jrcrs-2022100201

Editorial: JRCRS. 2022; 10(02): e1-e2

Dr. Muhammad Iqbal Tariq¹
Managing Editor JRCRS.
¹Assistant Professor, Faculty of Rehabilitation and Allied Health Sciences, Riphah International University Islamabad Campus.
Corresponding Email id: iqbal.tariq@riphah.edu.pk

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1- Physical Activity and Exercise Need of Time for Osteoarthritis: Reminder on World Physical Therapy Day 2022

Osteoarthritis (OA) is a debilitating weight-bearing joint disease and the leading cause of chronic pain and disability. Globally around 527 Million people have Osteoarthritis. The reported prevalence of 291 conditions, hip and Knee osteoarthritis were ranked as 11^th highest contributor to disability.⁽¹⁾ 3.1–4.6% urban and 3.6% rural population have knee OA but the scanty data is available in Pakistan. The incidence of OA are expected to increases in Pakistan as well as worldwide due to growing population day by day.⁽²⁾

Despite of the latest advancement about the knowledge of OA disease pathogenesis, the management is still a challenge and contrasting. Therapeutic choice is difficult because approach would be different according to the joint involvement. Three options are available in the current practice of management of OA (i-e conservative, pharmacological and surgical). Pharmacological therapies for OA are only partially effective in pain and inflammation management but they do not provide a cure. Surgical treatment like hemi and total replacement of joints is indicated for the severe and advance OA.⁽³⁾

A good reminder about various benefits of the exercise for OA; on world physical therapy day 2022 which usually held on 8 September. The beneficial effects of physical Activity/exercise should be incorporated in management for OA impairments and symptoms are supported, strongly suggested by the latest Clinical Practice Guidelines (CPGs) and research evidence.^(4-5)

There are different types of exercise are suggested by literatures includes aerobic exercises, flexibility, and strength training have better effects on pain and disability than generalized physical activity like walking. Other recommended options includes weight loss interventions programs, patient education programs, promotion of physical activity, use of assistive devices (i.e walker, cane etc.) and self-management programs (including life style modifications).

The benefits of exercise includes decreasing pain, improving joint movement, decreases muscle stiffness, enhance walking capacity, improve functional mobility and overall Quality of life. The PT clinicians should follow the FITT (frequency, intensity, time, and type) guidelines for the exercise prescription for OA patients but keeping in mind the co-morbidities. For Example: Recommendations suggested for the hip and knee strengthening exercises are to be performed for 2 sessions per week, 8–12 repetitions with two to four sets, at 60%–80% intensity of 1‑repetition maximum under Physical therapist supervision for more than 12 weeks have shown to be beneficial effects in hip and knee OA management.⁽⁶⁾

Awareness and educating about the physical therapy is the most important aspect to cover by the PT clinicians in the management of OA. Choosing the correct exercise dosage, duration and frequency is as much as important but also to educate about NOT to discontinue the exercise prematurely which diminishes the effects. It is Important because sometimes patient decided themselves to stop exercise when they think there are no effect or harmful effects by continuing it. For that reason, PT clinicians must educate and highlight the effects of exercise and alternative exercise options for the management of OA, and regarding this all decision making process must be shared with patient (recommended by Arthritis Foundation guidelines). Though, it must be in native language to improve the patient adherence to physical therapy services.⁽⁷⁾

It is dire need of time to provide awareness and education to community regarding the importance of exercise and physical activity to prevent the OA and decrease the complications of disease. It is importance for PT clinicians to follow the recommended guidelines and latest evidence based practice for the management of OA.

Reference:

1. Long H, Liu Q, Yin H, Wang K, Diao N, Zhang Y, Lin J, Guo A. Prevalence trends of site‐specific osteoarthritis from 1990 to 2019: findings from the Global Burden of Disease Study 2019. Arthritis & Rheumatology. 2022 Mar 1.
2. Kumar DS, Farooqi A. Osteoarthritis. Best Pract Res Clin Rheumatol. 2008 Sep 08; 22(04):657-675.
3. Rönn K, Reischl N, Gautier E, Jacobi M. Current surgical treatment of knee osteoarthritis. Arthritis 2011;2011:454873
4. Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SM, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, Blanco FJ. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and cartilage. 2019 Nov 1;27(11):1578-89.
5. Clinical Practice Guidelines Osteoarthritis. Available from: https://www.rheumatology.org/Practice‑Quality/Clinical‑Support/ Clinical‑Practice‑Guidelines/Osteoarthritis.
6. Skou ST, Pedersen BK, Abbott JH, Patterson B, Barton C. Physical activity and exercise therapy benefit more than just symptoms and impairments in people with hip and knee osteoarthritis. Journal of orthopaedic & sports physical therapy. 2018 Jun;48(6):439-47.
7. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken) 2020;72:149‑62