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New guideline from the Royal Australian College of General Practitioners for the non-surgical management of hip and knee osteoarthritis: weight loss, walking, Tai Chi, cycling and Hatha yoga recommended
Best practice management of acute as well as long-term care for patients with osteoarthritis includes optimal use of medicines, non-pharmacological management, appropriate care and referral pathways, patient self-management education and psychosocial support. Non-pharmacological interventions generally have low or no side effects and are used in conjunction with a pharmacological regimen to decrease pain and promote functioning and quality of life.
The guide makes the following recommendations for non-pharmacological therapy:
- Regular exercise is important for relieving pain and improving function in people with knee and/or hip osteoarthritis. For knee osteoarthritis, land-based exercise such as muscle strengthening, walking and Tai Chi are strongly recommended. Other land-based exercise that could be considered for some people include stationary cycling and Hatha yoga. The best land-based exercise for people with hip osteoarthritis could not be determined because of limited research. Aquatic exercise may be considered for some people with knee and/or hip osteoarthritis.
- Weight management is strongly recommended for people with knee and/or hip osteoarthritis who are overweight or obese. Cognitive behavioural therapy could be considered for some people, particularly in conjunction with exercise, and taking into account existing mental health conditions, personal preference, cost and access.
- Heat packs or hot water bottles may be applied as a self-management strategy.
- Using a cane or other devices (eg, walker, crutches) may be appropriate for some people with knee and/or hip osteoarthritis to help improve pain, mobility and balance.
- A short course of manual therapy or massage could be considered for some people with knee and/or hip osteoarthritis as an adjunct to lifestyle management.
- Transcutaneous electrical nerve stimulation that can be used at home may be appropriate for some people with knee and/or hip osteoarthritis.
- There is a conditional recommendation against the following treatments: therapeutic ultrasound, shockwave therapy, laser therapy, interferential therapy, footwear marketed for knee osteoarthritis, cold therapy, valgus braces and lateral wedge insoles for medial knee osteoarthritis, patellofemoral braces and Kinesio Taping.
The Royal Australian College of General Practitioners. Guideline for the management of knee and hip osteoarthritis. 2nd edn. East Melbourne, Vic: RACGP, 2018.
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PEDro indexes 41,000+ reports
We are pleased to announce that PEDro has just achieved two new milestones for the amount of evidence. There are now 41,000+ reports of trials, reviews and guidelines indexed on PEDro.
PEDro update (3 September 2018)
PEDro contains 41,192 records. In the 3 September 2018 update you will find:
- 32,397 reports of randomised controlled trials (31,574 of these trials have confirmed ratings of methodological quality using the PEDro scale)
- 8,136 reports of systematic reviews, and
- 659 reports of evidence-based clinical practice guidelines
PEDro update (September 2018)
PEDro was updated on 3 September 2018. For latest guidelines, reviews and trials in physiotherapy visit Evidence in your inbox.
Next PEDro update (September 2018)
The next PEDro update is on Monday 3 September 2018.
More on exercise and cancer
An area of research that's rapidly developed over recent years centres around the idea that exercise can improve the treatment and outcomes of people who are diagnosed with cancer. Dr Catherine Granger reported on exercise in cancer for the the ABC Radio National Health Report Health Report. Catherine is one of the ABC's Top 5 scientists who've been learning the art of broadcasting at the ABC this year. She is a senior lecturer and research physiotherapist at the University of Melbourne and the Royal Melbourne Hospital.
Listen to the ABC Radio National Health Report on exercise and cancer.
Systematic review found that exercise after curative treatment for breast cancer might reduce mortality
This recent systematic review evaluates the effects of exercise on body composition, quality of life and survival in women after treatment of early-stage breast cancer (stage I to III). Randomised controlled trials evaluating exercise programs after the end of adjuvant treatment were included. Exercise programs could be counselling or structured, supervised or individualised. The primary outcomes were overall survival and disease-free survival. Secondary outcomes were weight loss, body mass index, waist-hip ratio, body fat, and quality of life. The review identified 60 randomised controlled trials (6,303 participants), with structured or individualised exercise being the most common types of exercise evaluated. Only one trial had data for the primary outcomes and suggested that 8 months of exercise reduced overall mortality compared to usual care (hazard ratio 0.45, 95% CI 0.21 to 0.97), but had no effect on disease-free survival (hazard ratio 0.66, 95% CI 0.38 to 1.17). There was low-quality evidence that exercise reduced body mass index (mean difference 0.89kg, 95% CI 0.28 to 1.5) and percentage body fat (mean difference 1.6%, 95% CI 0.88 to 2.31). There was very low-quality evidence that exercise reduced weight (mean difference 1.36kg, 95% CI 0.21 to 2.51), general quality of life (standardised mean difference 0.45, 95% CI 0.2 to 0.69), physical aspects of quality of life (standardised mean difference 0.51, 95% CI 0.23 to 0.79), and mental aspects of quality of life (standardised mean difference 0.28, 95% CI 0.06 to 0.5). This review highlighted the need for more well-designed and large-scale randomised controlled trials to evaluate the effects of exercise on mortality outcomes.
Soares Falcetta F, et al. Effects of physical exercise after treatment of early breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 2018;170(3):455-76
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Support for PEDro comes from Suomen Fysioterapeutit-Finlands Fysioterapeuter, Società Italiana di Fisioterapia, Singapore Physiotherapy Association, and Lietuvos Kineziterapeutų Draugija
We thank the Suomen Fysioterapeutit-Finlands Fysioterapeuter, Società Italiana di Fisioterapia, Singapore Physiotherapy Association, and Lietuvos Kineziterapeutų Draugija who have just renewed their partnerships with PEDro for another year.