Transcript Turkish Balneological Symposium Heviz, 7

EFFECT OF BALNEOTHERAPY
ON THE TEMPOROSPATIAL
GAIT CHARACTERISTICS OF
KNEE OSTEOARTHRITIS
PATIENTS
Önder KILIÇOĞLU,* Arif DÖNMEZ,** Yener TEMELLİ,*
Zeki KARAGÜLLE,** Nergis Erdoğan**
Istanbul University, Istanbul Medical Faculty
*Department of Orthopedics and Traumatology and
**Department of Medical Ecology and Hydroclimatology, IstanbulTURKEY
5th Hungarian - Turkish Balneological Symposium
Heviz, 7-10 June 2007
OBJECTIVE
Balneotherapy is one of the
treatment options for knee osteoarthritis
Efficacy of balneotherapy has been
questioned in several clinical studies
previously
Gait analysis is an objective method
for quantification of musculoskeletal
system disorders and also to evaluate their
treatment results
This prospective study aims to
investigate the efficacy of balneotherapy
in treatment of knee osteoarthritis
patients using gait analysis
PATIENTS and METHODS
30 patients (15 males, 15 females)
• Mean age: 69 years (range 49 – 77)
• Uni- or bilateral knee arthritis
Mild or no other joint involvement
• Balneotherapy in Gönen Spa Center, Turkey
• Thermomineral water: 51-78°C
• Na, SO4, HCO3, Cl, Fl
• Two water pool baths per day for 2 weeks
• 36-37°C, 20 minutes / bath
• No change in daily medical treatment
• Clinical evaluation and gait analysis within 2
weeks before and after treatment
Outcome parameters
Clinical parameters
• Lequesne Knee Osteoarthritis Index
• WOMAC score
• Health Assessment Questionaire
(HAQ)
• Visual analog scale (VAS) for
• Pain
• Global patient severity assessment
• Global physician severity
assessment
Gait analysis
• Istanbul Medical Faculty,
Dept. Orthopedics and
Traumatology
Gait Analysis Laboratory
• High speed 6 camera
system,
• Minimum 2 trials / analysis
• End result: Mean of both
sides of all trials
Statistical evaluation
• Paired Student’s t-test for comparison
of pre- and post treatment results
• Software: Excel, Microsoft Office
2003
Terminology used to describe parts of a typical gait cycle.
(msec)
1400
1200
* P<0,05
1000
800
*
600
400
200
0
802 755 546
465 465 395
12611220 941
stance time
swing time
stride time
before
after
*
172 150 70
double support time
laboratory standard
Results of temporal parameters (Absolute values)
(% stride)
70
**
* P<0,05 ** P<0,01
60
50
*
40
30
20
*
10
0
63
62
58
stance time
before
37
38
sw ing time
after
42
13,2
12,1
6
double support time
laboratory standard
Results of temporal parameters (Percentage of gait cycle)
Cadence (number of steps per minute)
steps/min
3,5
3
2,5
before
2
after
1,5
laboratory standard
1
0,5
2,2
2,3
0
cadence
3
(m m )
1400
* P<0,05
1200
*
1000
800
*
600
400
200
494
522
562
0
anterior step length
before
996 1057 1176
stride length
after
148
143
106
step w idth
laboratory standard
Results of distance parameters (distances)
(m /sec)
3,5
3
* P<0,05
*
2,5
before
2
after
1,5
laboratory
standard
*
1
0,5
2,2
3
2,3
0,82
0,89
1,25
0
sw ing velocity
mean velocity
Results of distance parameters: velocities
** P<0,01 ***P<0,001
60
**
**
50
***
40
before
30
after
20
10
57 33
55 31
54 28
0
Pain
Patient GA
Investigator GA
Graph summarizing VAS results. GA: general assessment.
14
**
12
** P<0,01 ***P<0,001
10
8
***
6
after
4
2
0
before
12,1
10
Lequesne
6,3
4,69
WOMAC
Graph summarizing results of Lequesne and WOMAC scores
0,95
0,9
before
0,85
after
0,8
0,75
0,79
0,92
0,7
HAQ
Graph summarizing results of HAQ scores
CONCLUSIONS
1.
2.
3.
4.
Statistically significant changes were observed
between pre- and post treatment results of
clinical health quality parameters and gait
analyses in this prospective study. According
to our findings, we can draw following
conclusions:
Gait analysis results are generally better, but
not normalized after the treatment.
Patients are walking faster, with an increased
cadence and increased step and stride length.
Stance and double support times are
decreased, indicating an improve of antalgic
gait.
Gait analysis findings are supported by the
clinical health quality parameters.
Possible mechanisms therapeutic effects
of balneotherapy in knee osteoarthritis
• A combination of mechanical, thermal and chemical effects
– Heat
• Analgesia
• Anti inflammatory effect
• Muscle tonus decrease
• Peripheral vasodilatation
• ß-endorphin level
• Gate-control theory
– Buoyancy and hydrostatic pressure
• affect muscle tone,
• joint mobility
• pain intensity by decreasing joint load
– Mineral water chemical implications
• Environmental change
• Non-competitive atmosphere
• Absence of work duties
THANK YOU