The efficacy of balneotherapy and mud-pack therapy in patients with knee osteoarthritis. Comparing the efficacy of mature mud pack and hot pack treatments for knee osteoarthritis. The effect of Neydharting mud-pack therapy on knee osteoarthritis: a randomized, controlled, double-blind follow-up pilot study
 Mud-bath therapy and oral glucosamine sulfate in patients with knee osteoarthritis: a randomized, controlled, crossover study. Effect of Mud-Bath Therapy on Serum Biomarkers in Patients with Knee Osteoarthritis: Results from a Randomized Controlled Trial. Anti-inflammatory effect as a mechanism of effectiveness underlying the clinical benefits of pelotherapy in osteoarthritis patients: regulation of the altered inflammatory and stress feedback response Effects of mud therapy on perceived pain and quality of life related to health in patients with knee osteoarthritis. One-year follow-up of mud-bath therapy in patients with bilateral knee osteoarthritis: a randomized, single-blind controlled trial Hydrotherapy Versus Conventional Land-Based Exercise for the Management of Patients With Osteoarthritis of the Knee: A Randomized Clinical Trial Therapy With Mud Compresses for Knee Osteoarthritis: Comparison of Natural Mud Preparations With Mineral-Depleted Mud Tidal irrigation as treatment for knee osteoarthritis: a sham-controlled, randomized, double-blinded evaluation. Mud pack therapy in osteoarthrosis. Changes in serum levels of chondrocyte markers. The effectiveness of a self-management program on quality of life for knee osteoarthritis (OA) patients. Randomised controlled trial of the cost-effectiveness of water-based therapy for lower limb osteoarthritis. Therapeutic home exercise versus intraarticular hyaluronate injection for osteoarthritis of the knee: 6-month prospective randomized open-labeled trial EULAR recommendations for the management of knee osteoarthritis: report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT) Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial.
OBJECTIVES Knee osteoarthritis ( OA ) is a common chronic degenerative disorder . There are various treatment modalities . This study was planned to investigate the efficacy of balneotherapy , mud-pack therapy in patients with knee OA . METHODS A total of 80 patients with knee OA were included . Their ages ranged between 39 - 78 . The patients were separated in to three groups . Group I ( n=25 ) received balneotherapy , group II ( n=29 ) received mud-pack therapy and group III ( n=26 ) was hot-pack therapy group . The therapies were applied for 20 min duration , once a day , five times per week and a total of 10 session . Patients were assessed according to pain , functional capacity and quality of life parameters . Pain was assessed by using Visual Analogue Scale ( VAS ) and Western Ontario McMaster Osteoarthritis Index ( WOMAC ) pain scale ( 0 - 4 likert scale ) . Functional capacity was assessed by using WOMAC functional capacity and WOMAC global index . Quality of life was evaluated by Nottingham Health Profile ( NHP ) self-administered question naire . Also physician 's global assessment and the maximum distance that patient can walk without pain , were evaluated . The assessment parameters were evaluated before and after three months . RESULTS There were statistically significant improvement in VAS and WOMAC pain scores in group I ( p<0.001 ) , group II and III ( p<0.05 ) . The WOMAC functional and global index also decreased in group I ( p<0.05 ) , group II ( p<0.001 ) and hot-pack group ( p<0.05 ) . Quality of life results were significantly improved in balneotherapy and mud-pack therapy groups ( p<0.05 ) . No difference was observed in hot-pack therapy group ( p>0.05 ) . The maximum distance was improved both in group I and II ( p<0.05 ) but not in group III . Also physician 's global assessment was found to be improved in all groups ( p<0.05 ) . CONCLUSIONS Balneotherapy and mud-pack therapy were effective in treating patients with knee OA OBJECTIVE The objective of this study is to compare the efficacy of mature mud pack and hot pack therapies on patients with knee osteoarthritis . DESIGN This study was design ed as a prospect i ve , r and omized-controlled , and single-blinded clinical trial . Twenty-seven patients with clinical and radiologic evidence of knee osteoarthritis were r and omly assigned into two groups and were treated with mature mud packs ( n 15 ) or hot packs ( n=12 ) . Patients were evaluated for pain [ based on the visual analog scale ( VAS ) ] , function ( WOMAC , 6 min walking distance ) , quality of life [ Short Form-36 ( SF-36 ) ] , and serum levels of tumor necrosis factor-alpha ( TNF-α ) , interleukin-6 ( IL-6 ) , and insulin-like growth factor-1 ( IGF-1 ) at baseline , post-treatment , and 3 and 6~months after treatment . RESULTS The mud pack group shows a significant improvement in VAS , pain , stifness , and physical function domains of WOMAC . The difference between groups of pain and physical activity domains is significant at post-treatment in favor of mud pack . For a 6 min walking distance  , mud pack shows significant improvement , and the difference is significant between groups in favor of mud pack at post-treatment and 3 and 6 months after treatment . Mud pack shows significant improvement in the pain subscale of SF-36 at the third month continuing until the sixth month after the treatment . Significant improvements are found for the social function , vitality/energy , physical role disability , and general health subscales of SF-36 in favor of the mud pack compared with the hot pack group at post-treatment . A significant increase is detected for IGF-1 in the mud pack group 3 months after treatment compared with the baseline , and the difference is significant between groups 3 months after the treatment . CONCLUSION Mud pack is a favorable option compared with hotpack for pain relief and for the improvement of functional conditions in treating patients with knee osteoarthritis The aim of this study was to evaluate the effects of Neydharting mud-pack therapy on the clinical parameters and quality of life in patients with knee osteoarthritis . In this double-blind , r and omized , follow-up study on 53 patients with knee osteoarthritis , one group received hot mud-pack therapy , whereas the other ( control ) group was treated with hot packs of a substance manufactured on 10 occasions for 2 weeks . Western Ontario and McMaster Universities Arthritis Index ( WOMAC ) , EuroQoL-5D quality -of-life measure and need for analgesics and non-steroidal anti-inflammatory drugs were recorded before treatment , at the end of treatment ( at Week 2 ) , and at Weeks 6 and 12 . The WOMAC and the EQ5D quality -of-life scores improved from the baseline to the end of treatment in both groups , and further improvement was observed during the follow-up period ( p < 0.001 , respectively , in both groups ) . The need for medications for knee joint pain improved in both groups , and these changes were significant only in the mud-treated group ( p < 0.001 ) , but not in the control group ( p = 0.106 ) compared to baseline . The number of patients requiring medications for knee joint pain showed a continuous downward trend at the subsequent post-treatment visits by the mud-treated group , and these changes became significant by Visit 4 compared to baseline ( p = 0.016 ) . The control group showed only temporary and not significant decrease . The difference was not significant between the groups in any of the outcome parameters at any visits . The Neydharting mud pack has a favorable effect on the clinical parameters , quality of life , and need for medications in patients with knee osteoarthritis . To evaluate the chemical effect , the number of patients should be increased OBJECTIVES To evaluate the efficacy and safety of combined treatment of mud-bath therapy and glucosamine crystalline sulfate ( GlcN-S ) in patients with knee osteoarthritis ( OA ) . METHODS This study was a r and omised , controlled , crossover investigation . Patients were r and omly assigned ( 1:1 ) by the investigators to two groups , named group 1 and 2 . Group 1 included twenty-three patients receiving oral GlcN-S treatment from the beginning of the study  ( T0 ) to the end of the 3rd month of treatment ( T3 ) and a combined treatment of both mud-bath therapy and GlcN-S from T3 to the end of the study at six months ( T6 ) . Group 2 included twenty-two patients receiving a combined treatment of both mud-bath therapy and GlcN-S from T0 to T3 and that discontinued mud-bath therapy , receiving GlcN-S treatment alone , from T3 to T6 . Primary endpoints of the study consisted of evaluating OA severity and activity at baseline and at follow-up visits . RESULTS All 45 patients , eligible for the study , completed the period of the crossover . In group 1 , no significant difference was shown in the comparison from T0 to T3 , while from T3 to T6 most variables were significantly improved . In group 2 , instead , the comparison between T0 and T3 showed a significant difference in different parameters . When comparing T3 and T6 , despite an improvement of all the variables , no significant difference was shown . CONCLUSIONS The association of GlcN-S and mud-bath therapy has a positive and safe role in improving pain , function and quality of life in knee OA patients BACKGROUND Balneotherapy is one of the most commonly used non-pharmacological approaches for osteoarthritis ( OA ) . Recent data indicate that