Thermotherapy for treatment of osteoarthritis
Editorial Group: Cochrane Musculoskeletal Group
Published Online: 20 OCT 2003
Assessed as up-to-date: 23 AUG 2003
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Brosseau L, Yonge KA, Welch V, Marchand S, Judd M, Wells GA, Tugwell P. Thermotherapy for treatment of osteoarthritis. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD004522. DOI: 10.1002/14651858.CD004522.
- Publication Status: Edited (no change to conclusions)
- Published Online: 20 OCT 2003
Osteoarthritis is a degenerative joint disease that affects mostly the weight-bearing joints in the knees and hips. As the affected joint degenerates pain and restriction of movement often occur. Inflammation can also occur sometimes resulting in edema of the joint with OA. Treatment focuses on decreasing pain and improving movement.
To determine the effectiveness of thermotherapy in the treatment of OA of the knee. The outcomes of interest were relief of pain, reduction of edema, and improvement of flexion or range of motion (ROM) and function.
Two independent reviewers selected randomized and controlled clinical trials with participants with clinical and/or radiological confirmation of OA of the knee; and interventions using heat or cold therapy compared with standard treatment and/or placebo. Trials comparing head to head therapies, such as two different types of diathermy, were excluded.
Randomized and controlled clinical trials including participants with clinical or radiographical confirmation of OA of the knee and interventions using heat or cold compared to standard treatment or placebo were considered for inclusion.
Data collection and analysis
Study results were extracted by two independent reviewers. Outcomes were continuous in nature (pain, strength, improvement) and were analyzed by weighted mean difference using a fixed effects model. Graphical data were used when table data were not available.
Three randomized controlled trials, involving 179 patients, were included in this review. The included trials varied in terms of design, outcomes measured, cryotherapy or thermotherapy treatments and overall methodological quality. In one trial, administration of 20 minutes of ice massage, 5 days per week, for 3 weeks, compared to control demonstrated a clinically important benefit for knee OA on increasing quadriceps strength (29% relative difference). There was also a statistically significant improvement, but no clinical benefit in improving knee flexion ROM (8% relative difference) and functional status (11% relative difference). Another trial showed that cold packs decreased knee edema.
Ice massage compared to control had a statistically beneficial effect on ROM, function and knee strength. Cold packs decreased swelling. Hot packs had no beneficial effect on edema compared with placebo or cold application. Ice packs did not affect pain significantly, compared to control, in patients with OA. More well designed studies with a standardized protocol and adequate number of participants are needed to evaluate the effects of thermotherapy in the treatment of OA of the knee.
Plain language summary
Thermotherapy (heat treatment) for treating osteoarthritis of the knee
To answer this topic, scientists found and analyzed three studies. Over 170 people with osteoarthritis continue to take their medications but used hot, cold or ice packs/towels with or without massage or no treatment. The studies were not of high quality but this Cochrane review provides the best evidence we have today.
What is thermotherapy and how might it help osteoarthritis of the knee?
Osteoarthritis (OA) is the most common form of arthritis that can affect the hands, hips, shoulders and knees. In OA, the cartilage that protects the ends of the bones breaks down and causes pain and swelling. Thermotherapy involves applying heat or cold to joints to improve the symptoms of osteoarthritis and can be done with packs, towels, wax, etc. Heat may work by improving circulation and relaxing muscles, while cold may numb the pain, decrease swelling, constrict blood vessels and block nerve impulses to the joint. Thermotherapy can be used in rehabilitation programmes or at home.
How well does thermotherapy work?
One study showed that massaging with ice for 20 minutes, 5 days a week for 2 weeks, improved muscle strength in the leg, the range of motion in the knee and decreased time to walk 50 feet compared to no treatment.
Another study showed that ice packs for 3 days a week for three weeks improved pain just as well as no treatment.
Another study showed that cold packs for 20 minutes for 10 periods decreased swelling more than no treatment. Hot packs for the same amount of time had the same effect on swelling as no treatment.
How safe is it?
No side effects were reported in the studies, but in general, studies report that thermotherapy is safe when applied carefully.
What is the bottom line?
Since the studies were small and of low quality firm conclusions cannot be made. There is "silver" level evidence that ice massage could be used to improve
range of motion and strength of the knee and function in people with osteoarthritis of the knee. Cold packs may be used to decrease swelling.
兩位作者獨立進行資料摘錄。連續性結果﹝疼痛、力量、進步﹞使用固定效應模型(fixedeffects model)及加權平均差異(weighted mean difference：WMD)來分析。如果表格資料不存在時則使用圖表資料
這項回顧包括了3個研究包含179例病患。各研究之設計、結果測量、熱療法或冷療法與研究的品質差異大。1篇研究3週，每週5天，每天20分鐘冰療法，比較控制組在四頭肌力量(相對增加29%)。另外在膝彎曲活動角度﹝相對增加8% ﹞與功能改善﹝相對增加11% ﹞有顯著差異，但臨床無幫助之改善。另1篇研究顯示冰敷減少膝關節腫脹。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
熱療治療膝蓋退化性關節炎的效果有多好，到底有多安全？ 要回答這個問題，科學家們發現和分析三項研究。超過 170位退化性關節炎患者持續使用藥物，但也使用熱，冷或冰包布/毛巾加上按摩或不按摩或不治療。這些研究品質不高，但 Cochrane 回顧提供了今日我們所擁有最好的證據。 熱療是什麼，如何幫助膝退化性關節炎？ 退化性關節炎是關節炎最常見形式，會影響手，髖部，肩膀和膝蓋。在退化性關節炎，保護兩端骨頭的軟骨破損斷裂，導致疼痛和腫脹。熱療涉及應用熱或冷到關節來改善退化性關節炎的症狀，可以藉由包布紮，毛巾，蠟，其他等來完成。熱可透過改善循環和放鬆肌肉，而冷可麻痺疼痛，減少腫脹，收縮血管並阻止神經衝動到關節。熱療可用於復健計畫或在家裡。 熱療的效果有多好？ 一項研究表明，比起不治療，用冰按摩20分鐘，每週 5天共2週，可提高腿的肌肉力量，膝蓋運動範圍，減少步行50英尺時間。另一項研究表明，冰敷3天，每週 3天共3個星期改善疼痛的程度等同不治療。另一項研究表明，冷敷20分鐘 10個療程可減少腫脹勝過不治療。若是熱敷同一時間與劑量，對於腫脹也會有相同的效果勝過不治療。 安全性如何呢？ 沒有副作用的研究被報告，但總體而言，研究報告說，熱療若小心使用是安全的。什麼是底線？由於研究規模較小，低品質所以無法作出結論。有“銀”級的證明，冰敷按摩可以用來改善膝蓋退化性關節炎患者的運動範圍和膝蓋強度和功能。冷敷可用於減少腫脹。