Jämförelse av effekter från gruppträning i bassäng med landträning hos patienter med knäartros
Utvärdering av effekter på smärta, funktion i det dagliga livet och fritid- och idrottsaktiviteter
AbstractAimThe aim of the pilot study was to compare short- and long-term effects from group exercise in water with land-based exercise on pain at rest and pain with movement, along with the effects on function in daily life and practice of sports and leisure activities in patients with knee osteoarthritis. The aims were: Is there a difference in short- and long-term effects on pain intensity at rest and pain with movement after exercise in water or land in patients with knee osteoarthritis? Is there a correlation between the degree of pain intensity at rest and with movement, respectively and long-term effects from the two different exercises on function in daily life and practice of sports and leisure? MethodThe study was a randomized intervention study without a control group. Twenty patients with radiographic knee osteoarthritis were under a total of eight weeks treated with either land- or water-based exercise lead by a physiotherapist. The patients rated pain intensity at rest and with movement on a numerical rating scale (NRS) before and after the first training session, before and after the eighth training session, before and after the fifteenth training session and before the last and sixteenth training session. Knee injury and Osteoarthritis Outcome questionnaire Score (KOOS) were answered before the first and the last training session but only the function on activities in daily life (ADL) and the practice of sports and leisure were analyzed. ResultsNineteen patients completed the study. Using a Mann Whitney U-test a significant short-term pain reduction on pain with movement was found both in the land- and the water-based exercise group (p=0.02, respectively). A tendency to a significant long-term pain reduction on pain with movement was seen in the land-based group (p=0.1). A 30 % clinically relevant short-term reduction in pain was demonstrated for pain at rest and pain with movement in the water-based group but only on pain with movement in the land-based group. The long-term assessment showed a clinically significant reduction both in pain at rest and pain with movement in the land-based group but only on pain with movement in the water-based group. No significant effect was seen on KOOS in comparison between time one and sixteen. A negative moderate correlation between pain at rest and ADL and a negative good correlation between pain with movement and ADL were found in the land-based group on the first training session. In the water-based group the correlations between pain at rest and pain with movement, respectively were with ADL negative fair and with function in sports and leisure negative moderate on the first training session. The correlations in the land-based group had on the last training session become weaker whilst in the water-based group the correlations had become stronger, especially for pain with movement and ADL as well as with function in sports and leisure, respectively where the correlations now were negative good. ConclusionsWater- and land-based training primarily affected pain with movement in this study. A significant pain reduction was seen on short-term pain with movement and a clinically reduction in pain was seen on pain with movement on both short- and long-term in the two training groups. A negative good correlation was seen only in the water-based group between long-term pain with movement and function in ADL and sports and leisure, respectively. Based on the results from the study physiotherapists are recommended to ask the patients to distinguish between pain at rest from pain with movement during pain intensity ratings since training treatments seemed to primarily reduce pain with movement.