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Physical Training for Patients with Severe Osteoarthritis

Am Fam Physician. 1999 Mar 1;59(5):1268-1276.

Osteoarthritis is a common disease, and its prevalence increases with age. Osteoarthritis may lead to complaints of joint stiffness and pain, instability and loss of function. Because of knee involvement, patients with osteoarthritis may have significant difficulty rising from a chair, climbing stairs, kneeling, standing, walking and maintaining stability. Røgind and colleagues studied the impact of physical training in patients with severe osteoarthritis of the knee. They also observed the impact of this training on the patient's general fitness, lower-extremity strength, agility, balance and coordination.

The study population consisted of outpatients who fulfilled the American College of Rheumatology criteria for osteoarthritis of the knee and had positive radiographic evidence of severe arthritis. All patients enrolled in the study underwent a baseline evaluation of physical function before the study. The study subjects were randomly assigned to an intervention group or a control group. Patients in the intervention group underwent training by a physiotherapist twice weekly for three months. The training sessions focused on lower-extremity mobility, muscle strengthening, flexibility and ability to balance and coordinate the body. Members of both groups were reassessed for pain and stiffness symptoms, maximum walking distance and ability to perform activities of daily living at three and 12 months. Evaluation of the lower extremities included physical examination, basic function testing, postural sway and muscle strength.

The intervention group participated in 77.9 percent of the training sessions. After three months, these patients had better clinical parameters, lower pain scores (particularly at bedtime), and improved basic functioning and muscle strength than those in the nonintervention group. No change in postural sway was evident between the two groups. The most pronounced impact on the physical training group was the increase in lower-extremity muscle strength. These improvements persisted at the 12-month re-evaluation despite the fact that the organized training sessions had stopped after three months. The only adverse outcome noted was that the group that underwent physical training had an increased incidence of knee effusion during the study.

The authors conclude that physical training can have a significant positive benefit in patients with osteoarthritis. They also note that patients will comply with a structured program. These improvements may create a lasting benefit and improve the level of functioning in patients with osteoarthritis of the knee and decrease their pain as well.

KARL MILLER, M.D.

Røgind H, et al. The effects of a physical training program on patients with osteoarthritis of the knees. Arch Phys Med Rehabil. November 1998;79:1421–7.


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