Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
School of Physical Therapy, Faculty of Health Sciences, Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.
Osteoarthritis Cartilage. 2023 Oct;31(10):1312-1326. doi: 10.1016/j.joca.2023.06.011. Epub 2023 Jul 7.
Insights related to the pathogenesis of osteoarthritis (OA) have informed rehabilitative treatments that aim to mitigate the influence of several known impairments and risk factors for OA, with the goal to improve pain, function, and quality of life. The purpose of this invited narrative review is to provide fundamental knowledge to non-specialists about exercise and education, diet, biomechanical interventions, and other physical therapist-delivered treatments. In addition to summarizing the rationale for common rehabilitative therapies, we provide a synthesis of current core recommendations. Robust evidence based on randomized clinical trials supports exercise with education and diet as core treatments for OA. Structured, supervised exercise therapy is advised. The mode of exercise may vary but should be individualized. The dose should be based on an initial assessment, the desired physiological changes, and progressed when appropriate. Diet combined with exercise is strongly recommended and studies demonstrate a dose-response relationship between the magnitude of weight loss and symptom improvement. Recent evidence suggests the use of technology to remotely deliver exercise, diet and education interventions is cost-effective. Although several studies support the mechanisms for biomechanical interventions (e.g., bracing, shoe inserts) and physical therapist-delivered (passive) treatments (e.g., manual therapy, electrotherapeutic modalities) fewer rigorous randomized trials support their clinical use; these therapies are sometimes recommended as adjuncts to core treatments. The mechanisms of action for all rehabilitative interventions include contextual factors such as attention and placebo effects. These effects can challenge our interpretation of treatment efficacy from clinical trials, yet also provide opportunities to maximize patient outcomes in clinical practice. When evaluating rehabilitative interventions, the field may benefit from increased emphasis on research that considers contextual factors while evaluating mechanistic, longer-term, clinically-important and policy-relevant outcome measures.
骨关节炎（OA）发病机制的相关研究为康复治疗提供了依据，这些治疗旨在减轻 OA 的几个已知损伤和风险因素的影响，目标是改善疼痛、功能和生活质量。本特邀叙述性综述的目的是向非专业人士提供有关运动和教育、饮食、生物力学干预以及其他物理治疗师提供的治疗的基本知识。除了总结常见康复治疗的基本原理外，我们还综合了当前的核心建议。基于随机临床试验的有力证据支持运动与教育和饮食相结合作为 OA 的核心治疗方法。建议进行结构化、监督的运动疗法。运动的模式可能会有所不同，但应因人而异。剂量应基于初始评估、所需的生理变化，并在适当的情况下进行调整。强烈建议结合运动进行饮食，研究表明体重减轻的幅度与症状改善之间存在剂量反应关系。最近的证据表明，使用技术远程提供运动、饮食和教育干预是具有成本效益的。尽管有几项研究支持生物力学干预（例如，支具、鞋垫）和物理治疗师提供的（被动）治疗（例如，手法治疗、电疗模式）的机制，但较少有严格的随机试验支持其临床应用；这些治疗方法有时被推荐作为核心治疗的辅助手段。所有康复干预措施的作用机制包括注意力和安慰剂效应等环境因素。这些效应可能会对我们从临床试验中对治疗效果的解释提出挑战，但也为在临床实践中最大限度地提高患者的治疗效果提供了机会。在评估康复干预措施时，该领域可能会受益于更多地强调考虑环境因素的研究，同时评估机制、长期、临床上重要和与政策相关的结果测量。
