IRMB, University of Montpellier, INSERM, Clinical immunology and osteoarticular diseases Therapeutic Unit, Lapeyronie University Hospital, CHU Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier CEDEX 05, France.
Université Paris Cité, Faculté de Santé, UFR de Médecine, 15, rue de l'école de médecine, 75006 Paris, France; AP-HP.Centre-Université Paris Cité, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 27 rue du Faubourg Saint-Jacques, Paris 75014, France; INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, 45 rue des Saints-Pères, 75006 Paris, France.
Ann Phys Rehabil Med. 2024 Oct;67(7):101883. doi: 10.1016/j.rehab.2024.101883. Epub 2024 Oct 28.
Although non-pharmacological therapies for knee osteoarthritis (OA) are essential pillars of care, they are often poorly considered and inconsistently applied.
Under the umbrella of the French Society of Rheumatology (SFR) and the French Society of Physical Medicine and Rehabilitation (SOFMER), we aimed to establish consensual recommendations for the non-pharmacological management of people with knee OA.
A group of fellows performed a systematic literature review on the efficacy and safety of non-pharmacological modalities (up to October 2021). The fellows then took part in discussions with a multidisciplinary group of experts to draft a list of recommendations. The list was then submitted to an independent reading committee who rated their level of agreement with each recommendation. Each recommendation was assigned a strength of recommendation and a level of evidence.
Five general principles were unanimously accepted: (A) the need to combine non-pharmacological and pharmacological measures; (B) the need for personalized management; (C) the need to promote adherence; (D) the need for adapted physical activity; and (E) the need for person-centered education. Specific positive or negative recommendations were defined for 11 modalities: (1) unloading knee brace; (2) kinesiotaping or knee sleeves; (3) shoes and/or insoles; (4) using a cane; (5) physical exercise program; (6) joint mobilization; (7) electro- or thermo-therapy; (8) acupuncture; (9) weight loss; (10) thermal spa therapy; and (11) workplace accommodation.
These SFR/SOFMER recommendations provide important and consensual knowledge to assist health professionals in decision-making for non-pharmacological treatments for knee OA.
尽管非药物疗法是膝骨关节炎（OA）治疗的重要支柱，但这些疗法往往未得到充分考虑且应用不一致。
在法国风湿病学会（SFR）和法国物理医学与康复学会（SOFMER）的框架下，我们旨在为膝骨关节炎患者的非药物治疗制定共识推荐意见。
一组研究员对非药物治疗方法的疗效和安全性进行了系统的文献回顾（截至 2021 年 10 月）。然后，研究员们参与了一个多学科专家组的讨论，起草了一份推荐意见清单。该清单随后提交给一个独立的阅读委员会，由他们对每一条推荐意见的同意程度进行评分。每条推荐意见都被赋予了推荐强度和证据水平。
五项普遍原则得到一致认可：（A）需要结合非药物和药物措施；（B）需要个性化管理；（C）需要促进坚持；（D）需要进行适应性的身体活动；以及（E）需要进行以患者为中心的教育。针对 11 种治疗方法确定了具体的积极或消极建议：（1）减轻膝关节负重；（2）运动贴布或护膝；（3）鞋子和/或鞋垫；（4）使用拐杖；（5）体育锻炼计划；（6）关节松动术；（7）电疗或热疗；（8）针灸；（9）减肥；（10）温泉疗法；以及（11）工作场所适应。
这些 SFR/SOFMER 推荐意见提供了重要且一致的知识，以帮助医疗保健专业人员在膝骨关节炎的非药物治疗决策中做出决策。