some biomarkers could be useful to predict OA progression and to assess therapeutic response . OBJECTIVES To evaluate the effects of mud-bath therapy on serum biomarkers in patients with knee OA . METHODS The study group comprised 103 patients with primary symptomatic bilateral knee OA who were r and omly assigned to receive a  cycle of mud-bath therapy over a period of 2 weeks or to continue their st and ard therapy alone . Clinical and biochemical parameters were assessed at baseline and after 2 weeks . Clinical assessment s included global pain score on a visual analogue scale ( VAS ) and the Western Ontario and McMaster Universities Index ( WOMAC ) subscores for knee OA . Cartilage oligomeric matrix protein ( COMP ) , C-terminal cross-linked telopeptide type II collagen ( CTX-II ) , myeloperoxidase ( MPO ) and high sensitivity C-reactive protein ( hsCRP ) serum levels were assessed by ELISA . RESULTS At the end of mud-bath therapy we observed a statistically significant improvement in VAS and WOMAC subscores . Serum levels of COMP , MPO and hsCRP did not show any significant modification in either group , while a significant increase ( P < 0.001 ) in CTX-II serum levels was observed in the mud-bath group after the treatment . CONCLUSIONS A cycle of mud-bath therapy added to the usual treatment had a beneficial effect on pain and function in patients with knee OA . The evaluation of serum biomarkers showed a significant increase of CTX-II only , perhaps due to an increase of cartilage turnover induced by thermal stress The purpose of the present investigation was to evaluate whether an anti-inflammatory effect together with an improvement of the regulation of the interaction between the inflammatory and stress responses underlies the clinical benefits of pelotherapy in osteoarthritis ( OA ) patients . This study evaluated the effects of a 10-day cycle of pelotherapy at the spa centre ‘ El Raposo ’ ( Spain ) in a group of 21 OA patients diagnosed with primary knee OA . Clinical assessment s included pain intensity using a visual analog scale ; pain , stiffness and physical function using the Western Ontario and McMaster Universities Arthritis Index ; and health-related quality of life using the EuroQol-5D question naire . Serum inflammatory cytokine levels ( IL-1β , TNF-α , IL-8 , IL-6 , IL-10 and TGF-β ) were evaluated using the Bio-Plex ® Luminex ® system . Circulating neuroendocrine-stress biomarkers , such as cortisol and extracellular 72 kDa heat shock protein ( eHsp72 ) , were measured by ELISA . After the cycle of mud therapy , OA patients improved the knee flexion angle and OA-related pain , stiffness and physical function , and they reported a better health-related quality of life . Serum concentrations of IL-1β , TNF-α , IL-8 , IL-6 and TGF-β , as well as eHsp72 , were markedly decreased . Besides , systemic levels of cortisol increased significantly . These results confirm that the clinical benefits of mud therapy may well be mediated , at least in part , by its systemic anti-inflammatory effects and neuroendocrine-immune regulation in OA patients . Thus , mud therapy could be an effective alternative treatment in the management of OA OBJECTIVE To analyze the effects of mud therapy on perceived pain , Health Related Quality of Life ( HRQL ) and drug use in patients diagnosed with knee osteoarthritis . MATERIAL AND METHODS A prospect i ve , controlled clinical trial . The sample ( n=147 ) was divided into an experimental group ( EG ) of 61 subjects ( 69.13 ± 5,60 years ) who received 11 consecutive sessions of peloids in the knee/s affected by the process described and a control group ( CG ) of 60 subjects ( 73.08 ± 8,90 years ) who continued routine drug treatment . The sample was assessed before and after intervention using the SF-36 , Visual Analogue Scale and changes in drug use , setting a significance level of P ≤ .05 . RESULTS After the intervention , there were statistically significant differences ( P<.05 ) in all parameters analyzed between EG and CG , reduced drug use in the EG versus no change in the CG . The general health , bodily pain and perceived pain are those that show major changes between the two groups . CONCLUSIONS Mud therapy in patients diagnosed with knee osteoarthritis attains immediate effects on perceived pain and HRQOL , reducing the consumption of specific drugs . Studies are needed to evaluate the scientific evidence from the effects of such intervention The objective of this prospect i ve parallel r and omized single-blind study was to assess that a cycle of mud-bath therapy ( MBT ) provides any benefits over usual treatment in patients with bilateral knee osteoarthritis ( OA ) . Patients with symptomatic primary bilateral knee OA , according to ACR criteria , were included in the study and r and omized to one of two groups : one group received a cycle of MBT at spa center of Chianciano Terme ( Italy )  in addition to the usual treatment , and one group continued their regular care routine alone .  