Artículos Seleccionados 1998 - REUMATOLOGIA

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A randomized controlled trial to evaluate the efficacy of community based physical therapy in the treatment of people with rheumatoid arthritis.

Management of localized scleroderma.

Nonmedicinal therapies for osteoarthritis.

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Título en Inglés: A randomized controlled trial to evaluate the efficacy of community based physical therapy in the treatment of people with rheumatoid arthritis.

Autor/es: Bell-MJ; Lineker-SC; Wilkins-AL; Goldsmith-CH; Badley-EM

Lugar: Arthritis Community Research and Evaluation Unit, Wellesley Hospital Research Institute, Toronto, Ontario, Canada. drmjbell@ibm.net

Fuente: J-Rheumatol. 1998 Feb; 25(2): 231-7

ISSN: 0315-162X

Idioma: ENGLISH

Resumen: OBJECTIVE: To evaluate the short term efficacy of a community based physical therapy (PT) program for people with rheumatoid arthritis (RA) through a single blind randomized controlled trial. METHODS: Adults with active RA were referred by their physician for community based PT. Participants were randomized to either an immediate intervention group [experimental group (EG)] or a wait list control group (CG). The intervention was a standardized program of education and exercise consisting of at least 4 visits or 3 h of PT over 6 weeks. Baseline, 6, and 12 week assessments were by a blinded independent assessor. The primary outcome instrument was the Stanford Arthritis Self-Efficacy Scale (SES) and secondary outcome measures included the ACREU Rheumatoid Arthritis Knowledge Questionnaire (KQ) and visual analog scale for pain (VAS). Duration of morning stiffness, grip strength, and tender joint count were also collected at each assessment. Outcome analysis was conducted using analysis of variance. RESULTS: Of 150 eligible and randomized participants, 127 completed the study according to protocol. Baseline analysis showed no differences between the EG and CG for demographics, disease status, or other characteristics. At the 6 week assessment, primary outcome analysis for those who completed the protocol identified a mean change (improvement) of 13.5% in the EG and 5.8% in the CG, representing a 7.7% difference in change scores between the 2 groups [F(1,121) = 6.03; p = 0.015]. A statistically significant difference in change scores was also identified for the KQ [F(1,120) = 6.67; p = 0.011], but not for the VAS. Disease status measures did not change, except for duration of morning stiffness, which improved by 68.8 min in the EG and 8.3 min in the CG (F(1,121) = 4.50; p = 0.036]. CONCLUSION: Four hours of a community based PT intervention delivered over 6 weeks significantly improved self-efficacy, disease management knowledge and morning stiffness in people with RA.

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Título en Inglés: Management of localized scleroderma.

Autor/es: Hunzelmann-N; Scharffetter-Kochanek-K; Hager-C; Krieg-T

Lugar: Department of Dermatology, University of Cologne, Germany.

Fuente: Semin-Cutan-Med-Surg. 1998 Mar; 17(1): 34-40

ISSN: 1085-5629

Idioma: ENGLISH

Resumen: Localized scleroderma denotes a spectrum of conditions characterized by circumscribed fibrotic areas involving different levels of the dermis, subcutis, and sometimes underlying soft tissue and bone. Although the clinical course of the disease is often benign, widespread lesions and disabling joint contractures may lead to significant complications. The pathogenesis of the different types of localized scleroderma is still unknown. Numerous therapeutic agents have been reported to be effective in this disease spectrum, but controlled studies are rare. The purpose of this review is to summarize previous experience and to discuss recent advances in the management of localized scleroderma.

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Título en Inglés: Nonmedicinal therapies for osteoarthritis.

Autor/es: Felson-DT

Lugar: Boston University School of Medicine, MA, USA.

Fuente: Bull-Rheum-Dis. 1998 Apr; 47(2): 5-7

ISSN: 0007-5248

Idioma: ENGLISH

Resumen: Given the modest efficacy of medicinal therapy for OA, nonpharmacologic therapy is popular. Convincing evidence exists to support the efficacy of exercise and muscle strengthening for patients with knee OA. Weight loss is likely to be effective, as are some types of biomechanical alterations, possibly including elastic knee supports and the use of canes and crutches. The clinical management of patients with OA should sample broadly from these treatments, especially because they may offer other health benefits as well (i.e., aerobic exercise and weight loss). The optimal use of these modalities requires a team approach to patient care, in which the physician works closely with a physical therapist and nutritionist. This integrated approach may lead to decreases in pain and disability for the patient with OA.

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