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فهمان جلس الغمان المحري Council of Health Insurance Knee Osteoarthritis (OA) Physical Therapy Clinical Practice Guideline Tool and Recommendations الجمعيه السعوديه لطب الاسره والмеج Saudi Society of Family and Community Medicine Background Knee pain classifications: - Acute knee pain is defined as knee pain lasting less than 6 weeks. - Chronic knee pain last more than 6 weeks. Kellgren & Lawrence Systems Severity Classification Box 1 Knee OA severity can be classified radiologically by using Kellgren & Lawrence systems into 4 grades: - Grade 0: normal healthy knee - Grade 1: questionable (patient is asymptomatic) - Grade 2 (mild) : definite osteophytes and possible Joint Space Narrowing (JSP), (Patient will experience symptoms after prolonged walking and will feel joint stiffness). - Grade 3 (moderate): moderate multiple osteophytes, definite JSN, some sclerosis, and possible bony deformity (Frequent pain during movement, joint stiffness will also be more present, especially after sitting for long periods and in the morning). - Grade 4 (severe): large osteophytes, significant JSN, severe sclerosis, and definite bony deformity (This stage is normally associated with high levels pain and discomfort during walking or moving the joint and maybe at rest) Patient present with chronic knee pain suggesting OA Box 2 Red flags: - History of trauma - Fever, palpable warmth, joint erythema - Lumps or bumps around the knee - Locking, catching or giving way - Night pain - History of cancer KOOS questionnaire * This tool is designed to: - Assess five outcome measures (pain, symptoms, ADL, sport & recreation function and knee related quality of life) - Evaluate the course of knee OA and treatment outcomes KOOS questionnaire forms: https://www.worksafe.qld.gov.au/ data/assets/pdf_file/0022/24097/knee-injury-and-osteoarthritis-outcome-score-koos1.pdf ((English) http://www.koos.nu/koosarabicsaudiarabia.pdf ((Arabic) Therapeutic process level of evidence: On the basis of the currently available evidence, the Guideline Development Committee (1) Exercise therapy for knee OA: recommends the use of exercise therapy to alleviate pain and improve physical performance (level 1). (2) Ultrasound for osteoarthritis of the knee: cannot recommend the use of ultrasound (level 2). (3) Taping for patellofemoral osteoarthritis: recommends taping the patella to alleviate the pain, preferably in combination with muscle strengthening and functional exercise therapy and patient education (level 2). (4) Electromagnetic field therapy for osteoarthritis of the knee: cannot recommend the use of electromagnetic field therapy (level 1). (5) Patient education and promoting effective self-management of osteoarthritis of the knee: On the basis of the currently available evidence and best practice, the Guideline Development Committee recommends a combination of exercise therapy and patient education / self-management interventions to improve the patient's mental and physical performance and alleviate pain (level 2). References (1) • Fransen M, McConnell S. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2008;(4):CD004376. • Hernandez-Molina G, Reichenbach S, Zhang B, Lavalley M, Felson DT. Effect of therapeutic exercise for hip osteoarthritis pain: results of a meta-analysis. Arthritis Rheum. 