Clinical assessment s were performed 7 days before enrollment ( screening visit ) , at the time of enrollment ( basal time ) , after 2 weeks , and after 3 , 6 , 9 , and 12 months after the beginning of the study . All assessment s were conducted by two research ers blinded to treatment allocation . The primary efficacy outcomes were the global pain score evaluated by Visual Analog Scale ( VAS ) and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) subscore for physical function ( W-TPFS ) .  Of the 235 patients screened , 103 met the inclusion criteria : 53 patients were included in the MBT group and 50 in the control group . In the group of patients treated with MBT , we observed a statistically significant ( p < 0.001 ) reduction of VAS and W-TPFS score at the end of the treatment ; this improvement was significant ( p < 0.05 ) also at 3 months of follow-up . The control group did not show significant differences between baseline time and all other times . The differences between one group were significant for both primary parameters already from the 15th day and persisted up to the 9th month . This beneficial effect was confirmed by the significant reduction of symptomatic drug consumption . Tolerability of MBT seemed to be good , with light and transitory side effects . Our results confirm that a cycle of MBT added to usual treatment provides a beneficial effect on the painful symptoms and functional capacities in patients with knee OA that lasts over time . Mud-bath therapy can represent a useful backup to pharmacologic treatment of knee OA or a valid alternative for patients who do not tolerate pharmacological treatments Background and Purpose : This study was design ed to evaluate the effectiveness of hydrotherapy in subjects with osteoarthritis ( OA ) of the knee compared with subjects with OA of the knee who performed l and -based exercises .  Subjects and Methods : Sixty-four subjects with OA of the knee were r and omly assigned to 1 of 2 groups that performed exercises for 18 weeks : a water-based exercise group and a l and -based exercise group . The outcome measures included a visual analog scale ( VAS ) for pain in the previous week , the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , pain during gait assessed by a VAS at rest and immediately following a 50-foot ( 15.24-m ) walk test ( 50FWT ) , walking time measured at fast and comfortable paces during the 50FWT , and the Lequesne Index . Measurements were recorded by a blinded investigator at baseline and at 9 and 18 weeks after initiating the intervention . Results : The 2 groups were homogenous regarding all parameters at baseline . Reductions in pain and improvements in WOMAC and Lequesne index scores were similar between groups . Pain before and after the 50FWT decreased significantly over time in both groups . However , the water-based exercise group experienced a significantly greater decrease in pain than the l and -based exercise group before and after the 50FWT at the week-18 follow-up . Discussion and Conclusion : Both water-based and l and -based exercises reduced knee pain and increased knee function in participants with OA of the knee .  Hydrotherapy was superior to l and -based exercise in relieving pain before and after walking during the last follow-up . Water-based exercises are a suitable and effective alternative for the management of OA of the knee Mud pack therapy is an alternative mode of treatment for rheumatic diseases . It is based on the application of heated mud packs to the entire body or to specific areas , such as over joints . The aim of the current study was to evaluate the efficacy of treatment with mud compresses at patients ’ homes for osteoarthritis of the knee . Fifty-eight patients with osteoarthritis of the knee were enrolled in a prospect i ve , double-blinded , controlled study . Forty patients were treated with natural mineral-rich mud compresses and 18 patients were treated with mineral-depleted mud compresses . Mud compresses were applied 5 times each week during 3 weeks for a total of 15 treatments . Patients were assessed at baseline , at completion of the 3-week treatment period , and twice after the conclusion of the treatment period — after 1 month and after 3 months . The main outcome measures were the Lequesne Index of severity of knee osteoarthritis , patient self- assessment of pain , and severity of knee pain on a visual analog scale . A reduction of 20 % or more in the pain scores was considered clinical ly