Home Therapy for Knee Arthritis Patients

11.08.2018

by Julie Maurer
Contributing Writer, MedPage Today

Treatment for knee pain in osteoarthritis patients doesn’t just take place in the physician’s office, as patients are often sent home with a list of exercises to do on their own time.

“Many people who develop knee pain change their gait, and if that goes on for long enough they may develop muscle imbalance or weakness,” Carol Lin, MD, an orthopedic physician at Cedars-Sinai in Los Angeles, Calif. told MedPage Today in an email. “This, in turn, causes further abnormalities in gait which really affects the transfer of pressure and weight across the knee.”

She said she recommends functional exercises that focus on hip, quadriceps, and hamstring strengthening. The American Academy of Orthopedic Surgeons recommends some basic moves that patients can do at home.

“I also advise patients with OA to avoid any high or medium impact activities and activities which require knee flexion beyond 90 degrees because these motions increase the stress across the knee joint,” Lin said. “I recommend pool exercises as a good starting point because patients can do resistance exercises without additional pressure across the joint.”

Mood boost

And it’s not just the joint pain that the home exercises can improve, in an April 2018 Cochrane Review, researchers aimed to study the connection between the activities and psychosocial function in osteoarthritis patients as well.

They reviewed 21 trials with more than 2,300 patients and found that home exercise indeed has impact on osteoarthritis patients.

“There was moderate quality evidence that exercise reduced pain by an absolute percent reduction of 6 percent, equivalent to reducing (improving) pain by 1.25 points from 6.5 to 5.3 on a 0 to 20 scale and moderate quality evidence that exercise improved physical function by an absolute percent of 5.6 percent,” the study authors wrote.

The reviewers also found evidence that exercise in osteoarthritis patients improves social function.

“People are confused about the cause of their pain and bewildered by its variability and randomness. Without adequate information and advice from healthcare professionals, people do not know what they should and should not do, and, as a consequence, avoid activity for fear of causing harm,” the authors wrote.

Improving the programs

In 12 of the studies of the Cochrane Review, patients offered feedback on how the home exercise programs could be improved.

“From the patients’ perspectives, ways to improve the delivery of exercise interventions included: provide better information and advice about the safety and value of exercise; provide exercise tailored to individual’s preferences, abilities and needs; challenge inappropriate health beliefs and provide better support,” they noted.

In line with this concept, researchers from Turkey set out to determine if these patients would benefit from additional education by a physiotherapist before attempting to do the exercises.

Merve Yilmaz, a physiotherapist whose mother has knee osteoarthritis, became curious on the topic and decided to conduct a study.

“I don’t think it is appropriate that doctors give home exercises,” Yilmaz told MedPage Today in an email. “Therefore, I wanted to show the difference of the home exercise program taught by physiotherapists.”

The study included just 80 patients, but Yilmaz hopes it will lead to further research on the topic. Half were given the home exercise brochure by their orthopedist, and the other half were taught exercises by a physiotherapist. He believes patients show improvement in range of motion for the patients who were taught the exercises.

“Physicians are very important to treat for all patient with knee osteoarthritis and exercise training is required for all patients. But, the physiotherapist is the one who should give the best exercise. It is very significant to work multidisciplinary,” Yilmaz said.

This topic has been explored in the past. A 2014 study randomized 214 patients to two groups.

“Both groups were given a home exercise program aimed at increasing lower limb strength, and endurance, and improving balance. The supplemented group also attended 8 weeks of twice-weekly knee classes run by a physiotherapist,” the study authors wrote.

The group with supplemental education exhibited improvement in locomotion and pain relief, however, these were not maintained over 12 months.

As-needed basis

Lin said she recommends daily home therapy for patients first, but physiotherapists do have benefits for patients in providing additional guidance, supervision, and manual exercise that only they can provide.

“But only doing exercises once or twice a week with a therapist is usually not enough,” Lin said. “I recommend physiotherapy on an individual basis for patients who may not be comfortable initiating therapy on their own, those who have limited range of motion, or who are not seeing expected improvement on their own.”

She added that the biggest long-lasting factor in pain improvement for knee osteoarthritis is to maintain a healthy weight.

“When we walk, and especially when we go up and down stairs, somewhere between 3-5 times our body weight passes through the knee. So, gaining or losing 5 (pounds) really makes a difference,” Lin said.