Ottawa panel evidence-based clinical practice guidelines for therapeutic exercises and manual therapy in the management of osteoarthritis: appendix.
Appendix 1.
Previous Evidence-Based Clinical Practice Guidelines for
Therapeutic Exercises for Osteoarthritis (a)
Quality of Published
Author/Year Evidence Clinical Recommendations
Philadelphia Good scientific Good evidence (grade A) to
Panel, (36) evidence (level 1) include strengthening and
2001 for therapeutic stretching exercises alone
exercises for knee OA
ACR, (31) 2000 N/R Exercise programs are
recommended to maintain or
improve joint ROM and
periarticular muscle force
AGS, (32) 2001 N/R Exercise programs should be
individualized. They are
recommended for controlling
pain, increasing
flexibility, and improving
muscle force and endurance
APS, (33) 2002 Good-quality evidence Exercise--ROM, stretching,
stengthening (isometric,
dynamic), aerobic exercise,
and physical activity--is
recommended for pain relief
OPOT, (35) 2000 Good-quality evidence Exercise programs (stretching
and quadriceps femoris
muscle strengthening;
aerobic exercise, including
walking and swimming; and
and resistance exercises)
are recommended to reduce
pain and to improve
function in patients with
OA of the knee
BM-1, (34) 2003 N/R Likely to be beneficial for
pain relief and to improve
function
(a) Interventions with no data are not exhibited. ACR=American
College of Rheumatology Subcommittee on Osteoarthritis Guidelines,
AGS=American Geriatrics Society Panel on Exercise and
Osteoarthritis, APS=American Pain Society, OPOT=Ontario Program
for Optimal Therapeutics, BM1=BMJ Books, N/R=not reported,
OA=osteoarthritis, ROM=range of motion.
Appendix 2.
Details of Included Trials (a)
Sample
Author/Year Size Population Details
Bautch et RCT Inclusion criteria: patients
al, (63) 1997 Total: 30 who met the ACR
Gr1: 15 clinical and
Gr2: 15 radiographic criteria
for primary OA of the
knee; were [greater than
or equal to] 59 y of
age and living
independently, without
physical or medical
problems for which an
exercise program
would be
contraindicated; were
not currently enrolled
in a regular exercise
program; had not
received intra-articular
or systematic steroids
within the past 2 y;
and did not routinely
use NSAIDs
Borjessson et RCT Inclusion criteria: patients
al, (64) 1996 Total: 68 who were aged 55-
Gr1: 34 70 y, had medial
Gr2: 34 knee OA (grades I-III)
based on weight-
bearing radiographs,
were scheduled for
surgery, had unilateral
symptoms, and had no
symptoms in hip or
ankle
Deyle et al, (30) RCT Inclusion criteria: patients
2000 Total: 83 who (1) had knee
Gr1: 42 pain, were aged [less than or
Gr2: 41 equal to] 38 y, and had bony
enlargement; (7 had
knee pain, were aged
[less than or equal to] 39 y, and
had morning stiffness for
more than 30 min and
bony enlargement; (3)
had knee pain,
crepitus on active
motion, morning
stiffness for more than
30 min, and bony
enlargement; or (4)
had knee pain,
crepitus on active
motion, and morning
stiffness for more than
30 min and were
aged [less than or equal to] 38 y
Evcik and CCT Inclusion criteria: patients
Sonel, (47) Total: 81 with knee OA
2002 Gr1: 27 Exclusion criteria:
Gr2: 28 patients who had
Gr3: 26 taken a quadriceps
femoris muscle
exercise program
during the last 6 mo
or who had effusion
on knees, previous
knee replacement
severe cardiovascular
diseases, or grade 4
OA according to
Kellgren and
Lawrence criteria
Fransen et RCT Inclusion criteria: patients
al, (65) 2001 First part: who were aged [less than or equal
Total: to] 50 y, had experienced
126 knee pain most days
Gr1: 43 of the past months,
Gr2: 40 and had evidence of
Gr3: 43 radiographic disease
Second Exclusion criteria:
part: patients who had
Total: intra-articular cortisone
121 injections within the
Gr1: 62 past 2 mo, lower-limb
Gr2: 59 joint arthroplasty,
unstable cardiac
comorbidity
ocluding exercise at
50%-60% of maximal
HR, or other
comorbidiy after gait
Garfinkel et RCT Inclusion criteria: patients
al, (66) 1994 Total: 30 who had OA of the
Gr1: 19 distal or proximal
Gr2: 11 interpholongeal joints
of the fingers and who
had pain, aching, or
stiffness in the hands;
specific criteria for
inclusion were those of
Altman et al (b)
Gur et al, (67) RCT Inclusion criteria: patients
2002 Total: 23 who had bilateral
Gr1: 9 complaints of knee
Gr2: 8 OA, who had grade II
Gr3: 6 or III OA as judged by
criteria of Kellg ren
and Lawrence based
on weight-bearing
radiographs, and who
did not have any
health problems that
might pose a risk
during the maximal
test and training
Hurley and CCT Inclusion criteria: patients
Scott, (68) Total: 60 had to fulfill the ACR
1998 Gr1: 44 criteria for knee OA;
Gr2: 16 the predominant
complaint of all
patients was knee
pain; patients who
reported coexistent
mild symptomatic OA
in other joints were
not excluded from the
trial unless the pain
from these other joints
interfered with the
performance of the
assessment procedures
Kovar et al, (69) RCT Inclusion criteria: patients
1992 Total: 92 who were aged [greater than or
Gr1: 47 equal to] 40 y; who had a
Gr2: 45 documented diagnosis
of chronic, stable,
primary OA of one or
both knee joints in
association with at least
4-mo history ofknee
symptomatic pain
occurring during
weight-bearing
activities (patients who
had multiple joint
involvement, who had
undergone major joint
surgery, or who had a
lower joint prosthesis
also were eligible);
who had radiographic
evidence of primary
OA of one or both
knee joints, as
demonstrated by joint
space narrowing,
marginal spur
formation, or
subchondral cyst
formation; who used
any of the various
common, over-the-
counter NSAIDs [less than
or equal to] 2
days a week; and who
were not participating
in a regular program of
physical activity at the
time of enrollment
Kreindler et RCT Inclusion criteria: patients
al, (70) 1989 Total: 32 with primary diagnosis
Gr1: 8 of OA of the knee
Gr2: 5
Gr3: 10
Gr4: 9
Messier et RCT Inclusion criteria: patients
al, (45) 1997 Total: who (1) were aged
103 [greater than or equal
Gr1: 33 to] 60 y, (2) had pain
Gr2: 34 on most days of the
Gr3: 36 month in one or both
knees, (3) showed
radiographic evidence
of knee OA in the
tibiofemoral
compartments of the
painful knee, and (4)
had difficulty with at
least one of the
following activities due
to knee pain--walking
0.4 km, climbing
stairs, getting in and
out of car, rising
from a chair, lifting
and carrying
groceries, getting out
of bed, getting out of
a bathtub, shopping,
cleaning, or self-care
Minor et al, (48) RCT Inclusion criteria: patients
1989 Total: with current symptoms
115 of chronic pain and
Gr1: 36 stiffness in involved
Gr2: 47 weight-bearing joints;
Gr3:32 objective evidence of
joint pain and
crepitation with
PROM; and
documented
roentgenographic
signs of hypertrophic
changes, subchondral
sclerosis, or
nonuniform joint space
narrowing in involved
joints
O'Reilly et RCT Inclusion criteria: patients
