Supervised or unsupervised exercise for the treatment of hip and knee osteoarthritis. Clinical practice recommendations.

OBJECTIVES: To develop clinical practice guidelines concerning supervised or unsupervised kinesiotherapy for treating lower-limb osteoarthritis (OA). METHOD: The SOFMER (French Physical Medicine and Rehabilitation Society) methodology, associating systematic literature review, collection of everyday clinical practice, and external review by a multidisciplinary expert panel, was used to develop guidelines. RESULTS-CONCLUSION: Physical exercise is a part of the treatment of lower-limb OA. An educational pre-program is recommended to inform the patient about the ease and effectiveness of the physical exercise. Use of the SOFMER methodology led to recommending a program of initial physical exercise supervised by a physiotherapist, then an unsupervised program at home with compliance. The type, intensity, and frequency of the exercises must be adapted to each patient. Complementary randomized controlled studies are necessary to characterize the best exercises and their intensity and frequency. The OA location and gravity, functional need, and characteristics of patients will be useful in future studies.

[Evaluation after four years of exercise therapy for chronic low back pain]. / Evaluation à quatre ans d'un programme de reconditionnement à l'effort pour lombalgie chronique.

OBJECTIVE: To assess at four years follow-up the efficiency of exercise therapy for chronic low back pain in terms of pain, physical ability, quality of life and return to work. MATERIALS AND METHODS: Patients who graduated from a functional restoration program between April 1997 and June 1999, answered a questionnaire at one year follow-up. The patients who had answered this questionnaire were evaluated 48 months later: they first answered another questionnaire and then most underwent a clinical examination assessing pain on a visual analogue scale, flexibility by use of the Schöber index and the finger-ground distance test, endurance of abdominal and spinal muscles, and quality of life as assessed by the Dallas pain questionnaire. RESULTS: Thirty-four patients graduated from the program; 26 were studied at four-year follow-up. Pain intensity was significantly reduced. Improvement in flexibility after the program remained at four-year follow-up, whereas improvement in endurance did not. Scores on the Dallas pain questionnaire remained as improved as those at one-year follow-up. Initially, 23 of the 26 patients had a job; 19 were on sick leave for an average of 35 weeks. At four-year follow-up, 16 patients were still working, and 56% had changed jobs. Six patients pursued a regular activity before entering the program; at four-year follow-up, 17 were regularly active. No significant relationship was found between the pursuit of physical activity and return to work. Nevertheless, a significant relationship was found between having a regular physical activity and improvement of the finger-ground distance and endurance of spinal muscles. This observation was not true for the Dallas pain questionnaire scores. CONCLUSION: Despite the lack of a control group, this study seems to favour a benefit in the functional restoration program.