2008 Sep 15;59(9):1221-8. • Jamtvedt G, Dahm KT, Christie A, Moe RH, Haavardsholm E, Holm I, et al. Physical therapy interventions for patients with osteoarthritis of the knee: an overview of systematic reviews. Phys Ther. 2008 Jan;88(1):123-36. • Moe RH, Haavardsholm EA, Christie A, Jamtvedt G, Dahm KT, Hagen KB. Effectiveness of nonpharmacological and nonsurgical interventions for hip osteoarthritis: an umbrella review of high-quality systematic reviews. Phys Ther. 2007 Dec;87(12):1716-27. • Doi T, Akai M, Fujino K, Iwaya T, Kurosawa H, Hayashi K, et al. Effect of home exercise of quadriceps on knee osteoarthritis compared with nonsteroidal antiinflammatory drugs: a randomized controlled trial. Am J Phys Med Rehabil. 2008 Apr;87(4):258-69. • Jan MH, Tang PF, Lin JJ, Tseng SC, Lin YF, Lin DH. Efficacy of a target- matching foot-stepping exercise on proprioception and function in patients with knee osteoarthritis. J Orthop Sports Phys Ther. 2008 Jan;38(1):19-25. • Jan MH, Lin JJ, Liau JJ, Lin YF, Lin DH. Investigation of clinical effects of high- and low-resistance training for patients with knee osteoarthritis: a randomized controlled trial. Phys Ther. 2008 Apr;88(4):427-36. • Lim BW, Hinman RS, Wrigley TV, Sharma L, Bennell KL. Does knee malalignment mediate the effects of quadriceps strengthening on knee adduction moment, pain, and function in medial knee osteoarthritis? A randomized controlled trial. Arthritis Rheum. 2008 Jul 15;59(7):943-51. • Aglamis B, Toraman NF, Yaman H. The effect of a 12-week supervised multicomponent exercise program on knee OA in Turkish women. J Back Musculo Rehab. 2008;(2):121-8. (2) • Welch V, Brosseau L, Peterson J, Shea B, Tugwell P, Wells G. Therapeutic ultrasound for osteoarthritis of the knee. Cochrane Database Syst Rev. 2001;(3):CD003132. • Kozanoglu E, Basaran S, Guzel R, Guler-Uysal F. Short term efficacy of ibuprofen phonophoresis versus continuous ultrasound therapy in knee osteoarthritis. Swiss Med Wkly. 2003 Jun 14;133(2324):333-8. • Huang MH, Lin YS, Lee CL, Yang RC. Use of ultrasound to increase effectiveness of isokinetic exercise for knee osteoarthritis. Arch Phys Med Rehabil. 2005 Aug;86(8):1545-51. • Ozgonenel L, Aytekin E, Durmusoglu G. A double-blind trial of clinical effects of therapeutic ultrasound in knee osteoarthritis. Ultrasound Med Biol. 2009 Jan;35(1):44-9. • Warden SJ, Hinman RS, Watson Jr. MA, Avin KG, Bialokerkowski AE, Crossley KM. Patellar taping and bracing for the treatment of chronic knee pain: a systematic review and meta-analysis. Arthritis Rheum. 2008 Jan 15;59(1):73-83. • Quilty B, Tucker M, Campbell R, Dieppe P. Physiotherapy, including quadriceps exercises and patellar taping, for knee osteoarthritis with predominant patello-femoral joint involvement: randomized controlled trial. J Rheumatol. 2003 Jun;30(6):1311-7. (4) • Bjordal JM, Johnson MI, Lopes-Martins RA, Bogen B, Chow R, Ljunggren AE. Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials. BMC Musculoskelet Disord. 2007;8:51. • Cantarini L, Leo G, Giannitti C, Cevenini G, Barberini P, Fioravanti A. Therapeutic effect of spa therapy and short wave therapy in knee osteoarthritis: A randomized, single blind, controlled trial. Rheumatol Int. 2007;27(6):523-9. • Ay S, Evcik D. The effects of pulsed electromagnetic fields in the treatment of knee osteoarthritis: a randomized, placebo-controlled trial. Rheumatol Int. 2009;29(6)663-6. • Rattanachaiyanont M, Kuptniratsaikul V. No additional benefit of shortwave diathermy over exercise program for knee osteoarthritis in peri-/post-menopausal women: an equivalence trial. Osteoarthritis Cartilage 2008 Jul;16(7):823-8. • Bartels EM, Lund H, Hagen KB, et al. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev. 2007;(4):CD005523. • van Baar ME, Dekker J, Oostendorp RA, Bijl D, Voorn TB, Bijlsma JW. Effectiveness of exercise in patients with osteoarthritis of hip or knee: nine months' follow up. Ann Rheum Dis. 2001;60(12):1123-1130.