Better self-reported effect after hydrotherapy vs. land exercises for rheumatoid arthritis .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):202 BMC Musculoskelet Disord. 2007 Mar 1;8:23115 patients with rheumatoid arthritis were randomized to either receive exercises in warm water (hydrotherapy) or similar land-based exercises. The results indicated that patients who completed exercises in heated water reported feeling much better in comparison to those who performed land-based exercises. However, there was no reported difference between the two groups regarding pain intensity, quality of life, or physical function.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Ja = 1
Ungewiss = 0.5
Nicht relevant = 0
Nein = 0
Die Bewertung der Berichtskriterien bewertet die Transparenz, mit der die Autoren die methodischen und studienspezifischen Merkmale der Studie in der Veröffentlichung angeben. Die Bewertung ist in fünf Kategorien unterteilt, die im Folgenden vorgestellt werden.
4/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Der Fragilitätsindex ist ein Instrument, das bei der Interpretation signifikanter Ergebnisse hilft und ein Maß für die Stärke eines Ergebnisses liefert. Der Fragilitätsindex gibt die Anzahl der aufeinanderfolgenden Ereignisse an, die zu einem dichotomen Ergebnis hinzugefügt werden müssen, damit das Ergebnis nicht mehr signifikant ist. Eine kleine Zahl steht für ein schwächeres Ergebnis und eine große Zahl für ein stärkeres Ergebnis.
Warum wurde diese Studie jetzt benötigt?
Hydrotherapy - exercise in heated water - is considered beneficial to patients with rheumatoid arthritis, by reducing loads placed on the joints and facilitating exercise against water resistance. However, there has been a paucity of randomized controlled trials exploring the comparative efficacy of exercise in water warm water to exercises on land for those suffering from rheumatoid arthritis, indicating the need for this study.
Was war die wichtigste Forschungsfrage?
Does performing exercises in warm water (hydrotherapy) provide superior results in overall improvement in health, physical function and quality of life as compared to exercises on land, measured over a 3 month period?
- More of the patients that were treated with hydrotherapy (40/46, 87%) felt much/very much better than the patients who received land based exercise (19/40, 47.5%) (p<0.001, Fisher's exact test), measured once on the day of treatment.
- Eleven patients from the land exercises group did not attend the treatment program, in comparison to only four who did not attend in the hydrotherapy group.
- With the assumption that non-completers would have been non-responders, response rate for hydrotherapy=70%, land=33% (p<0.001). In assuming that non-completers would have had same response as completers, response rate for hydrotherapy=82%, land=55% (p=0.002). Both of these analyses are in favour of hydrotherapy.
- Ten meter walk time improved from time of treatment to 3 months post-treatment in both cases (results from combination of both groups=median pre-treatment time 10.9s, post treatment 9.1s, 3 months post treatment 9.6s). No difference observed between groups (p=0.551).
- No differences between groups with respect to pain scores, HAQ, EQ-5D or EQ VAS scores.
Was sollte ich mir besonders merken?
Individuals suffering from rheumatoid arthritis were more likely to report feeling much or very much better after completing exercises in warm water, in comparison to similar exercises on land. However, these reported benefits were not seen in the measures of pain, HAQ, EQ-5D or EQ VAS scores.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
The results suggest that hydrotherapy has an immediate effect of making patients feel better. However, it has not been concluded that hydrotherapy would to be more efficacious than other intensive rehabilitation programs, and therefore, future studies are required.
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