al, (71) 1999 Total: with [less than or equal to 1
191 mo of pain in
Gr1: or around the knee on
113 most days and any
Gr2: 78 pain in the past year
Peloquin et RCT Inclusion criteria: patients
al, (72) 1999 Total: who (1) were aged
124 [less than or equal to] 50 y; (2)
Gr1: 59 had no contraindications to
Gr2: 65 exercise; (3) were not
absent from city for
more than 2 wk; (4)
had an independent,
non institutional
lifestyle; (5) had no
intra-articular steroid
or viscoelastic device
injections within the
previous 2 mo; (6)
had stable regimen
using analgesics or
NSAIDs for at least 2
wk before the
beginning of the
study; (7) had
diagnosis of minimal
to moderate idiopathic
OA of 1 or both knee
joints; (8) had >15[degrees]
Nixed-flexion deformity;
(9) had >10[degrees] of genu
varum or valgum; and
(10) had no joint
blocking
Penninx et RCT Inclusion criteria: patients
al, (73) 2001 Total: who (1) were aged
250 [less than or equal to] 60
Gr1: 82 y; (2) had pain
Gr2: 88 in the knee(s) on most
Gr3: SO days of the month; (3)
had difficulty with at
least one of the
following because of
knee pain--walking
0.4 km; climbing
stairs getting in and
out of a car, bath, or
bed; rising from a
chair; or performing
shopping, cleaning, or
self-care activities; and
(4) showed
radiographic evidence
of knee OA
Peterson et RCT Inclusion criteria: patients
al, (74) 1993 Total: 91 who (1) had at least a
Gr1: 47 4-mo history of
Gr2: 44 smptomatic knee pain
during weight-bearing
activities; 2) had
radiograpnic evidence
of OA of the knee
joint(s), as
demonstrated by joint
space narrowing,
marginal spur formation,
or subchondral cyst
formation; and (3) used
NSAIDs 2 or more days
a week
Exclusion criteria: patients
who were enrolled in a
regular program of
physical exercise at the
time of the pretrial
interview
Petrella, (75) RCT Inclusion criteria: patients
2000 Total: who were aged >65
179 y, had pain in one
Gr1: 91 knee on most days,
Gr2: 88 had radiographic
evidence of OA in the
tibiofemoral
compartment, and had
difficulties in
performing ADL
Rejeski et RCT Inclusion criteria: patients
al, (76) 1998 Total: who (1) were aged
357 [less than or equal to]
60 y, (2) had pain
on most days of the
month in one or both
knees, (3) had
difficulty with at least
one ADL leg getting
in and out of a car),
and (4) showed
radiograPhic evidence
of knee OA
Rodgers et CCT Inclusion criteria: patients
al, (77) 1998 Total: 20 with unilateral primary
Gr1: 10 TKA for OA
Gr2: 10
Rogind et RCT Inclusion criteria: patients
al, (78) 1998 Total: 25 who met the ACR
Gr1: 12 criteria for OA in the
Gr2: 13 knee that they
reported as the most
affected knee with the
radiograph of this
knee rated at least 3
on the Kellgren scale,
and who were
capable of getting
down on the floor and
up again of
independent walking
and transport, and of
taking one flight of
stairs unassisted to
reach the training
facilities
Schilke et RCT Inclusion criteria: patients
al, (79) 1996 Total: 20 who had not
Gr1: 10 participated in a
Gr2: 10 strength-training
program within the
past 6 mo
Stamm et RCT Inclusion criteria: Patients
al, (80) 2002 Total: 40 who met the ACR
Gr1: 20 criteria for hand OA;
Gr2: 20 medication with
analgesics or NSAIDs
was allowed during
the study, but had to
remain stable at least
1 mo before and
throughout the study
Suomi and RCT Inclusion criteria: patients
Lindauer, (81) Total: 30 who were women
1997 Gr1: 20 aged 45-70 y, had
Gr2: 10 been diagnosed with
RA or OA by either a
rheumatologist or an
orthopedic physician,
had current symptoms
of chronic pain and
stiffness in weight-
bearing joints, scored
15 or less on the
AIMS knee/hip scales,
had no medical
condition precluding
increased physical
activity, had not been
involved in an
organized exercise
program for the past 3
mo, had a stable
medication regimen
for at least 3 mo
before entering the
study, and had
medical clearance
through their primary
physician to
participate in the
Arthritis Foundation
Aquatic Program
Topp et al, (42) RCT Inclusion criteria: patients
2002 Total: with a diagnosis of
102 knee OA and a score
Gr1: 35 of 5 or more on the
Gr2: 32 Western Ontario and
Gr3: 35 McMaster Universities
Osteoorthritis Index
pain subscale
van Baar et RCT Inclusion criteria: patients
al, (82) 1998 Total: with OA of the hip or
191 knee according to the
Gr1: 93 clinical criteria of the
Gr2: 98 ACR
van Baar et RCT Inclusion criteria: patients
al, (83) 2001 Total: with OA of the hip or
200 knee according to the
Gr1: 98 clinical criteria of the
Gr2: ACR
102
Symptom
Author/Year Duration Age (y)
Bautch et N/A 69
al, (63) 1997
Borjessson et 7.5 y 55-70
al, (64) 1996
Deyle et al, (30) N/A Gr1:
2000 [bar.X]=59.6,
SD=10.1
Gr2:
[bar.X]=62.4,
SD=9.7
Evcik and N/A Gr1:
Sonel, (47) [bar.X]=56.3,
2002 SD=6.1
Gr2:=56.9,
SD=6.5
Gr3:
[bar.X]=55.8,
SD=6.9
Fransen et N/A First part:
al, (65) 2001 Gr1:
[bar.X]=68.5,
SD=8.7
Gr2:
[bar.X]=65.3,
SD=7.1
Gr3:
[bar.X]=66.1,
SD=10.3
Second part:
Gr1:
[bar.X]=66.7,
SD=10.1
Gr2:
[bar.X]=66.8,
SD=7.5
Garfinkel et N/A 52-79
al, (66) 1994
Gur et al, (67) N/A Gr1: [bar.X]=56,
2002 SD=12
Gr2: [bar.X]=55,
SD=12
Gr3: [bar.X]=57,
SD=9
Hurley and Gr1: [bar.X]=51 mo, Gr1: [bar.X]=62,
Scott, (68) SD= SD=12.0
1998 27.75 mo Gr2: R=61,
Gr2: [bar.X]=54 mo, SD=11.75
SD=
42.75 mo
Kovar et al, (69) Gr1: [bar.X]=12 y, Gr1:
1992 SD=12 y [bar.X]=70.38,
Gr2: [bar.X]=11 y, SD=9.11
SD=11 y Gr2:
[bar.X]=68.48,
SD=11.32
Kreindler et N/A [bar.X]=67.42,
al, (70) 1989 SD=8.38
Messier et N/A Gr1:
al, (45) 1997 [bar.X]=70.3,
SD=1.3
Gr2:
[bar.X]=67.2,
SD=0.9
Gr3:
[bar.X]=69.2,
SD=1.0
Minor et al, (48) N/A N/M
1989
O'Reilly et N/A Gr1:
al, (71) 1999 [bar.X]=61.94,
SD=10.01
Gr2:
[bar.X]=62.15,
SD=9.73
Peloquin et Gr1: [bar.X]=7.92 Gr1:
al, (72) 1999 y, SD=7.90 [bar.X]=65.64,
y SD=7.41
Gr2: [bar.X]=6.38 Gr2:
y, SD=6.05 [bar.X]=66.43,
y SD=6.39
Penninx et N/A Gr1:
al, (73) 2001 [bar.X]=68.8,
SD=5.2
Gr2:
[bar.X]=69.9,
SD=5.8
Gr3:
[bar.X]=68.5,
SD=5.4
Peterson et N/A 69.4
al, (74) 1993
Petrella, (75) N/A Gr1:
2000 [bar.X]=72.9,
SD=4.5
Gr2:
R=74.6,
SD=5.2
Rejeski et N/A [bar.X]=68.65,
al, (76) 1998 SD=5.50
Rodgers et N/A Gr1: [bar.X]=70,
al, (77) 1998 SD=3.75
Gr2: [bar.X]=65,
SD=8.25
Rogind et N/A Gr1:
al, (78) 1998 [bar.X]=69.3,
SD=8.2
Gr2:
[bar.X]=73.0,
SD=6.5
Schilke et <10y Gr1:
al, (79) 1996 [bar.X]=64.5,
SD=3.75
Gr2:
[bar.X]=68.4,
SD=8
Stamm et N/A Gr1:
al, (80) 2002 [bar.X]=60.5,
SD=8.33
Gr2:
[bar.X]=60.4,
SD=8.43
Suomi and Gr1: [bar.X]=21.3 Gr1:
Lindauer, (81) y, SD=6 y [bar.X]=59.8,
1997 GS: [bar.X]=19.0 SD=5.5
y, SD=4.5 y Gr2:
[bar.X]=54.4,
SD=4.75
Topp et al, (42) N/A Gr1:
2002 [bar.X]=60.94,
SD=10.77
Gr2:
[bar.X]=65.57,
SD=10.77
Gr3:
[bar.X]=63.53,
SD=10.75
van Baar et N/A Gr1:
al, (82) 1998 [bar.X]=68.3,
SD=8.4
Gr2:
[bar.X]=67.7,
SD=9.2
van Baar et N/A Gr1:
al, (83) 2001 [bar.X]=68.3,
SD=8.4
Gr2:
[bar.X]=67.7,
SD=9.2
Comparison
Author/Year Intervention Group
Bautch et Gr1: Patients Gr2: Same as Gr1
al, (63) 1997 participated in 1 h/ plus exercises.
