (49.3 % in group I and 31.3 % in group II, respectively) (p < 0.001) and improvement in group I was significantly higher than group II (p < 0.001). VAS scores for pain reduced in both groups (37.3 % and 30.1 %) and this reduction was significantly higher in group I (p = 0.003). All other 3 measures also showed significant improvements in both groups and again improvements were significantly higher in group I than group II. Conclusions: Both traditional spa therapy regimens could significantly improve the functional status and pain on patients with knee OA

Comparison of two Traditional Spa Therapy Regimens in Patients with Knee Osteoarthritis: An Exploratory Study

Physikalische Medizin Rehabilitationsmedizin Kurortmedizin, 2002

Ziel der Studie: Vergleich der Wirkungen zweier verschiedener traditioneller Kurortbehandlungsregimes bei Patienten mit Knieosteoarthritis auf Kniefunktion und Schmerzen. Methodik: Alle Patienten mit nachgewiesener Knieosteoarthritis, die im Badeort Sandikli eine traditionelle Kur (8-tägig) durchführten, wurden um eine Teilnahme an der Studie gebeten. 49 Patienten stimmten der Teilnahme nach entsprechender Aufklärung zu und wurden in die folgenden Behandlungsgruppen eingeteilt: Gruppe I (n = 24) erhielt je ein Thermalwasserbad (39 8C, 20 min) und ein Peloidbad (45 8C, 20 min) pro Tag; Gruppe II (n = 25) erhielt zwei Thermalwasserbäder (39 8C, 20 min) pro Tag. Hauptzielparameter war der Lequesne-Index für Kniebeschwerden. Sekundäre Zielparameter waren Schmerzintensität (VAS), 10-Meter-Gehzeit, Dauer von drei Kniebeugen und Zeit für das Herauf-und Herabgehen von 10 Treppenstufen. Diese Parameter wurden von einem nicht verblindeten Untersucher zu Beginn und am Ende der Therapiephase erhoben. Ergebnisse: In beiden Gruppen fand sich eine signifikante (p < 0,001) Verbesserung des Lequesne-Knie-Index (Gruppe I: 49,3 %; Gruppe II: 31,3 %). Die Verbesserung war in Gruppe I signifikant stärker als in Gruppe II (p < 0,001). Die Schmerzangaben in der VAS verringerten sich in beiden Gruppen (Gruppe I: 37,3; Gruppe II: 30,1 %). Diese Reduktion war in Gruppe I signifikant stärker als in Gruppe II (p = 0,003). Auch die anderen drei Parameter zeigten signifi-

Efficacy of Paraffin Wax Bath with and without joint mobilization techniques in rehabilitation of post-traumatic stiff hand

Pakistan Journal of Medical Sciences, 2013

Post-traumatic stiff hand is common a condition which causes pain and disability, the paraffin wax bath and joint mobilizations have the key role in its rehabilitation. We conducted the present study to determine the efficacy of paraffin wax bath with mobilization techniques compared with joint mobilization alone. Methodology: This single blind randomized control trial was conducted on 71 patients in department of physical therapy and rehabilitation, Riphah International University Islamabad, and patients with posttraumatic stiff hand after distal upper extremity fractures, were included. The patients were randomized into two groups: the joint mobilization techniques with paraffin wax bath were included in group A, and joint mobilization techniques without paraffin wax bath in group B. The study variables were pain score on visual analogue scale (VAS) 0/10, thumb function score (TFS) and passive range of motion (PROM) of wrist flexion, extension, radial and ulnar deviation, and were compared at baseline and at completion on planof-care after six weeks. Results: Seventy one patients with post-traumatic stiff hand were enrolled and placed randomly into two groups. The baseline characteristics were similar in both groups. Six week after intervention, patients in group A had more improvement in pain score (p=0.001), TFS (p=0.003), and PROM of wrist flexion (p=0.002), extension (p=0.003), radial deviation (p=0.013), and ulnar deviation (p=0.004), as compared to group B. However, in group B the improvement was less in pain score (p=0.104), TFS (p=0.520), and PROM of wrist flexion (p=0.193), extension (p=0.1081), radial deviation (p=0.051), and ulnar deviation (p=0.168), as compared to group A. Conclusion: Paraffin wax bath with joint mobilization techniques are more effective than mobilization techniques without paraffin wax bath in the rehabilitation of post traumatic stiff hand.

