Individuals with osteoarthritis of the knee

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Clinical Scenario:
Jane is a 65-year-old woman who presents to her orthopedic provider’s office with complaints of persistent pain and decreased mobility in her right knee. She reports that the pain has been affecting her daily life, making it difficult for her to walk, climb stairs, or even perform simple household tasks.
Upon physical examination, the provider observes signs of joint inflammation, crepitus, and a limited range of motion in Jane’s right knee. An X-ray confirms the presence of osteoarthritis in the affected knee, with joint space narrowing and bone spurs.
The NP discusses treatment options with Jane, emphasizing the importance of physical therapy in managing her osteoarthritis. Jane expresses a strong interest in pursuing physical therapy but is uncertain about whether to choose aquatic therapy or land-based therapy. The NP provides information on both options to help Jane make an informed decision.
PICO Question:
In individuals with osteoarthritis of the knee, how does aquatic therapy compared to land based therapy impact pain and mobility?

 

Sample Solution

Literature Review

A systematic review of 20 randomized controlled trials (RCTs) found that aquatic therapy and land-based therapy were equally effective in reducing pain and improving physical function in individuals with knee osteoarthritis (OA). However, the authors noted that the studies included in the review were of mixed quality, and that further research is needed to confirm these findings.

Another RCT found that aquatic therapy was more effective than land-based therapy in improving pain and mobility in older adults with knee OA. The study authors suggested that the buoyancy of water and the reduced impact on the joints may make aquatic therapy a more suitable option for older adults with knee OA.

A third RCT found that a combination of aquatic therapy and land-based therapy was more effective than aquatic therapy alone in improving pain and function in individuals with knee OA. The study authors suggested that the combination of the two therapies may provide the best of both worlds, with the buoyancy of water reducing impact on the joints and the land-based exercises providing stronger muscle strengthening.

Overall, the literature suggests that aquatic therapy and land-based therapy are both effective treatments for knee OA. However, further research is needed to compare the two therapies head-to-head and to identify the best treatment approach for different individuals.

Recommendation for Jane

Based on the available evidence, Jane has a few options to consider when choosing between aquatic therapy and land-based therapy. She may want to choose the type of therapy that she is most comfortable with and that best fits her lifestyle. She may also want to consider the following factors:

  • Age: Older adults may benefit more from aquatic therapy because it is less impactful on the joints.
  • Comorbidities: Individuals with other comorbidities, such as obesity or cardiovascular disease, may benefit more from land-based therapy because it can help to improve overall fitness and cardiovascular health.
  • Personal preference: Ultimately, the best way to decide which type of therapy is right for Jane is to try both and see which one she prefers.

Jane should also discuss her options with her physical therapist and orthopedic provider. They can help her to develop a personalized treatment plan that is tailored to her individual needs and goals.

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