wk educational ROM exercises
program consisting of of trunk and of
content related to upper and
health, exercise, and lower
arthritis. extremities.
Then
individualized
low-intensity
walking on
treadmill,
beginning at
3.22 kmyh and
grade 0,
increasing by
1% each
minute.
Distances were
increased
weekly.
Joint protection:
good walking
shoes, wood
floor in exercise
facility, cane on
the contralateral
side, and chair
exercise aimed
at strengthening
the quadriceps
femoris muscle
group
Borjessson et Gr1: Exercises. Warm Gr2: control
al, (64) 1996 up 10 min on
stationary bicycle.
Then knee extension
from 90[degrees] to
maximal extension,
sitting, with 1-3 kg
around ankle; knee
flexion from 90[degrees]
to maximal flexion,
standing on heel and
toes; knee flexion,
standing, with hip
straight; hamstring
muscle force; hip
abduction; hip
extension; passive
knee extension. Two
sets of 10 repetitions,
10-s isometric hold.
Stretches performed 5
times. Total of 3 times
a week, 40 min each
time, for 5 wk.
Deyle et al, (30) Gr1: Manual therapy Gr2: control.
2000 and knee exercises. Subtherapeutic
Passive physiologic ultrasound for
and accessory joint 10 min at 0.1
movements, muscle W/[cm.sup.2] and
stretching, and soft- 10% pulsed
tissue mobilization, mode
applied primarily to
the knee. Closely
supervised
standardized knee
exercise program:
AROM for the knee,
strengthening
exercises for the hip
and knee, muscle
stretching for the
lower limbs,
stationary bicycle,
and home program.
Evcik and Gr1: home exercise Gr3: control
Sonel, (47) program: isometric (physical
2002 straight leg lifts, therapist told
isometric quadriceps patients to
femoris muscle continue their
contraction and normal daily
isotonic quadriceps activities)
femoris muscle
contraction exercises
progressed by adding
weight from 0.5 to 5
kg, 10 repetitions
Gr2: regular walking
program
Fransen et Gr1: individual exercise Gr3: control;
al, (65) 2001 Tx; choice, frequency, patients were
and duration at the on the waiting
discretion of the list (were
physical therapist offered Tx for
Gr2: group format the second part
program; patients of the study and
were under the put in either the
supervision of a individual or
physical therapist for group exercise
1h, and the group program)
program was
supplemented with a
home exercise
program
Garfinkel et Gr1: supervised yoga Gr2: control; no Tx
al, (66) 1994 and relaxation
techniques and
patient education;
eight 60-min sessions,
1 time a week;
stretching and
strengthening
exercises
emphasizing
extension and
alignment; group
discussion, supportive
encouragement, and
general questions and
answers
Gur et al, (67) Gr1: concentric; 12 Gr3: control;
2002 concentric extension patients
and concentric flexion maintained their
movements, normal physical
continuous mode activities and
were used, and the received no
patients trained training but
reciprocally for the were tested
knee extensors and twice
flexors throughout the
Gr2: concentric-eccentric; 8-wk
6 concentric extension experimental
and eccentric period
extension movements,
then 6 concentric
flexion and eccentric
flexion movements
Hurley and Gr1: exercise program Gr2: control;
Scott, (68) for 5 wk, 2 times a rehabilitation
1998 week for 30 min; 24 was delayed
isometric quadriceps
femoris muscle
voluntary contractions
(4 x 6 repetitions,
field 4 s, 2-min rest
between sets), 2-min
stationary bicycle,
1-min isotonic knee
extension (concentric
quadriceps femoris
muscle contractions)
and flexion feccentric
quadriceps temoris
muscle contractions)
to 90[degrees] of flexion
using therapeutic
resistance bands, 3
functional exercises
(sit-stand, step-ups,
step-downs), and 3
balance/coordination
exercises (unilateral
stance, balance
boards) that were
each performed for
1 min
Kovar et al, (69) Gr1: Exercise. Twenty- Gr2: control; each
1992 four 90-min sessions week, the
of walking and patients were
education designed contacted by
and led by a physical the study
therapist. Light coordinator via
stretching and telephone to
strengthening discuss the
exercises; guest nature of their
speakers on the ADL
medical aspects of
OA and exercise;
group discussion
about barriers and
benefits of walking;
instruction in proper
walking techniques
and the maintenance
of a walking
program; supportive
encouragement and
up to 30 min of
walking.
