Physikalische Therapie der Arthrose - Was ist gesichert?

Physikalische Therapieformen vermögen unter anderem die pathogenetische Entwicklung der Arthrose zu hemmen, indem sie die trophischen Bedingungen des Gelenkknorpels durch Wärmeeinfluss verbessern, myalgisch-myasthenische Dekompensationssyndrome dämpfen und kompensieren. Für diese werden Schmerzbeeinflussung durch Elektrotherapie, Muskeltonusausgleich durch Massagen, gezielte Ausgleichübungen sowie Beweglichkeits-, Kraft- und Koordinationserhalt durch die spezifische Bewegungstherapie angestrebt. Auch die Synovialitis bei aktivierter Arthrose scheint durch entzündungsdämpfende, physikalisch-therapeutische Maßnahmen beeinflussbar.

Inwieweit diese Maßnahmen durch Studienergebnisse gesichert werden konnten, soll anhand einer Literaturanalyse dargelegt werden. Ihre Ergebnisse sowie Probleme in der Beurteilung der Datenlage und bei der Durchführung kontrollierter Studien zur physikalischen Therapie der Arthrose werden aufgezeigt und diskutiert.

Physical therapy may inhibit the pathogenetic development of osteoarthritis by improving trophic conditions in the joint cartilage through heat transfer and by soothing myalgic-myasthenic decompensation syndromes. For the decompensation syndrome, analgetic treatment with electrotherapy, balancing of muscular tone through massages, and focused kinesitherapy for improving coordination, as well as maintenance of flexibility, strength and endurance are aspired to. Synovitis in active osteoarthritis can be treated with anti-inflammatory physical therapy measures.

Which physical therapy for osteoarthritis is based on scientific research in literature is reviewed and the results, as well as the problems concerning the data and the design of a controlled study to physical therapies for osteoarthritis, are presented and discussed.

