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)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
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
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
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.
¿Cuál era la pregunta principal de la investigación?
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.
¿Qué es lo que más debo recordar?
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.
¿Cómo afectará esto al cuidado de mis pacientes?
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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