Kreindler et Gr2: progressive Gr4: 10
al, (70) 1989 exercise program quadriceps
consisting of femoris muscle
quadriceps femoris setting exercises
and hamstring muscle for warm-up
strengthening before
exercises; exercises exercising on
were begun in the Cybex; the
session , monitored exercise
3 times a week, and positions on the
progressed at weekly Cybex matched
intervals for 6 the evaluation
consecutive wk positions; 2-min
Gr3: same as Gr1, rest periods
combined with were granted
progressive Kinetron between test
program; patients speeds
exercised at spBeds Gr1: control group
that registered was evaluated
readings of 100-150 and told to
psi; as patients continue normal
progressed above the activities and
100- to 150-psi level, return for
they progressed to reevaluation in
the next higher speed 6 wk
Messier et Gr1: aerobic training Gr3: control;
al, (45) 1997 5-min warm-up, 40- regularly
min walking phase at scheduled
an intensity equal to contacts similar
50%-85% of the to those of the 2
subject's HR reserve, intervention
and 5-min cool-down groups; patients
Gr2: strengthening were divided
training; warm-up, 9 into groups of
upper- and lower- 12-15 to
body exercises using participate in
dumbbells and cuff monthly on-site
weights (leg health
extension, leg curl, education
step-up, heel-raise, sessions during
chest fly, upright row, months 1-3;
military press, bicep during the
curls, and pelvic tilt), transition phase
and cool-down (4-6 mo),
phase; 2 sets of 10- biweekly
12 repetitions were telephone
performed for each contact was
exercise made; the
maintenance
phase (7-18
mo) consisted of
monthly
telephone calls
Minor et al, (48) Gr1: walking on a level Gr3: control;
1989 course, progressing gentle AROM
from 10 to 30 min at and isometric
exercise HR strengthening
Gr2: joggrog in shallow and relaxation
and deep water and exercises, with
modified calisthenics no aerobic
performed in chest- stimulus period
high water
O'Reilly et Gr1: Exercise program Gr2: control; no Tx
al, (71) 1999 consisting of the
following: (1)
isometric quadriceps
femoris muscle
contraction in full
extension, held for 5
s; (2l isotonic
quadriceps femora
muscle contraction in
mid flexion; (3)
isotonic quadriceps
femoris muscle
contraction in full
flexion; (4) isotonic
quadriceps femoris
muscle contraction in
full extension; and (5)
dynamic stepping
exercise. Exercises
increased to a
maximum of 20
repetitions and were
performed at home
on a daily basis.
Subjects were visited
at weeks 2 and 6
and at month 3.
Peloquin et Gr1: 3 times a week, Gr2: control; 1-h
al, (72) 1999 1-h exercise session; education/
5-min warm-up, brisk information
walk, muscle sessions 2 times
strengthening with a week
Thera-Band, (c)
resistance program
(isometric contractions
at 3 different angles),
5-min cool-down
Penninx et Gr1: Strengthening Gr3: Control.
al, (73) 2001 training. Ten-min During the first
warm-up and cool- 3 mo, monthly
down phase and 40- group sessions
min phase consisting on education
of 2 sets of 12 related to
repetitions of 9 arthritis
exercises: leg management,
extension, leg curl, including time
step-up, heel-raise, for discussions
chest fly, upright row, and social
military press bicep gatherings.
curls, and pelvic tilt. Later,
Home program. participants
Gr2: Aerobic training. were called
Ten-min warm-up and bimonthly
cool-down and 40- (months 4-6) or
min period of walking monthly (months
at an intensity of 7-18) to
50%-70% of HR maintain health
reserve. During updates and
months 4-6, exercise provide support.
leader visited 4 times
and called 6 times to
offer assistance with
home program.
Peterson et Gr1: 8 wk, hospital- Gr2: control;
al, (74) 1993 based educational patients were
and walking program. telephoned
The sessions included each week for a
warm-up, report on health
strengthening, and and exercise
cool-down exercises. activities
The course began with
easily mastered
frequency and intensity
of walking. At first,
subjects walked 3
times a week for 5 min
and always so that
knee pain was not
exacerbated. Each
walking session was
increased by 2.5 min
a week, if tolerated,
until the subject
walked 4 times a
week for 30 min each
session.
Petrella, (75) Gr1: Progressive Gr2: knee
2000 exercise program unloading (joint
consisting of the capsule stretch),
following exercises: ROM (knee
(1) knee unloading extension),
(joint capsule stretch) without
with an ankle weight progression
of 1-2 kg; (2) ROM
(knee extension) with
foot elevated, patients
push the knee toward
the floor; (3) open
kinetic gain
resistance exercises
(SLR with "T" motion)
3 times; and (4)
closed kinetic chain
resistance exercises
(eccentric wall slide
to knee flexion of
30[degrees], and patients
push off on a towel
wrapped under the
foot, with the knee
bent at 30[degrees]).
All exercises with
progression.
Rejeski et Gr1: Aerobic Tx group. Gr3: Control.
al, (76) 1998 Participants walked at Participants
an intensity of 50%- were
75% of HR reserve. consolidated in
Gr2: Resistance training of 10-
group. Participants 15. During
performed 9 different months 1-3,
upper- and lower- they received a
body exercises: leg monthly
extensions, leg curs, education
step-ups, heel-raises, session that
chest flies, upright lasted 1.5 h.
rows, military Patients in this
presses bicep curls, condition were
and pelvic tilts. contacted by
Participants telephone once
completed 2 sets of every 2 wk for
each exercise at a months 4-6 and
frequency of 10-12 then monthly for
repetitions. the remainder
of the study.
Rodgers et Gr1: 6 wk preoperative Gr2: concurrent
al, (77) 1998 PT, 3 times a week; therapy only
program
individualized
according to baseline
physical capacity.
Stretching and warm-
up, heel-slides,
isometric quadriceps
femoris muscle sets
(quad sets), SLR,
short-arc quad sets,
standing squats, step-
ups, and stationary
bicycle.
Rogind et Gr1: Mobility training Gr2: control; no Tx
al, (78) 1998 and venous therapy
performed from
supine position,
moving the joints of
the lumbar spine,
hips, knees, ankles,
shoulders, and
elbows. LE and
truncal strengthening:
repetitive exercises
for quadriceps
femoris, hip adductor
and abductor,
hamstring, gluteus
maximus, erector
spinae, and
abdominal muscles.
Stretching: calf,
quadriceps femoris,
hip adductor,
hamstring, gluteus
maximus, lower back,
and pectoralis major
muscles. Balance and
coordination
exercises.
Schilke et Gr1: Exercise. Warm-up Gr2: control; no Tx
al, (79) 1996 of 5 min on stationary
bicycle, then
isokinetic exercise at
90[degrees]/s for 24
sessions. Session 1, 1
set of 5 contractions;
session 2, 2 x 5
contractions (1-min
rest between sets);
session 3, 3 x 5
contractions (1-min
rest between sets);
session 4, 4 x 5
contractions (1-min
rest between first 2
sets, 15-min rest
between sets 3 and
4); session 5, 5 x 5
contractions (1-min
rest between first 2
sets and between sets
4 and 5, 15-min rest
between sets 3 and
4); and sessions 6-
24, 6 x 5
contractions (1-min
rest between first 3
sets and last 3 sets,
15-min rest between
sets 3 and 4).
Stamm et Gr1: Exercise. Each Gr2: Control. Oral
al, (80) 2002 patient received 30 and written
min of oral and information
written instructions for about hand
oint protection and OA, joint
5 min of training in anatomy, and
home exercises pathogenesis of
which consisted of 7 OA. Patients
exercises to perform received a
with both hands 10 piece of
times a day. Dycem (a) to open
jars for the
study period of
3 mo.
Suomi and Gir1: Water exercises Gr2: Control.
Lindauer, (81) were performed in a Patients were
1997 therapeutic pool with asked to refrain
a water temperature from engaging
of 85[degrees]-87[degrees]F in any
depth of 1.07-1,52 organized
m (3.5-5.0 ft) for 45 physical activity
min, 3 times a week program or
for 6 wk, following beginning any
Arthritis Foundation new physical
Aquatic Program activity for the
guidelines. duration of the
investigation.
