Osteoarthritis of the knee: Explanations for the effects of exercise therapy on pain and functioning: a qualitative study

Onderzoeksoutput: Meeting abstract (Journal)

Samenvatting

Purpose
The present qualitative research aims to provide an overview of the scientific foundation of theoretical models that are put forward to explain the treatment effects of exercise in osteoarthritis of the knee (Oak).

Relevance
Exercise therapy is a conservative treatment for OAk of which the effectiveness is well substantiated: exercise significantly diminishes the pain and improves the patient's functioning. No clear explanation is given for this health improving effect of exercise. Understanding the pathways through which exercise influences pain and function of OAk patients may contribute to the design of a comprehensive treatment plan.

Methods
We included studies collected in Cochrane reviews emphasizing on exercise therapy for OAk. Therefore we used the search engine of the Cochrane Library website (http://www.cochrane.org/; keywords: osteoarthritis, exercise, knee). We also collected guidelines that are included in the Physiotherapy Evidence Database (http://www.pedro.org.au/) and that are related to the treatment of OAk (keywords: osteoarthritis, practice guideline, body part: lower leg or knee). If exercise therapy is recommended in these guidelines, the studies that were used to empower this advice were included in our work. The introduction and discussion parts of the included studies were subsequently screened for plausible explanations supporting influences of exercise on OAk. First, we listed general opinions that were given concerning potential explanations. Second, core theoretical concepts were formulated. Third, tentative linkages were developed between the core theoretical concepts and the scientific foundations that were used to empower the theoretical models.

Analysis
This study uses an inductive qualitative approach that is based on the 'grounded theory' of Glaser and Straus.

Results
Three Cochrane reviews and 7 guidelines were identified. These referred to 65 full papers (after eliminating double references). Potential explanations for the effects of exercise for OAk were mentioned in 24 papers. Consequently, six core theoretical concepts were formulated: cartilage integrity, stability, psychology, energy absorbing capacity of periarticular muscles, weight loss, others. The most scientific foundation is supplied for the first three concepts in this checklist.

Conclusions
The most founded explanations for the effect of exercise on Oak are a decreased focal cartilage pressure, (through better stability, energy absorbing capacity of muscles and weight loss) and an improved mental state.

Implications
Designing a physical therapy protocol that is based on the 5 major scientifically founded explanations that are cited in the literature, may contribute to a comprehensive therapy plan. Future research should focus on an exercise treatment plan that concentrates on stability, weight loss, muscle strengthening and providing information concerning coping strategies.
Originele taal-2English
Pagina's (van-tot)eS116-eS117
TijdschriftPhysiotherapy
Volume97
Nummer van het tijdschriftSuppl S1
StatusPublished - 23 jun 2011
EvenementWorld Physical Therapy 2011 - Amsterdam, Netherlands
Duur: 20 jun 201323 jun 2013

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