Key words

osteoarthritis - physical therapy - evaluation

Literatur

• 1 Akai M, Shirasaki Y, Tateishi T.. Electrical stimulation on joint contracture: an experiment in rat model with direct current.  Arch Phys Med Rehabil. 1997;  78 405-409
• 2 Baker K, McAlindon T.. Exercise for knee osteoarthritis.  Current Opinion in Rheumatology. 2000;  12 456-463
• 3 Bautch JC, Malone DG, Vailas AC.. Effects of exercise on knee joints with osteoarthritis: a pilot study of biologic markers.  Arthritis Care Res. 1997;  10 48-55
• 4 Bellometti S, Cecchettin M, Lalli A, Galzigna L.. Mud pack treatment increases serum a anti-oxidant defense in osteoarthrosic patients.  Biomed Pharmacother. 1996;  50 37
• 5 Bellometti S, Cechettin M, Galzigna L.. Mud pack therapy in osteoarthrosis changes in serum levels of chondrocyte markers.  Clinica Chimica Acta. 1997;  268 101-106
• 6 Brandt KD.. Nonsurgical management of osteoarthritis, with an emphasis on nonpharmacologic measures.  Arch Fam Med. 1995;  4 1057-1064
• 7 Chard JA, Tallon D, Dieppe PA.. Epidemiology of research into interventions for the treatment of osteoarthritis of the knee joint.  Ann Rheum Dis. 2000;  59 414-418
• 8 Easton BT.. Evaluation and treatment of the patient with osteoarthritis.  J Fam Practice. 2001;  50 791-797
• 9 Elkayam O, Wigler I, Tishler M. et al. . Effect of spa therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis.  J Rheumatol. 1991;  12 1799-1803
• 10 Engel JM.. Schmerztherapie der Arthrose.  Internist. 1994;  35 41-48
• 11 Ernst E, Pittler MH.. Wie effektiv ist die Kur? Eine systematische Übersicht randomisierter Studien.  Dtsch Med Wschr. 1998;  123 273-277
• 12 Ettinger WH, Afable RF.. Physical disability from knee osteoarthritis: the role of exercise as an intervention. Med Sci Sports Exer 1994: 1435-1440
• 13 Falconer J, Hayes KW, Chang RW.. Effect of ultrasound on mobility in osteoarthritis of the knee.  Arthritis Care Res. 1992;  5 29-37
• 14 Fisher NM, White SC, Yack HJ. et al. . Muscle function and gait in patients with knee osteoarthritis before and after muscle rehabilitation.  Disability Rehabil. 1997;  19 47-55
• 15 Forestier R.. Magnitude and duration of the effects of two spa therapy courses on knee and hip osteoarthritis: an open prospective study in 51 consecutive patients.  Joint Bone Spine. 2000;  67 296-304
• 16 Goddard R, Dowson D, Longfield MD, Wright V.. Steifheit des Knies bei Gesunden und bei Arthrosepatienten.  Schweiz med Wschr. 1970;  100 862-867
• 17 Gür H, Cakin N, Akova B. et al. . Concentric versus combined concentriceccentric isokinetic training: effects on functional capacity and symptoms in patients with osteoarthritis of the knee.  Arch Phys Med Rehabil. 2002;  83 308-316
• 18 Hulme J, Robinson V, DeBie R. et al. .Electromagnetic fields for the treatment of osteoarthritis. Cochrane Library, Issue 2 Oxford: Update Software 2002: 1-11
• 19 Hurley M, Walsh N.. Physical, functional and other non-pharmacological interventions for osteoarthritis.  Best Practise Res Clin Rheumatol. 2001;  4 569-581
• 20 Hurley MV, Scott DL.. Improvements in quadriceps sensorimotor function and disability of patients with knee osteoarthritis following a clinically practicable exercise regime.  Bri J Rheumatol. 1998;  37 1181-1187
• 21 Jacobi E, Wolf J, Jäckel W, Krüskemper HL.. Untersuchungen zur physikalischen Therapie der Coxarthrose.  Akt Rheumatol. 1982;  7 14-18
• 22 Jan MH, Lai JS.. The effects of physiotherapy on osteoarthritic knees of females.  J Formosan Med Assoc. 1991;  90 1008-1013
• 23 Leivseth G, Torstensson J, Reikeras O.. Effect of passive muscle stretching in osteoarthritis of the hip.  Clin Sci. 1989;  76 113-117
• 24 Linsheng W, Yanli J.. Treatment of bony gonarthritis with herbal medicine and by massotherapy - Analysis of 121 cases.  J Tr Chin Med. 1997;  17 32-36
• 25 Madsen OR, Bliddal H, Egsmose C, Sylvest J.. Isometric and isokinetic quadriceps strength in gonarthrosis; inter-relations between quadriceps strength, walking ability, radiology, subchondral bone density and pain.  Clin Rheumatol. 1995;  3 308-314
• 26 Mangione KK, McCully K, Gloviak A. et al. . The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis.  J Gerontol Med Sci. 1999;  54
• 27 Marks R, De F. Palma. Clinical efficacy of low power laser therapy in osteoarthritis.  Physiother Res Int. 1999;  4 141-157
• 28 McKinney RH, Ling SM.. Osteoarthritis: no cure, but many options for symptom relief.  Cleveland Clin J Med. 2000;  67 665-671
• 29 Nyholm A, Johannsen F.. Ultrasound therapy in musculoskeletal disorders: a meta-analysis.  Pain. 1995;  63 85-91
• 30 Osiri M, Welch V, Brosseau L. et al. .Transcutaneous electrical nerve stimulation for knee osteoarthritis. Cochrane Library, Issue 2 Oxford: Update Software 2002: 1-14
• 31 Penninx BWJH, Messier SP, Rejeski J. et al. . Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis.  Arch Int Med. 2001;  161 2309-2316
• 32 Perkins PJ, Doherty M.. Nonpharmacologic therapy of osteoarthritis.  Curr Rheumatol Rep. 1999;  1 48-53
• 33 Puett DW, Griffin MR.. Published trials of nonmedicinal and noninvasive therapies for hip and knee osteoarthritis.  Ann Int Med. 1994;  121 133-140
• 34 Quirk AS, Newmann RJ, Newmann KJ.. An evaluation of interferential therapy, shortwave diathermy and exercise in the treatment of osteoarthritis of the knee.  Physiother. 1985;  71 55-57
• 35 Quittan M, Schuhfried O, Wiesinger GF, Fialka-Moser V.. Klinische Wirksamkeiten der Magnetfeldtherapie - eine Literaturübersicht.  Acta Med Austr. 2000;  3 61-68
• 36 Schmidt KL.. Physikalische Therapie und Balneotherapie der Arthrosen.  Ther Umsch. 1991;  48 46-51
• 37 Stamm TA, Machold KP, Smolen JS. et al. . Joint protection and home hand exercises improve hand function in patients with hand osteoarthritis: a randomized controlled trial.  Arthr Care Res. 2002;  47 44-49
• 38 Stelian J, Gil I, Habot B. et al. . Improvement of pain and disability in elderly patients with degenerative osteoarthritis of the knee treated with narrow-band light therapy.  JAGS. 1992;  40 23-26
• 39 Sukenik S, Flusser D, Codish S, Abu-Shakra M.. Balneotherapy at the Dead Sea area for knee osteoarthritis.  IMAJ. 1999;  1 83-85
• 40 Svarcova J, Trnavsky K, Zvarova J.. The influence of ultrasound, galvanic currents and shortwave diathermy on pain intensity in patients with osteoarthritis.  Scand J Rheumatol. 1988;  67 83-85
• 41 van Baar ME, Assendelft WJJ, Dekker J. et al. . Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee.  Arthr Rheum. 1999;  42 1361-1369
• 42 van Baar ME, Dekker J, Oostendorp RAB. et al. . Effectiveness of exercise in patients with osteoarthritis of hip or knee: nine months` follow up.  Ann Rheum Dis. 2001;  60 1123-1130
• 43 Verhagen AP, de Vet HCW, de RA Bie. et al. .Balneotherapy for rheumatoid arthritis and osteoarthritis. Cochrane Library, Issue 2 Oxford: Update Software 2002: 1-15
• 44 Vuori IM.. Dose-response of physical activity and low back pain, osteoarthritis, and osteoporosis. Med Sci Sports Exerc 2001: 551-610
• 45 Welch V, Brosseau l, Peterson J. et al. .Therapeutic ultrasound for osteoarthritis of the knee. Cochrane Library, Issue 2 Oxford: Update Software 2002: 1-10
• 46 Wigler I, Elkayam O, Paran D, Yaron M.. Spa therapy for gonarthrosis: a prospective study.  Rheumatol Int. 1995;  15 65-68

Korrespondenz