Topp et al, (42) Gr1: dynamic resistance Gr3: no
2002 with Thera-Band intervention
elastic bands; warm-
up 5 min, strength
tramin 30 min, cool-
down min
Gr2: standard isometric
training techniques;
resistance with Thera-
Band elastic bands
that patients were
unable to stretch
Gr1 and Gr2: muscles
were ankle plantar
flexors and
dorsiflexors, knee
extensors and flexors,
and hip extensors
and flexors
van Baar et Gr1: Exercises for Gr2: concurrent
al, (82) 1998 muscle functions therapy only
(force and length,
mobility, and
coordination and
exercises for
elementary movement
abilities and
locomotion abilities.
Instructions for the
adaptation of ADL
and home exercises
were given.
Combined with
concurrent therapy.
van Baar et Gr1: Exercises for Gr2: concurrent
al, (83) 2001 muscle functions therapy only
(force and length(,
mobility, and
coordination and
exercises for
elementary movement
abilities and
locomotion abilities.
Instructions for the
adaptation of ADL
and home exercises
were given. Exercises
occurred 1-3 times a
week de ending on
pain level, 30 min
per session.
Concurrent
Author/Year Outcomes Therapy
Bautch et Pain (VAS, 0-10) N/A
al, (63) 1997 AIMS (0-good
health status)
Borjessson et Pain Buring walking N/A
al, (64) 1996 (11-grade
category scale)
Muscle torte (peak
torque [Nxm]) of
knee flexors and
extensors
Ability to step up
and down (3-
grade scale:
improved,
unchanged, or
worse)
Deyle et al, (30) WOMAC (mm) N/A
2000 Mean distance (m)
walked in 6 min
Evcik and WOMAC-pain (0- None
Sonel, (47) 10
2002 VAS (0-10)
WOMAC-physical
function (0-68)
NHP-pain
NHP-energy
NH P-Physical
mobility
NHP-sleep
Fransen et WOMAC-pain (0- N/A
al, (65) 2001 100)
WOM C-function
(0-100, 100=no
pain)
Knee extensor and
flexor force (N)
Gait analysis: fast
speed (cm/s), fast
cadence (steps/
min and fast
stride length (cm)
SF-36-physical
mean-50, SF-36-
mental mean=50
Garfinkel et Hand pain (VAS) N/A
al, (66) 1994 Tenderness of the
fingers
(dolorimeter)
ROM
Hand grip force
Circumference of the
finger joints
Hand function
(Stanford Hand
Assessment
Questionnaire)
Gur et al, (67) Pain at night For Gr1 and Gr2,
2002 Pain after inactivity a spectrum of
Pain sitting angular
Pain rising from a velocities
chair var~ing from
Pain standing 30[degrees]/s to
Pain climbing stairs 180[degrees]/s at
Pain descending 30[degrees] inter-
stairs vals (30[degrees],
Pain total score (10- 60[degrees],
point scale, 90[degrees], etc)
0=no pain) bilaterally was
15-m walk (,s) used, a 2-min
Time rising trom a rest was given
chair (s) between knee
Time climbing stairs extensor and
(s) flexor
Time descending movements in
stairs (s) Gr2, and a
Total score functional 5-min rest was
tests (s) given between
the legs in both
training groups
Hurley and Isometric quadriceps N/A
Scott, (68) femoris muscle
1998 force (muscle
voluntary
contraction)
Quadriceps femoris
muscle voluntary
activation (%)
Knee joint ositicn
sense ([degrees])
Aggregate functional
performance
time (s)
Lequesne Index
(0-24)
Kovar et al, (69) 6-min test of walking N/A
1992 distance (m)
AIMS subscales:
hysical activity
0-10,
10=greater
disability), arthritis
impact (0-10,
10=poorer health
status)
Arthritis pain (0-10,
10-greater pain),
medication use
(0-6, 6-less
frequent
medication use)
Kreindler et Quadriceps femoris N/A
al, (70) 1989 muscle force
relative to body
weight at 60[degrees],
80[degrees], and
120[degrees]/s
measured with the
Cybex 3 times a
week for 6 wk
Messier et Walking speed For Gr1 and Gr2,
al, (45) 1997 (cm/s) cadence 18-mo period;
(steps/min), stride 3-mo facility-
length (cm), based program
stance time (s), % followed by
swing 15-mo home-
based
program: (1)
3-mo transitory
phase of
contacts once
every 2 wk (4
home visits and
6 telephone
calls) and (2)
12-mo
maintenance
phase of
telephone
contacts once
every 3 wk
during the first
3 mo and
monthly contact
during mo 9-
18
Minor et al, (48) Change in AIMS- Gr1 and Gr2:
1989 pain (0-10) patients with
Change in AIMS- exercise HR that
physical (0-10) varied 60%-
Chane in morning 80% of
stiffness (h) maximal HR
Change in grip force were assigned
(mm Hg) individually to
Change in trunk participate in
flexibility (cm) aerobic
Change in 15.2-m exercises (pool
(50-ft) walking and walk
time (s) groups); classes
Change in aerobic included a
capacity (mL/kg warm-up,
[MIN.SUP.-1]) general
Change in exercise flexibility and
endurance (min) isometric
Change in resting strengthening of
blood pressure: postural
systolic and muscles, an
diastolic (mm Hg) aerobic stimulus
Change in exercise period
HR (bpm) pregressing to
30 min of
continuous
activety, and a
cooldown of
10 min of
AROM and
stretching
O'Reilly et WOMAC-pain (0-- N/A
al, (71) 1999 20, higher
score=more pain)
WOMAC-function
(0-68, higher
score=more
disability)
Isometric quadriceps
femoris muscle
force
Self-reported health
status (SF-36, 0-
100, higher
score=better
health)
Peloquin et AIMS2 10-10, N/A
al, (72) 1999 0=good health
status)
Aerobic capacity (m)
Hamstring muscle
and low back
flexibility (in)
Quadriceps temoris
muscle isometric
force (N*m)
Hamstring muscle
isometric force
(N*m)
Quadriceps femoris
and hamstring
muscle isokinetic
force (N*m)
Penninx et Incidence of N/A
al, (73) 2001 disability in ADL
Disability in
transferring from a
bed to a chair
Disability in bathing
Disability in toileting
Disability in dressing
Disability in eating
Peterson et Fast and free: 6-min N/A
al, (74) 1993 walk (m)
Free speed (m/min)
Free cadence (steps/
min)
Free stride (m)
Fast speed (m/min)
Fast cadence (steps/
min)
Fast stride (ml
AIMS-physical
activity
AIMS-pain
AIMS-medication
use
Petrella, (75) Mean difference in Oxaprozin 1,200
2000 pain at rest, VAS mg orally daily
(0-10, 0=no pain)
Mean difference in
pain following self-
paced step test,
VAS (0-10, 0=no
pain)
Mean difference in
pain following self-
paced walk test,
VAS (0-10, O=no
pain)
Mean difference in
WOMAC=pain
(0-10 0=no pain)
Mean difference in
WOMAC-stiffness
(0-10, 0=no
stiffness)
Mean difference in
WOMAC-physical
activity (0-10,
O=no lack of
function)
ROM in knee flexion
([degrees])
Mean difference in
self-paced step test
(s)
Mean difference in
self-paced step test
(metabolic
equivalent units)
Mean difference in
self-paced walk test
Mean difference in
self-paced walk test
(metabolic
equivalent units)
Mean difference in
physical activity
scale for elderly
people
Rejeski et Stair-climbing time (s) Gr1 and Gr2: 3-
al, (76) 1998 Climbing self-efficacy mo facility-
score based exercise
(0-completely followed by
uncertain, 15-mo home
10-completely based phase. 3
certain) times a week,
General health status 10-min warm-
(0-100, 0=1 am up, 40-min
as healthy as stimulus phase,
anybody I know) and 10-min
cool-down.