The Ottawa Panel guidelines on programmes involving therapeutic exercise for the management of hand osteoarthritis

Clinical rehabilitation, 2018

To identify programmes involving therapeutic exercise that are effective for the management of hand osteoarthritis and to provide stakeholders with updated, moderate to high-quality recommendations supporting exercises for hand osteoarthritis. A systematic search and adapted selection criteria included comparable trials with exercise programmes for managing hand osteoarthritis. Based on the evaluated evidence, a panel of experts reached consensus through a Delphi approach endorsing the recommendations. A hierarchical alphabetical grading system (A, B, C+, C, C-, D-, D, D+, E, F) was based on clinical importance (≥15%) and statistical significance ( P &lt; 0.05). Ten moderate- to high-quality studies were included. Eight studies with programmes involving therapeutic exercise (e.g. range of motion (ROM) + isotonic + isometric + functional exercise) seemed to be effective. Forty-six positive grade recommendations (i.e. A, B, C+) were obtained during short-term (&lt;12 weeks) trials for...

Development of a manualized protocol of massage therapy for clinical trials in osteoarthritis

Trials, 2012

Background: Clinical trial design of manual therapies may be especially challenging as techniques are often individualized and practitioner-dependent. This paper describes our methods in creating a standardized Swedish massage protocol tailored to subjects with osteoarthritis of the knee while respectful of the individualized nature of massage therapy, as well as implementation of this protocol in two randomized clinical trials. Methods: The manualization process involved a collaborative process between methodologic and clinical experts, with the explicit goals of creating a reproducible semi-structured protocol for massage therapy, while allowing some latitude for therapists' clinical judgment and maintaining consistency with a prior pilot study. Results: The manualized protocol addressed identical specified body regions with distinct 30-and 60-min protocols, using standard Swedish strokes. Each protocol specifies the time allocated to each body region. The manualized 30-and 60-min protocols were implemented in a dual-site 24-week randomized dose-finding trial in patients with osteoarthritis of the knee, and is currently being implemented in a three-site 52-week efficacy trial of manualized Swedish massage therapy. In the dose-finding study, therapists adhered to the protocols and significant treatment effects were demonstrated. Conclusions: The massage protocol was manualized, using standard techniques, and made flexible for individual practitioner and subject needs. The protocol has been applied in two randomized clinical trials. This manualized Swedish massage protocol has real-world utility and can be readily utilized both in the research and clinical settings. Trial registration: Clinicaltrials.gov NCT00970008 (

Exercise for Hand Osteoarthritis: A Cochrane Systematic Review

The Journal of rheumatology, 2017

To assess the benefits and harms of exercise compared with other interventions, including placebo or no intervention, in people with hand osteoarthritis (OA). Systematic review using Cochrane Collaboration methodology. Six electronic databases were searched up until September 2015. randomized or controlled clinical trials comparing therapeutic exercise versus no exercise, or comparing different exercise programs. hand pain, hand function, finger joint stiffness, quality of life, adverse events, and withdrawals because of adverse effects. Risk of bias and quality of the evidence were assessed. Seven trials were included in the review, and up to 5 trials (n = 381) were included in the pooled analyses with data from postintervention. Compared to no exercise, low-quality evidence indicated that exercise may improve hand pain [5 trials, standardized mean difference (SMD) -0.27, 95% CI -0.47 to -0.07], hand function (4 trials, SMD -0.28, 95% CI -0.58 to 0.02), and finger joint stiffness (...

