Effectiveness of Aquatic Physical Therapy for Knee Osteoarthritis Patients
Condition: Osteoarthritis
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      The purpose of this study is to determine whether education or aquatic physical therapy are
      effective in the treatment of osteoarthritis in Knee due to intensity of pain, function
      capacity, quality of life and kinetic.
    

Detailed description: 
      Sixty patients will be recruited from clinics and through printed newspaper. Physicians who
      routinely evaluate patients with this diagnosis will be informed of the study, and the same
      will be announced by television call.

      After passing a medical examination confirming the clinical diagnosis of knee osteoarthritis
      by American College of Rheumatology and other criteria, the elect will be informed of the
      objectives of the study and invited to participate.

      After evaluation of the records of referrals of knee OA, patients receive phone calls, will
      be informed of the research objectives, questioned regarding the inclusion and exclusion
      criteria of the study and invited to participate in the study.

      Upon study entry, personal information (name, age, gender, address and telephone) will be
      confirmed by a secretary, who will give the registration number of the patient. Personal
      information, as well as their radiographs, will be kept in personal form, with number of
      study enrollment.

      Before and after implementation of treatment protocols, as well as after three months, all
      patients will be assessed by an independent examiner, ie, that have no knowledge about the
      intervention with respect to different variables. The independent examiner will have been
      previously trained for this role to become fit to do so.

      Individuals will be assessed using the rubric for the outcomes of pain intensity using a
      Visual Analogue Scale (VAS); functional capacity of the Western Ontario and McMaster
      Universities Index (WOMAC); balance the Activities-specific Balance Confidence (ABC) and by
      static posturography and reaction forces to the ground by static force platform. Body weight
      will be checked by portable scale; height, and waist circumference with tape measure to
      calculate BMI.

      After evaluation, patients will be divided by the numbers generated by the computer through
      the site (www.random.org) in both treatment groups with 30 patients. After the generation of
      numbers, they will be transformed into a card with the assigned treatment (1- Patient
      Education; 2 Aquatic Physiotherapy) and then placed in sealed, opaque, sequentially numbered
      envelopes. Thus, it prevented the evaluator and the therapist choose the group to which the
      patient is assigned. Procedures for randomization and allocation, as well as assessments and
      interventions will be blinded.

      The educational program will comprise a multidisciplinary team: doctor, pharmacist, nurse,
      nutritionist, psychologist, physiotherapist and physical educator. Classes will be weekly in
      groups for eight weeks, lasting two hours, to be held in the Parlor of Our Lady of Grace
      Church, belonging to the scope of the Health Unit Vila Brazil.

      The program will include education, following the suggestions of Coleman et al. the following
      items: guidelines about the disease and its complications, strategies for pain management
      (pharmacological and cognitive), physical exercise, nutrition and weight control, medication
      (type, interactions, current trends, side effects), balance, proprioception , fall
      prevention, coping with chronic pain. Following, practical activities on the themes will be
      addressed.

      To enhance the information at the end, patients will receive printed material with the
      guidelines given by the professional. Still, the first and last day of the education program,
      patients will respond a questionnaire addressing their knowledge about the disease developed
      by the researchers.

      Supervised aquatic exercise will run individually, twice a week, lasting 60 minutes, for
      eight weeks, totaling 16 sessions at the Center for Aquatic Physical Therapy Professor Paulo
      Armindo Seibert, Universidade Estadual de Londrina. The water temperature will be maintained
      at approximately 32 degrees, with a depth of 1.20m. The exercise protocol will consist of:
      five minutes of heating with walking and patellar mobilization; ten minutes stretching the
      muscles of the lower limbs (quadriceps, gluteus, adductors and abductors of hip sural triceps
      and hamstrings); ten minutes isometric and dynamic exercises with elastic (quadriceps,
      gluteus, adductors and abductors of hip sural triceps and hamstrings); twenty minutes away
      from aerobic exercise (stationary running deep water running); ten minutes in functional
      training step and proprioceptive exercises; and five minutes of cooling with stretching of
      muscles of lower limbs (quadriceps, gluteus, adductors and abductors of hip sural triceps and
      hamstrings).

      Both groups will receive guidance home exercises two to three times a week, and reinforced by
      familiar previously illustrated booklets, which include the same goals of aquatic exercises:
      heating, self stretching of the lower limb muscles, isometric and dynamic exercises of the
      lower limbs , proprioceptive and functional exercises, aerobic exercises is relaxation.

      Three months after the end of intervention protocols, ie, at the end of follow-up, patients
      in the group Education will be invited to perform aquatic therapy and patients in group
      aquatic therapy will receive the manual of educational guidelines.
    

Intervention name(s): Patient Education; Aquatic Physical Therapy
Intervention type(s): Other; Other
Intervention description(s): The educational program will comprise a multidisciplinary team: doctor, pharmacist, nurse, nutritionist, psychologist, physiotherapist and physical educator. Classes will be weekly in groups for eight weeks, with a duration of two hours.
The education program will include the following items: guidelines about the disease and its complications, strategies for pain management (pharmacological and cognitive), physical exercise, nutrition and weight control, medication (type, interactions, current trends, side effects ), balance, proprioception, fall prevention, coping with chronic pain.; The exercise protocol will consist of: five minutes of heating with walking and patellar mobilization; ten minutes stretching the muscles of the lower limbs (quadriceps, gluteus, adductors and abductors of hip sural triceps and hamstrings); ten minutes isometric and dynamic exercises with elastic (quadriceps, gluteus, adductors and abductors of hip sural triceps and hamstrings); twenty minutes away from aerobic exercise (stationary running deep running water); ten minutes in functional training step and proprioceptive exercises; and five minutes of cooling with stretching of muscles of lower limbs (quadriceps, gluteus, adductors and abductors of hip sural triceps and hamstrings).
Other intervention name(s): Health Education; Aquatic Exercise
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Osteoarthritis; Patient Education; Aquatic Exercise; kinetic