Home-based
phase: (1) 4
home visits and
6 telephone
contacts during
the first 3 mo
and (2)
telephone calls
every 3 wk for
the second 3
mo, then one
telephone call
each month for
the remainder
of the study.
Rodgers et ROM ([degrees]) Same knee
al, (77) 1998 Hospital for Special implant; same
Surgery Knee postoperative
Rating Scale score therapy,
including ankle
pumps, quad
sets, SLR, short-
arc quad sets,
heel-slides,
hamstring
muscle-
stretching,
hamstring
muscle sets, hip
abduction, and
hip adduction.
Patients started
gait training on
the first
postoperative
day. They were
discharged
depending on
their progress
and were
instructed to
begin a home
PT program.
Rogind et Pain at night (0-10, N/A
al, (78) 1998 0=no pain)
Pain at rest (0-10,
0=no pain)
Pain on wet ht
bearing (0-10,
0=nopain
ROM in knee flexion,
most affected knee
([degrees])
ROM in knee flexion,
least affected knee
([degrees])
Walking speed (m/s)
Stair-climbing time (s)
Stance, most affected
LE (s)
Stance, least affected
LE (s)
Algofunctional Index
(0=mild, 14 or
higher=extrenely
severe pain,
discomfort, or
stiffness during
ADL)
Posturography
([cm.sup.2]), stable
platform--eyes open
Posturography
([cm.sup.2]), stable
platform--eyes closed
Posturography
([cm.sup.2]), moving
platform--eyes open
Posturography
([cm.sup.2]), moving
platform--eyes closed
Schilke et Osteoarthritis N/A
al, (79) 1996 Screening Index-
pain (10 cm,
0=no pain)
Osteoarthritis
Screenin Index-
stiffness 0 cm,
0=no stiffness)
Osteoarthritis
Screenin Index-
mobility (10 cm,
0=good mobility)
AIMS-arthritis
activity (0=good
health status
Peak torque, right
knee extensors
(ft x lb)
Peak forgue, right
knee flexors (ft x lb)
Peak torque, left
knee extensors
(ft x lb)
Peak forque, left
knee flexors (ft x lb)
Stamm et Chan e of grip force N/A
al, (80) 2002 VAS (no. of patients
improved)
Suomi and Peak torque (N*m) N/A
Lindauer, (81) ROM([degrees])
1997
Topp et al, (42) WOMAC-stiffness None
2002 WOMAC-functional
limitation
WOMAC-pain
Time to et down to
floor (s)
Time to et up from
floor (s)
Time to go up stairs
(s)
Time to go down
stairs (s)
Pain while getting
down to floor
Pain while getting up
from floor
Pain while going up
stairs
Pain while going
down stairs
van Baar et Improvement in pain Tx by the general
al, (82) 1998 at assessment, practitioner:
VAS (0-100, prescription of
0-no pain) medication
Change in pain in (patients were
past week instructed to
Improvement in pain use as little as
in past month, possible) and
VAS (0-100, patient
O=no pain) education
Improvement in hip through
ROM brochure
Improvement in knee topics,
ROM including
Improvement in hip diagnosis,
muscle force prognosis,
Improvement in knee advice
muscle force concerning
Improvement in self- rest, daily
reported activities and
disability, diet, use of
influence of aids, and
Rheumatic Disease medical Tx
on General Health
and Lifestyle
Improvement in
physcial activity
van Baar et Pain, VAS (0-100, General
al, (83) 2001 0=no pain, practitioner
100=very severe prescribed
pain) acetaminophen;
Observed disability prescription of
(5-m walking time, NSAIDs
stand-to-sit time, restricted to
stand-to-recline naproxen,
time, and levels of diclofenac
caution and notrium, and
rigidity during ibuprofen.
performance of Patients
the tasks) instructed to
use as few as
possible.
Brochure for
patient
education
covering
diagnosis,
prognosis,
advice about
rest, daily
activities and
diet, use of
aids, and
medical Tx.
Frequency
and Follow-up Quality
Author/Year Duration Duration (R, B, W)
Bautch et 3 times a N/A 1, 0, 0
al, (63) 1997 week for
12 wk
Borjessson et 3 times a N/A 1, 0, 1
al, (64) 1996 week for
5 wk
Deyle et al, (30) 30 min 2 End of Tx 4 2, 1, 1
2000 times a wk
week for Follow-up at
4 wk 1 y
Evcik and Gr1: 2 6 mo 0, 0, 1
Sonel, (47) times a
2002 day for 3
mo
Gr2: 10
min, 3
times a
week for
3 mo;
gradually
increased
walking
time up
to 30 min
Fransen et 8 wk N/A 1, 0, 1
al, (65) 2001 Gr1: at the
physical
therapist's
discretion
Gr2: 2
times a
week
Garfinkel et 1 time a N/A 1, 0, 0
al, (66) 1994 week for
10 wk
Gur et al, (67) 3 days a N/A 1, 0, 0
2002 week for
8 wk
Hurley and 2 times a 6 mo 0, 0, 1
Scott, (68) week for
1998 5 wk
Kovar et al, (69) 3 times a N/A 2, 0, 1
1992 week for
8 wk
Kreindler et 3 times a 6 wk 2, 0, 0
al, (70) 1989 week for
6 wk
Messier et 3 times a N/A 2, 0, 0
al, (45) 1997 week for
18 mo
Minor et al, (48) 12 wk 3, 9 mo 1, 0, 1
1989
O'Reilly et 1 time a N/A 2, 0, 1
al, (71) 1999 day for 6
mo
Peloquin et 3 times a N/A 2, 0, 1
al, (72) 1999 week for
3 mo
Penninx et 3 times a N/A 1, 0, 1
al, (73) 2001 week,
3-m
supervised
facility-
based
program
and 15-m
home-
based
program
Peterson et 8 wk 8 wk 1, 0, 1
al, (74) 1993
Petrella, (75) Gr1: Weeks N/A 2, 1, 1
2000 1-2: 3
sessions/
wk, 2
reps/session
Weeks 3-4:
3
sessions/
wk; 3
reps/session
Weeks 5-6:
3
sessions/
wk; 3
reps/session
Weeks 7-8:
5
sessions/
wk; 5
reps/session
Gr2: 3 times
a week
for 8 wk
Rejeski et 3 times a N/A 1, 0, 0
al, (76) 1998 week for
the first 3
mo; 15-
mo home-
based
program
Rodgers et 3 times a 6 wk, 3 mo 0, 0, 1
al, (77) 1998 week for
6 wk
Rogind et 2 times a 3, 12 mo 2, 0, 1
al, (78) 1998 week for
3 mo
Schilke et 3 times a N/A 2, 0, 0
al, (79) 1996 week for
8 wk
Stamm et 3 mo N/A 1, 0, 0
al, (80) 2002
Suomi and 3 times a N/A 1, 0, 0
Lindauer, (81) week for
1997 6 wk
Topp et al, (42) 3 times a None 1, 0, 1
2002 week
(twice at
ome
and once
under
supervision)
van Baar et Gr1: 1-3 24 wk 2, 0, 1
al, (82) 1998 times a
week,
depending
on pain
level, for
12 wk
Gr2:
patients
consulted
their
general
practitioner
at least
twice, at
weeks 0
and 12,
and
when
needed
van Baar et 1-3 times a 24, 36 wk 2, 0, 1
al, (83) 2001 week for
12 wk
(a) R=randomization: 2 points maximum (Jadad scale (15)), B-blinding:
2 points maximum (Jadad scale (15), W=withdrawals: 1 point maximum
(Jadad scale (15), ACR=American College of Rheumatology, ADL=activities
of daily living, AIMS=Arthritis Impact Measurement Scales,
AIMS2=Arthritis Impact Measurement Scales 2, AROM-active range of
motion, CCT=controlled clinical trial, Gr=group, HR=heart rate,
LE=lower extremity, N/A=not available, N/M=not mentioned,
NHP=Nottingham Health Profile, NSAID=nonsteroidal anti-inflammatory
drug, OA=osteoarthritis, PROM=passive range of motion, PT=physical
therapy, RA=rheumatoid arthritis, RCT=randomized controlled trial,
ROM=range of motion, SD=standard deviation, SF-36=Medical Outcomes
Study 36-Item Short-Form Health Survey questionnaire, SLR=straight
leg raising, TKA=total knee arthoplasty, Tx=treatment, VAS=visual
analog scale, WOMAC=Western Ontario and McMaster Universities
Osteoarthritis Index.
