An Examination of the Value of Shortwave Diathermy and Hydrotherapy for Patients With Osteoarthritis of Their Knees
Condition: Knee Osteoarthritis
MeSH terms: Osteoarthritis
Study type: Interventional

Summary: 
      Osteoarthritis, a common disorder increasing in prevalence with advancing age, is
      particularly debilitating when the knees are affected. This study examined the value of
      hydrotherapy (exercise in water) and continuous short-wave diathermy (an electrical deep heat
      treatment) for the relief of osteoarthritic symptoms.
    

Detailed description: 
      Osteoarthritis is a common disabling disorder increasing in prevalence with advancing age
      (Blixen and Kippes, 1999). As there is a rapid increase in the percentage of people over 55
      years in Western countries (Okma-Keulen and Hopman-Rock, 2001) it has become increasingly
      important to address issues which relate to older people. In 2010, the projected percentage
      of the population aged 60 years or older in Europe will be approximately 25%. The increased
      incidence of arthritis among older people, which is a significant health care problem today,
      is set to become an even greater concern in the coming years (Reginster, 2002). Rheumatic
      diseases are a huge encumbrance on the health care systems of countries worldwide and account
      for significant disability, lost productivity and reduction in quality of life (Sangha,
      2000). The burden of disease relates not only to its prevalence but also to the cost of the
      disease to the health care system of the country, these costs include direct costs, such as
      the costs associated with drugs, medical care, hospitals, research, pensions and benefits and
      indirect costs, such as premature mortality and chronic disability (Reginster, 2002). Neither
      census statistics nor statistics from the Department of Health and Children revealed the true
      prevalence of osteoarthritis in Ireland. A search was also carried out using the Hospital
      Inpatient Enquiry (HIPE) system of The Economic and Social Research Institute of Ireland
      (ESRI) which likewise did not reveal the frequency of osteoarthritis in the population.

      Osteoarthritis is characterised by progressive loss of articular cartilage, appositional
      subchondral bone development and osteophyte formation at the joint margins. The resulting
      pain, stiffness and functional limitations (Jakobsson and Hallberb, 2002) lead to diminished
      quality of life. The knee is a particularly common site of involvement in osteoarthritis.
      Osteoarthritic knee pain has been found to be associated with poor perceived health and
      significant disability, while psychological distress strongly associates with both pain and
      disability (O'Reilly et al, 1998; Sangha, 2000). Restricted knee joint mobility, in
      particular flexion appears to be an important determinant of disability in patients with
      osteoarthritis (Steultjens et al, 2000). Minor et al (1999) noted that lower extremity
      impairments in older adults have been linked to the reduced ability to use public
      transportation, climb stairs, perform household chores, shop and engage in leisure
      activities. Similarly van Barr (1998) noted that disability in patients with lower limb
      osteoarthritis is significantly related to pain and joint range of motion. Due to the chronic
      nature of osteoarthritis, physical modalities, lifestyle modification and patient
      self-management in terms of education and exercise are considered important approaches to
      treatment (Sangha, 2000).

      Physiotherapists have an important role to play in the clinical management of osteoarthritis
      (Green et al, 1993) however, the effect of their involvement has rarely been assessed in
      terms of randomised controlled trials. Chard et al (2000) examined the research output in
      relation to a number of physiotherapy interventions available to patients with osteoarthritis
      of their knees and established that between 1950 to 1998 only 60 research articles were
      published, the majority of which occurred between 1985 and 1998. Advice (Maurer et al, 1999;
      Manek and Lane, 2000) and exercise (Puett and Griffin, 1994; Clarke, 1999; O'Reilly et al,
      1999) have been clearly identified as beneficial in terms of relieving the impairments
      experienced by individuals with knee osteoarthritis. Indeed there is a some evidence
      supporting the use of a number of physiotherapy interventions including hydrotherapy (Ahern
      et al, 1995; Norton et al 1997; Alexander et al, 2001) and continuous short-wave diathermy
      (CSWD) (Wright, 1964; Lankhorst et al, 1982) for the treatment of knee osteoarthritis but
      there are difficulties regarding the design of many of these studies thus undermining the
      conclusions that have been drawn. This study presents the results of a randomised controlled
      factorial trial (Polger and Thomas, 2000) designed to examine hydrotherapy and/or continuous
      short wave diathermy (CSWD) for patients with knee osteoarthritis while also examining the
      perceptions of patients participating in a physiotherapy programme.
    

Intervention name(s): Continuous short wave diathermy (CSWD); Hydrotherapy
Intervention type(s): Other; Other
Intervention description(s): CSWD applied twice a week for 4 weeks; Hydrotherapy (exercise in water) attended twice a week for 4 weeks
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Treatment