Bath thermal waters in the treatment of knee osteoarthritis: a randomized controlled clinical trial

European journal of physical and rehabilitation medicine, 2016

Osteoarthritis is a degenerative disease associated with pain, reduced range of motion, and impaired function. Balneotherapy or bathing in thermal or mineral waters is used as a non-invasive treatment for various rheumatic diseases. To evaluate the effectiveness of hot sulfurous and non-sulfurous waters in the treatment of knee osteoarthritis. A randomized, assessor-blind, controlled trial. A spa resort. One hundred and forty patients of both genders, mean age of 64.8 ± 8.9 years, with knee osteoarthritis and chronic knee pain. Patients were randomized into three groups: the sulfurous water (SW) group (n = 47), non-sulfurous water (NSW) group (n = 50), or control group (n = 43) who received no treatment. Patients were not blinded to treatment allocation. Treatment groups received 30 individual thermal baths (three 20-minute baths a week for 10 weeks) at 37°C-39°C. The outcome measures were pain (visual analog scale, VAS), physical function (Western Ontario and McMaster Universities ...

EULAR evidence based recommendations for the management of hand osteoarthritis: Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)

Annals of the Rheumatic Diseases, 2007

Objectives: To develop evidence based recommendations for the management of hand osteoarthritis (OA). Methods: The multidisciplinary guideline development group comprised 16 rheumatologists, 1 physiatrist, 1 orthopaedic surgeon, 2 allied health professionals and 1 evidence based medicine expert, representing 15 different European countries. Each participant contributed up to 10 propositions describing key clinical points regarding management of hand OA. Final recommendations were agreed using a Delphi consensus approach. A systematic search of MEDLINE, EMBASE, CINAHL, Science Citation Index, AMED, Cochrane Library, HTA and NICE reports was used to identify the best available research evidence to support each of the propositions. Where possible the effect size and number needed to treat were calculated for efficacy. Relative risk or odds ratio was estimated for safety and incremental cost-effectiveness ratio was used for costeffectiveness. The strength of recommendation was provided according to research evidence, clinical expertise and perceived patient preference. Results: Eleven key propositions involving 17 treatment modalities were generated through three Delphi rounds. Treatment topics included general considerations (eg, clinical features, risk factors, co-morbidities), non-pharmacological (eg, education plus exercise, local heat and splint), pharmacological (eg, paracetamol, NSAIDs, NSAIDs plus gastroprotective agents, COX-2 inhibitors, systemic slow acting disease-modifying drugs, intra-articular corticosteroid) and surgery. Of 17 treatment modalities, only 6 were supported by research evidence (education plus exercise, NSAIDs, COX-2 inhibitors, topical NSAIDs, topical capsaicin and chondroitin sulphate). Others were supported either by evidence extrapolated from studies of OA affecting other joint sites or by expert opinion. Strength of recommendation varied according to level of evidence, benefits and harms/costs of the treatment and clinical expertise. Conclusion: Eleven key recommendations for treatment of hand OA were developed using a combination of research-based evidence and expert consensus. The evidence was evaluated and the strength of recommendation was provided. Downloaded from Hand osteoarthritis (OA) is a common condition (1;2) though its prevalence varies according to the definition used. For example, the majority of people aged 55 years and over have radiographic changes of OA affecting at least one hand joint (3) while approximately one fifth of this population have symptomatic hand OA.(4) The correlation between symptoms and radiographic change is even less for hand OA than for OA of the hip or knee. Although many people affected by hand OA may never seek medical advice (5;6) the impact of hand OA and associated disability is significant (3;4;6). Importantly, many of the clinical consequences of hand OA are site-specific (e.g. interference with grip and fine precision pinch, dissatisfaction with cosmetic appearance) and distinct from those of knee and hip OA. Furthermore, compared to large joint OA, the small size and accessibility of hand joints makes them amenable to a different range of interventions. Due to differences in anatomy, function, risk factors and outcomes, OA at different sites may also show a different response to the same treatment. Therefore interventions for OA need to be examined in a site-specific fashion.