(b) Altman R, Alarcon G, Appelrouth D, et al. The American College
of Rheumatology criteria for the classification and reporting of
osteoarthritis of the hand. Arthritis Rheum. 1990;33:1601-1610.
(c) The Hygenic Corp, 1245 Home Ave, Akron, OH 44310-2575.
(d) Dycem Ltd, Units 2-4, Ashley Hill Trading Estate, Bristol
BS2 9BB, United Kingdom.
Appendix 3.
Literature Search Strategy (Part of a Global
Search) (a)
The literature search strategy used was as
follows:
1 exp osteoarthritis/
2 osteoarthritis.tw.
3 osteoarthrosis.tw.
4 degenerative arthritis.tw.
5 exp arthritis, rheumatoid/
6 rheumatoid arthritis.tw.
7 rheumatism.tw.
8 arthritis, juvenile rheumatoid/
9 caplan's syndrome.tw.
10 felty's syndrome.tw.
11 rheumatoid.tw.
12 ankylosing spondylitis.tw.
13 arthrosis.tw.
14 sjogren$.tw.
15 or/1-14
16 heat/tu
17 (heat or hot or ice).tw.
18 cryotherapy.sh,tw.
19 (vapocoolant or phonophoresis).tw.
20 exp hyperthermia, induced/
21 (hypertherm$ or thermotherapy).tw.
22 (fluidotherapy or compression).tw.
23 15 and 22
24 clinical trial.pt.
25 randomized controlled trial.pt.
26 tu.fs.
27 dt.fs.
28 random$.tw.
29 placebo$.tw.
30 ((sinq$ or doubl$ or tripl$) adj (masked
or blind$).tw.
31 sham.tw.
32 or/24-31
33 23 and 32
(a) Reprinted with permission of the American Physical
Therapy Association from: Ottawa Panel Evidence-Based
Clinical Practice Guidelines for Therapeutic
Exercises in the Management of Rheumatoid Arthritis
in Adults. Phys. Ther. 2004;84:934-972.
Appendix appendix, small, worm-shaped blind tube, about 3 in. (7.6 cm) long and 1-4 in. to 1 in. (.64–2.54 cm) thick, projecting from the cecum (part of the large intestine) on the right side of the lower abdominal cavity. 4. Evidence-Based Clinical Practice Guidelines clinical practice guidelines Clinical policies, practice guidelines, practice parameters, practice policies Medtalk Systematically developed statements to assist practitioner and Pt decisions about appropriate health care for specific clinical circumstances. See Psychology. (a) Strengthening Exercises Lower-extremity strengthening versus control, level 1 (RCT RCT Randomized Controlled Trial RCT Regimental Combat Team (infantry regiment with their own artillery, engineers, medical and tanks) RCT Rollercoaster Tycoon RCT Randomized Clinical Trial RCT Rhondda Cynon Taff , n=345): grade A for pain getting up from floor and functional status (clinically important benefit); grade C+ for pain during walking, pain while climbing stairs, functional tasks, and quadriceps femoris muscle
half way to rigidity, tetany; result of insufficient use of the part. , mobility, quadriceps femoris muscle force, muscle activation activation /ac·ti·va·tion/ (ak?ti-va´shun) 1. the act or process of rendering active. 2. the transformation of a proenzyme into an active enzyme by the action of a kinase or another enzyme. 3. , and quality of fife (no benefit). Patients with a diagnosis of OA of the knee. Lower-extremity isometric isometric /iso·met·ric/ (-met´rik) maintaining, or pertaining to, the same measure of length; of equal dimensions. i·so·met·ric adj. 1. strengthening versus control, level 1 (RCT, n=102): grade A for pain getting down to and up from floor (clinically important benefit); grade C+ for pain getting down and up stairs See Upstairs in the Vocabulary. See also: Stair and timed functional tasks (clinical benefit); grade C for stiffness and functional status (no benefit). Patients with a diagnosis of OA of the knee. Isotonic isotonic /iso·ton·ic/ (-ton´ik) 1. denoting a solution in which body cells can be bathed without net flow of water across the semipermeable cell membrane. 2. resistance training versus isotonic combined with isokinetic isokinetic /iso·ki·net·ic/ (-ki-net´ik) maintaining constant torque or tension as muscles shorten or lengthen; see isokinetic exercise, under exercise. (Kinetron *) resistance training for knee, level 1 (RCT, n=32): grade C for quadriceps femoris muscle peak torque (no benefit). Patients with a primary diagnosis of OA of the knee. Isotonic combined with isokinetic (Kinetron) resistance training for knee versus control, level 1 (RCT, n=32): grade C for muscle force (no benefit). Patients with primary diagnosis of OA of the knee. Eccentric eccentric, in mechanics, device for changing rotary to back-and-forth motion. A disk is mounted off center on a shaft. One flat, open, circular end of a rod fits around the edge of the disk; the other end is usually attached to a block that slides in a slot. resistance training (Cybex *) for knee versus control, level 1 (RCT, n=32): grade C for muscle force (no benefit). Patients with primary diagnosis of OA of the knee. Concentric Coming from the center, or circles within circles. For example, tracks on a hard disk are concentric. Tracks on optical media are concentric or spiral shaped (in a coil) depending on the type. resistance training for knee versus control, level 1 (RCT, n=23): grade A for pain at rest and during activities (clinically important benefit); grade C for global functional status (no benefit). Patients with knee OA bilaterally bi·lat·er·al adj. 1. Having or formed of two sides; two-sided. 2. Affecting or undertaken by two sides equally; binding on both parties: a bilateral agreement; bilateral negotiations. and grade II or III OA. Concentric-eccentric resistance training for knee versus control, level 1 (RCT, n=23): grade A for pain at rest and during specific functional activities: 15-m walk and stair stair n. 1. A series or flight of steps; a staircase. Often used in the plural. 2. One of a flight of steps. [Middle English, from Old English climbing/descending time (clinically important benefit). Patients with knee OA bilaterally and grade II or III OA. Home program strengthening for knee versus control, level 1 (CCT CCT Circuit CCT Commission Canadienne du Tourisme (Canadian Tourism Commission) CCT Correlated Color Temperature CCT Common Customs Tariff (EU) CCT Certificate of Completion of Training , n=81): grade A for pain, functional status, energy level, and ROM in flexion flexion /flex·ion/ (flek´shun) the act of bending or the condition of being bent. flex·ion n. 1. The act of bending a joint or limb in the body by the action of flexors. 2. (clinically important benefit); grade C for physical mobility, muscle force, swelling swelling /swell·ing/ (swel´ing) 1. transient abnormal enlargement of a body part or area not due to cell proliferation. 2. an eminence, or elevation. , and exercise (no benefit). Patients with OA of the knee. General LE exercise program (including muscle force, flexibility, and mobility/coordination) versus control, level 1 (RCT, n=490): grade A for pain at night and ability on stairs (clinically important benefit); grade C for knee flexion ROM, muscle force, knee joint position, gait, functional status, quality of life, muscle activation, stiffness, and physical activity (no benefit). Patients with a diagnosis of OA. Progression progression, in mathematics, sequence of quantities, called terms, in which the relationship between consecutive terms is the same. An arithmetic progression is a sequence in which each term is derived from the preceding one by adding a given number, d, versus no-progression LE strengthening exercises, level 1 (RCT, n=179): grade A for pain at rest and ROM (clinically important benefit); grade C for stiffness and functional status (no benefit). Patients with radiographic radiographic (rā´dēōgraf´ik), adj relating to the process of radiography, the finished product, or its use. evidence of OA in the tibiofemoral tibiofemoral /tib·io·fem·or·al/ (tib?e-o-fem´o-ral) pertaining to the tibia and femur. tibiofemoral pertaining to the tibia and femur. compartment compartment a part of the body as a whole and divided from the rest by a physical partition. fluid compartment that liquid part of the body excluded by cell membranes. Includes intravascular and intercellular compartments. . Hand strengthening versus control, level 1 (RCT, n=40): grade A for pain and grip force (clinically important benefit). Patients who met the American College American College is the name of:
