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Non pharmacological treatments for osteoarthritis

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Non pharmacological treatments for osteoarthritis

  1. 1. andpresentNon-pharmacological treatmentsNon-pharmacological treatmentsfor osteoarthritisfor osteoarthritis
  2. 2. Why use non-pharmacologicaltreatments? The international recommendations for osteoarthritisof the lower limbs and hands stress the importance ofindividualised care combining non pharmacological measureswith medicinal treatments Utility: Effects on symptoms and function at least equivalentto those of medicinal treatments No serious side effects Structural effects not demonstrated as yet2Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.
  3. 3. What exactly are they?Patient educationExercisesTechnical aids: insoles, crutches, braces, etc.Dietary adviceHydrotherapyWeight loss, for overweight patients with knee osteoarthritis3Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.Sellam, J, Berenbaum F. Arthrose. Rev Prat 2011;61:675-85.
  4. 4. Weight loss Most effective non-pharmacologicaltreatment for knee osteoarthritis Must be at least 5% of initial weightto be fully effective Improves function and decreasespain. Also has cardiovascular benefits,which is important given the highincidence of comorbidities in thesepatients4
  5. 5. Treatment education (1)The aim is to boost autonomy and compliancewith osteoarthritis recommendationsImproves treatment managementThis is not the same as patient informationand should be planned in several stagesSeveral healthcare professionals are involvedIt is a part of the patients treatment and mustbe assessed5 Beauvais C. Éducation thérapeutique en rhumatologie. Rev Prat Med Gen 2012 ;26 :155-60.
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  7. 7. Treatment education (2) Main treatment and educational goalsfor osteoarthritis*: compliance with non-pharmacologicaltreatments management of pain-relief and analgesics physical exercise and specific homeexercises (compliance, regularity) weight loss if necessary7Beauvais C. Education thérapeutique en rhumatologie. Rev Prat Med Gen 2012;26:155-60.*Osteoarthritis in the legs and fingers
  8. 8. Lifestyle measures* Weight loss for overweight patients Avoid standing for long periods, long walksand carrying heavy loads during painfulepisodes (relative rest) – “pacing ofactivities” Recommend strengthening exercisesbetween flares and regular aerobic activity Use a walking stick on the contralateral side Suitable footwear, cushioning soles8 Sellam, J, Berenbaum F. Arthrose. Rev Prat 2011;61:675-85.* Osteoarthritis of the legs
  9. 9. Endurance-building sports* Type: rapid walking (30 minutes 3 times a week),exercise bike or exercises in water Improve the aerobic capacity of patients and their quality of life Help maintain cardiorespiratory function Have an impact on joint range of motion, strengthen muscles, enhancemotor function and improve proprioception and balance disorders Improve sleep restoration, reduce pain, and improve energyand well-being9 Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.Bonan I. Rôle de la rééducation dans le traitement de la gonarthrose. Rev Prat 2009;59:1246-47.* Osteoarthritis of the legs
  10. 10. Knee osteoarthritis: two types of specificexercisesMuscle strengthening Aimed at the stabilising muscles of the knee:obviously the quadriceps but also the hamstrings Reduce pain and improve function Static exercises or exercises against gravity,natural resistance or weightsFor example: ask the patient in a sitting positionto hold their leg out straight (static) or to alternatebending and straightening the knee (dynamic)10Range of motion Exercises designed to fight knee flexion deformityRannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.Bonan I, Carson P. Rôle de la rééducation dans le traitement de la gonarthrose. Rev Prat 2009;59:1246-47.
  11. 11. Patello-femoral osteoarthritis: specificexercises Isometric rehabilitation of the internal portionsof the quadriceps (vastus medialis) Helps prevent the kneecap from rubbingon the trochlear as a result of subluxation11Sellam J, Berenbaum F. Arthrose. Rev Prat 2011;61:675-85.
  12. 12. Knee osteoarthritis: prescriptionfor rehabilitation (example)12 physiotherapy sessions at a rate of 2 sessions a weekRelaxing massagesFight against knee flexion deformityGentle motor reinforcementof the quadriceps and hamstrings,isometric exercises followedby dynamic exercisesProprioceptive rehabilitationStamina building exercisesExercises for home use12Bonan I, Carson P. Rôle de la rééducation dans le traitement de la gonarthrose. Rev Prat 2009;59:1246-47.
  13. 13. Knee osteoarthritis: sole orthoticsor insoles Advice on shoes: sports shoes, thick, flexible soles Cushioning soles: recommended, irrespective of the joint compartment affected(internal or external tibio-femoral, patello-femoral) can help relieve pain and improve walking custom-made by a podiatrist or purchased from the pharmacy Sole orthotics: with a posterior-external pronator corner to relieve the internalcompartment (internal tibio-femoral knee osteoarthritis) or a posterior-internal supinator wedge (external tibio-femoral kneeosteoarthritis) decrease pain and NSAID consumption13Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.Zhang W, et al.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 Therapeutic
  14. 14. Knee osteoarthritis: Knee orthotics Flexible, non-adhesive orthoses or elastic knee braceswith or without a peripatellar device Can reduce pain, enhance stability and decreasethe risk of falls Recommended for young subjects, to allow reintroductionof sports and for all other subjects with a view to delayingthe need for joint replacement14Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membresinférieurs. Rev Prat 2012;62:651-53.Zhang W, et al.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 Therapeu
  15. 15. Hip osteoarthritis: specific exercises Preserve joint range of motion Strengthen the hip stabiliser muscles Prevent angular deformity and loss of back-step function Reduce pain15Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.
  16. 16. Finger osteoarthritis: The following are recommended: Exercises: to protect the joints, improve mobilityand enhance muscle strength The application of heat (paraffin, heated dressings, etc.),especially before taking exercise Braces for osteoarthritis of the carpo-metacarpal jointof the thumb Orthoses for the prevention and correction of angulardeformities during lateral extension and flexion16Zhang W, et al.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 TheraAnn Rheum Dis. 2007;66:377-88.
  17. 17. Sample prescription for thumbosteoarthritis Osteoarthritis located between the trapezoid boneand the first metacarpal, most often bilateral Common (8 to 22% of women), affects more women (80%) than men17Prescription 1Increase in range of motion, stretching and self-stretching exercises aimed at the space between thethumb and indexStrengthening of the intrinsic and extrinsic muscles of the hand and thumb-index pincerFunctional exercisesAerobic exercisesHome trainingNo ultrasound, no massagePrescription 2Resting splint for the thumb-index pincer to be worn at nightRannou F, La rhizarthrose. Rev Prat 2012, 62:639.

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