significant . In the group treated with natural mud compresses , a significant reduction in knee pain was observed at all assessment s. Similarly , improvement in the Lequesne Index was seen at the end of therapy and a month after treatment . In the control group , given mineral-depleted mud compresses , no significant change in knee pain was seen at any assessment . Improvement in the Lequesne Index was seen 1 and 3 months after completion of the therapy , but not at the end of therapy . Seventy-two percent of the patients in the treatment group had an improvement of > 20 % in self- assessment of knee pain , compared with 33 % in the control group ( p = 0.005).The data suggest that treatment with mud compresses , but only in their natural form , temporarily relieves pain in patients with osteoarthritis of the knees . We believe that treatment with mud compresses might augment conventional medical therapy in these patients OBJECTIVE To evaluate the effectiveness of tidal irrigation ( TI ) in comparison with a well-matched sham irrigation ( SI ) procedure as a treatment for knee osteoarthritis ( OA ) . METHODS One hundred eighty subjects with knee OA were r and omized to receive TI or SI , with clinical followup over the ensuing 12 months . The primary outcomes of interest were change in pain and function , as measured by the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Subjects and the nurse assessor were blinded , and success of blinding was assessed . RESULTS Although the study groups were otherwise comparable , the baseline WOMAC pain and physical functioning scores were higher ( worse ) in the SI group . After adjustment for baseline , there were no differences between the effects We have previously shown that thermal mud therapy is able to influence chondrocyte activity of osteoarthrosic patients by modulating the production of serum cytokines , such as interleukin 1 , and this was related to the presence of an anti-inflammatory principle in mature thermal mud . Mud therapy influences many biochemical processes of the body , independently of the thermic stimulation alone and the present paper documents specific increases of insulin growth factor 1 and decreases of tumor necrosis factor alpha in serum of osteoarthrosic patients after 12 days of mud pack application PURPOSE To evaluate the effectiveness of the Taipei Osteoarthritis Program ( TOAP ) for community elderly persons who suffer from knee OA . METHODS A quasi-experimental study was conducted between January 2008 and December 2008 . Two hundred and five community-dwelling individuals aged 67±10 years with knee OA were recruited from four districts in Taipei City and r and omized . By a clustered r and omization according to the districts , 114 participants were in the intervention group ( IG ) with a 4-week TOAP program and 91 participants were in the control group ( CG ) with routine care . The main outcome measures included health-related quality of life ( HRQOL ) and disability level , which were assessed by the Short Form-36 Taiwan Version ( T-SF36 ) and the Western Ontario McMaster Universities Arthritis Index Taiwan Version ( T-WOMAC ) , respectively , and were repeatedly measured at the baseline , post invention ( 4 weeks after baseline ) , and follow-up ( 8 weeks after baseline ) . RESULTS Subjects in the IG increased their changes of GH scores from baseline to post-intervention and follow-up , which were significantly more than those of subjects in the CG ( p=0.011 and 0.005 , respectively ) . Significant difference of changes was also found at follow-up for the mental component scale between the groups ( p=0.013 ) . There was no change in disability level . CONCLUSIONS The arthritis self-management program improved the psychological outcomes among the participants , but it had no significant effect on a self-reported disability level OBJECTIVES To determine the efficacy of community water-based therapy for the management of lower limb osteoarthritis ( OA ) in older patients . DESIGN A pre-experimental matched-control study was used to estimate efficacy of water-based exercise treatment , to check design assumptions and delivery processes . The main study was a r and omised controlled trial of the effectiveness of water-based exercise ( treatment ) compared with usual care ( control ) in older patients with hip and /or knee OA . The latter was accompanied by an economic evaluation comparing societal costs and consequences of the two treatments . SETTING Water exercise was delivered in public swimming pools in the UK . Physical function assessment s were carried out in established laboratory setting s. PARTICIPANTS 106 patients ( 93 women , 13 men ) over the age of 60 years with confirmed hip and /or knee OA took