rheu·ma·tol·o·gy n. criteria criteria (krītēr´ē  ),n. for hand OA. (154) General Physical Activity, Including Fitness and Aerobic Exercises aerobic exercise, n sustained repetitive physical activity, such as walking, dancing, cycling, and swimming, that elevates the heart rate and increases oxygen consumption resulting in improved functioning of cardio-vascular and respiratory systems. Whole-body functional exercise versus control, level 1 (RCT, n=864): grade A for pain and functional status (mobility, walking, work, disability in ADL) (clinically important benefit); grade C for knee flexor flexor /flex·or/ (flek´ser) 1. causing flexion. 2. a muscle that flexes a joint. flexor retina´culum see entries under retinaculum. ROM, quadriceps femoris muscle force, hamstring muscle hamstring muscle n. Any of the three muscles constituting the back of the upper leg that serve to flex the knee joint, adduct the leg, and extend the thigh. force, gait, and quality of life (no benefit). Patients with OA of the knee. Walking program versus control, level 1 (RCT, n=1,089): grade A for pain, functional status, stride length stride length Biomechanics The distance between 2 successive placements of the same foot, consisting of 2 step lengths; SL measured between successive positions of the left foot is always the same as that measured by the right foot, unless the subject is walking in a curve , disability transferring from bed, disability bathing, aerobic aerobic /aer·o·bic/ (ar-o´bik) 1. having molecular oxygen present. 2. growing, living, or occurring in the presence of molecular oxygen. 3. requiring oxygen for respiration. 4. capacity, energy level, and medication medication /med·i·ca·tion/ (med?i-ka´shun) 1. medicine (1). 2. impregnation with a medicine. 3. administration of a medicine or other remedy. use (clinically important benefit); grade C+ for disability in ADL (clinical benefit); grade C for walking speed, disability toileting, disability dressing, blood pressure, morning stiffness, and quality of life (no benefit). Patients with OA. Jogging jogging Aerobic exercise involving running at an easy pace. Jogging (1967) by Bill Bowerman and W.E. Harris boosted jogging's popularity for fitness, weight loss, and stress relief. in water versus control, level 1 (RCT, n=115): grade A for physical activity and aerobic capacity (clinically important benefit); grade C for morning stiffness, pain, grip force, trunk A communications channel between two points. It generally refers to a high-bandwidth, fiber-optic line between telephone switching centers (central offices). Telephone "trunks" handle thousands of simultaneous voice and data signals, whereas telephone "lines" are the wires from the ROM, functional status, and exercise endurance Endurance See also Longevity. Atalanta feminine name denotes power of endurance. [Gk. Myth.: Jobes, 148] Boston marathon famous 26-mile race held annually for long-distance runners. [Am. Pop. Culture: Misc. (no benefit). Patients with current symptoms of chronic pain and stiffness in involved weight-bearing weight-bearing adjective Referring to the ability of a part of the body to resist or support weight. joints. Water exercises versus control, level 1 (RCT, n=30): grade C for torque and ROM (no benefit). Patients with OA or RA diagnosed by a rheumatologist rheumatologist /rheu·ma·tol·o·gist/ (roo?mah-tol´ah-jist) a specialist in rheumatology. rheu·ma·tol·o·gist n. A specialist in the diagnosis and treatment of rheumatic disorders. or an orthopedic orthopedic /or·tho·pe·dic/ (-pe´dik) pertaining to the correction of deformities of the musculoskeletal system; pertaining to orthopedics. physician. Yoga yoga (yō`gə) [Skt.,=union], general term for spiritual disciplines in Hinduism, Buddhism, and throughout S Asia that are directed toward attaining higher consciousness and liberation from ignorance, suffering, and rebirth. versus control, level 1 (RCT, n=30): grade A for pain during activity and ROM (clinically important benefit); grade C for tenderness, muscle force, swelling, and hand function (no benefit). Patients with OA of the distal distal /dis·tal/ (-t'l) remote; farther from any point of reference. dis·tal adj. 1. Anatomically located far from a point of reference, such as an origin or a point of attachment. interphalangeal interphalangeal situated between two contiguous phalanges. or proximal proximal /prox·i·mal/ (-mil) nearest to a point of reference, as to a center or median line or to the point of attachment or origin. prox·i·mal adj. interphalangeal joints in·ter·pha·lan·ge·al joint n. See digital joint. of the fingers. Combination of Exercises Manual therapy combined with exercise versus control, level 1 (RCT, n=83): grade A for pain (clinically important benefit); grade C for functional status (no benefit). Patients with a diagnosis of OA. (a) RCT=randomized controlled trial A randomized controlled trial (RCT) is a scientific procedure most commonly used in testing medicines or medical procedures. RCTs are considered the most reliable form of scientific evidence because it eliminates all forms of spurious causality. , OA=osteoarthritis osteoarthritis or osteoarthrosis or degenerative joint disease Most common joint disorder, afflicting over 80% of those who reach age 70. It does not involve excessive inflammation and may have no symptoms, especially at first. , CCT=controlled clinical trial controlled clinical trial, n a research strategy that calls for two samples: an experimental sample of patients receiving a pharmaceutical, and a second sample of control patients receiving a placebo. , ROM=range of motion, ADL=activities of daily living, RA=rheumatoid arthritis rheumatoid arthritis Chronic, progressive autoimmune disease causing connective-tissue inflammation, mostly in synovial joints. It can occur at any age, is more common in women, and has an unpredictable course. , LE=lower extremity lower extremity n. The hip, thigh, leg, ankle, or foot. Also called inferior limb, pelvic limb. . * Cybex International Inc, 10 Trotter trotter: see Standardbred horse. Dr, Medway
Medway is the name given to a conurbation and unitary authority in north Kent, England. , MA 02053. |
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