Effectiveness of application of therapeutic physical factors in osteoarthritis from the perspective of evidence-based medicine (scientific review)

Abstract

Osteoarthritis is a widespread and devastating disease that leads to pain, reduced quality of life and high healthcare costs. Much practical experience has been accumulated in the use of physical factors for osteoarthritis. A large number of publications, including randomized clinical trials, systematic reviews, and meta-analyses, have been devoted to analyzing the evidence for the effectiveness of physical therapy in osteoarthritis. We analyzed scientific and technical literature sources, including randomized clinical trials, meta-analyses and systematic reviews (search depth 20 years) on the issues of evaluating the efficacy of physical therapy (ultrasound therapy, laser therapy, electrical stimulation, cryotherapy, balneotherapy and mud treatment) in patients with osteoarthritis. In 4 systematic reviews with meta-analysis (51 studies, 2772 patients), 1 Cochrane review (341 patients) and 3 randomized clinical trials (250 patients) it was shown that the use of ultrasound therapy in both continuous and pulsed modes in patients with osteoarthritis of the knee joint can significantly reduce the severity of pain and increase the range of active movements in the diseased joint. According to the results of systematic reviews, including meta-analysis (122 studies) and 9 randomized clinical trials (369 patients), the use of percutaneous electroneuromyostimulation in patients with osteoarthritis of the knee joint can be considered as an optimal method of non-drug therapy in terms of achieving significant analgesia in the short term. Data from 4 randomized clinical trials (414 patients) and 1 Cochrane review (3 randomized clinical trials, 179 patients) proved that the use of cryotherapy in patients with osteoarthritis of the knee joint leads to a significant reduction in the intensity of pain sensations in the affected joint, while the achieved analgesic effect is maintained for the next 3 months. The use of sulfur-containing and sodium chloride mineral waters (4 randomized clinical trials, 325 patients and systematic reviews, including meta-analysis (42 randomized clinical trials, 1766 patients), as well as peloid therapy (5 randomized clinical trials, 370 patients) in patients with osteoarthritis of the knee joint contributes to a decrease in the severity of pain, increases the functional activity of knee joints, as well as the quality of life of patients.