part in the preliminary study . A similar , but larger , group of 312 patients ( 196 women , 116 men ) took part in the main study , r and omised into control ( 159 ) and water exercise ( 153 ) groups . INTERVENTIONS  Control group patients  received usual care with quarterly semi-structured telephone interview follow-up only . The intervention in the main study lasted for 1 year , with a further follow-up period of 6 months . MAIN OUTCOME MEASURES Pain score on the Western Ontario and McMaster Universities OA index ( WOMAC ) . Additional outcome measures were included to evaluate effects on quality of life , cost-effectiveness and physical function measurements . RESULTS Short-term efficacy of water exercise in the management of lower limb OA was confirmed , with effect sizes ranging from 0.44 [ 95 % confidence interval ( CI ) 0.03 to 0.85 ] on WOMAC pain to 0.76 ( 95 % CI 0.33 to 1.17 ) on WOMAC physical function . Of 153 patients r and omised to treatment , 82 ( 53.5 % ) were estimated to have complied satisfactorily with their treatment at the 1-year point . This had declined to 28 ( 18 % ) by the end of the 6-month follow-up period , during which support for the intervention had been removed and those wishing to continue exercise had to pay their own costs for maintaining their exercise treatment . High levels of co-morbidity were recorded in both groups . Nearly two thirds of all patients had a significant other illness in addition to their OA . Fifty-four control and 53 exercise patients had hospital inpatient episodes during the study period . Water exercise remained effective in the main study but overall effect size was small , on WOMAC pain at 1 year , a reduction of about 10 % in group mean pain score . This had declined , and was non-significant , at 18 months . Mean cost difference estimates showed a saving in the water exercise group of pound123 - -175 per patient per annum and incremental cost-effectiveness ratios ranged from pound3838 to pound5951 per quality -adjusted life-year ( QALY ) . Net reduction in pain was achieved at a net saving of pound135 - -175 per patient per annum and the ceiling valuation of pound580 - -740 per unit of WOMAC pain reduction was favourably low . CONCLUSIONS Group-based exercise in water over 1 year can produce significant reduction in pain and improvement in physical function in older adults with lower limb OA , and may be a useful adjunct in the management of hip and /or knee OA . The water-exercise programme produced a favourable cost -- benefit outcome , using reduction in WOMAC pain as the measure of benefit . Further research is suggested into other similar public health interventions . Investigation is also needed into how general practice can best be supported to facilitate access to participants for research trials in healthcare , as well as an examination of the infrastructure and workforce capacities for physical activity delivery and the potential extent to which healthcare may be supported in this way . More detailed research is required to develop a better underst and ing of the types of exercise that will work for the different biomechanical subtypes of knee and hip OA and investigation is needed on access and environmental issues for physical activity programmes for older people , from both a provider and a participant perspective , the societal costs of the different approaches to the management of OA and longer term trends in outcome measures ( costs and effects ) Background Treatment for osteoarthritis ( OA ) of the knee is controversial . Only a few studies have compared the effects of intraarticular injection of hyaluronate with those of home exercise for knee OA . We prospect ively evaluated the therapeutic effects of each treatment . Methods A total of 102 female subjects ( mean age 70.4 years ) were r and omly divided into two groups and followed up to the 24th week . The primary outcome measure was judged by three pain/function scales as follows : a visual analogue scale , the Japanese Knee Osteoarthritis Measure , and the Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International criteria . For secondary outcome measures , all data were categorized for logistic regression analysis and the chi-squared test to address factors affecting these outcomes . Results The two treatment groups demonstrated equal improvement regarding all three scales , and there was statistically no difference in between-group analyses , although there seemed to be better improvement in range of motion at 24 weeks in the home exercise group . In categorical analysis , OA stage was classified as early and advanced OA at 3 mm of joint space width obtained from st and ing anteroposterior radiographs . Logistic regression analysis revealed