Crenobalneotherapy (spa therapy) in patients with knee and generalized osteoarthritis: a post-hoc subgroup analysis of a large multicentre randomized trial

Annals of physical and rehabilitation medicine, 2014

To determine whether the addition of spa therapy to home exercises provides any benefit over exercises and the usual treatment alone in the management of generalised osteoarthritis associated with knee osteoarthritis. This study was a post-hoc subgroup analysis of our randomised multicentre trial (www.clinicaltrial.gov: NCT00348777). Participants who met the inclusion criteria of generalized osteoarthritis (Kellgren, American College of Rheumatology, or Dougados criteria) were extracted from the original randomised controlled trial. They had been randomised using Zelen randomisation. The treatment group received 18days of spa treatment in addition to a home exercise programme. Main outcome was number of patients achieving minimal clinically important improvement at six months (MCII) (≥-19.9mm on the VAS pain scale and/or ≥-9.1 points in a WOMAC function subscale), and no knee surgery. Secondary outcomes included the &quot;patient acceptable symptom state&quot; (PASS) defined as VAS ...

Exploring massage benefits for arthritis of the knee (embark)

Osteoarthritis and Cartilage, 2016

Therapeutic trials in hand osteoarthritis: A critical review

Osteoarthritis and Cartilage, 2000

Objective: To perform a critical review of the published therapeutic trials conducted in hand osteoarthritis (OA).

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

Physical Therapy Reviews, 2019

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.

Spa therapy in the treatment of knee osteoarthritis: a large randomised multicentre trial

Annals of the Rheumatic Diseases, 2009

Objective To determine whether spa therapy, plus home exercises and usual medical treatment provides any benefi t over exercises and usual treatment, in the management of knee osteoarthritis. Methods Large multicentre randomised prospective clinical trial of patients with knee osteoarthritis according to the American College of Rheumatology criteria, attending French spa resorts as outpatients between June 2006 and April 2007. Zelen randomisation was used so patients were ignorant of the other group and spa personnel were not told which patients were participating. The main endpoint criteria were patient self-assessed. All patients continued usual treatments and performed daily standardised home exercises. The spa therapy group also received 18 days of spa therapy (massages, showers, mud and pool sessions). The number of patients achieving minimal clinically important improvement (MCII) at 6 months, defi ned as ≥19.9 mm on the visual analogue pain scale and/or ≥9.1 points in a normalised Western Ontario and McMaster Universities osteoarthritis index function score and no knee surgery. The intention to treat analysis included 187 controls and 195 spa therapy patients. At 6 months, 99/195 (50.8%) spa group patients had MCII and 68/187 (36.4%) controls (χ 2 =8.05; df=1; p=0.005). However, no improvement in quality of life (Short Form 36) or patient acceptable symptom state was observed at 6 months. Conclusion For patients with knee osteoarthritis a 3-week course of spa therapy together with home exercises and usual pharmacological treatments offers benefi t after 6 months compared with exercises and usual treatment alone, and is well tolerated. Trial registration number NCT00348777. In Europe spa therapy is frequently prescribed for knee osteoarthritis. Of the 403 381 patients receiving spa therapy for rheumatism in 2007 in France, nearly half presented with knee osteoarthritis. Spa therapy is reimbursed by the social security in France and in many other continental European countries. Despite numerous small scale studies, high quality scientifi c evidence for the effi cacy of spa therapy for knee osteoarthritis is lacking. In a recent Cochrane systematic review, even those studies that met the selection criteria were found to be fl awed. 1 Therefore, spa therapy does not fi gure in the recommended treatments of the European League Against Rheumatism 2 or recent reviews. In this multicentre randomised controlled trial (RCT) we aimed to include enough patients to