that the OA stage at the baseline of the knee affected these improvements . For early OA the improvement rate regarding hydrops was significantly higher in the home exercise group , whereas for advanced OA there was a tendency for the rate of improvement in ROM to be inferior in the hyaluroni date group . Conclusions Taking into account the cost , convenience , and invasiveness to patients , exercise is thought to have some advantage over intraarticular injection of hyaluronate for the therapy of OA of the knee BACKGROUND Osteoarthritis ( OA ) is the most common joint disease encountered throughout Europe . A task force for the EULAR St and ing Committee for Clinical Trials met in 1998 to determine the method ological and logistical approach required for the development of evidence based guidelines for treatment of knee OA . The guidelines were restricted to cover all currently available treatments for knee OA diagnosed either clinical ly and /or radiographically affecting any compartment of the knee . METHODS The first stage was the selection of treatment modalities to be considered . The second stage comprised a search of the electronic data bases Medline and Embase using a combination of subject headings and keywords . All European language publications in the form of systematic review s , meta-analyses , r and omised controlled trials , controlled trials , and observational studies were included . During stage three all the relevant studies were quality scored . The summary statistics for vali date d outcome measures , when available , were recorded and , where practical , the numbers needed to treat and the effect size for each treatment were calculated . In the fourth stage key clinical propositions were determined by expert consensus employing a Delphi approach . The final stage ranked these propositions according to the available evidence . A second set of propositions relating to a future research agenda was determined by expert consensus using a Delphi approach . RESULTS Over 2400 English language publications and 400 non-English language publications were identified . Seven hundred and forty four studies presented outcome data of the effects of specific treatments on knee OA . Quantitative analysis of treatment effect was possible in only 61 studies . Recommendations for the management of knee OA based on currently available data and expert opinion are presented . Proposals for a future research agenda are highlighted . CONCLUSIONS These are the first clinical guidelines on knee OA to combine an evidence based approach and a consensus approach across a wide range of treatment modalities . It is apparent that certain clinical propositions are supported by substantial research based evidence , while others are not . There is thus an urgent need for future well design ed trials to consider key clinical questions OBJECTIVE To assess the effectiveness of physical therapy , given either as an individually attended treatment or in a small group format , in terms of pain , physical function , and health related quality of life for patients with osteoarthritis ( OA ) of the knee . METHODS After 2 baseline assessment s , 126 patients were r and omized into one of 3 allocation arms : individual treatments ( n = 43 ) , small group format program ( n = 40 ) , and waiting list control ( n = 43 ) . After re assessment at 8 weeks , patients allocated to waiting list control were r and omized into one of the 2 active treatment arms . Assessment s included both self-report measures ( WOMAC , SF-36 ) and objective measures of physical performance ( gait analysis and muscle strength ) . RESULTS Both physical therapy treatment allocations result ed in significant improvements in pain , physical function , and health related quality of life above the control group ( st and ardized response mean 0.36 to 0.65 ) . Improvements in the self-report measures were substantiated by significant correlated improvements in knee extensor strength and fast walking speed ( rho 0.36 - 0.42 ) . There were no significant differences in effectiveness between the 2 physical therapy allocations for any of the measured outcomes . Improvements gained were maintained for at least 2 months . Responsiveness to treatment was modified by loss of medial joint space width , the interaction being significant for physical function , gait , and knee extensor strength . CONCLUSION Physical therapy , either as an individually delivered treatment or in a small group format , is an effective intervention for patients with knee OA . Responsiveness to this 8 week intervention was modified by loss of medial joint space width
CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA .
OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA .