5. Osteoarthritis Measurement Scales
• Western Ontario and McMaster Osteoarthritis
Index (WOMAC)
– Questionnaire with twenty four questions
about pain, function, and stiffness
• Visual Analogue Scale
– 100 mm long line with descriptive words (no pain /
worst pain ever felt) on either side
• Lequesne Index
– Questionnaire 11 questions that ask about the
patient’s symptoms and functional ability
6. Review of Literature
• Exercise Related Therapy
• Pharmaceutical therapy
• Various procedures performed to relieve
symptoms
7. Exercise Therapy
• Indicated for mild to moderate osteoarthritis
• Water therapy – Very effective
– Good for elderly patients
• Exercise training – Effective
– Improvements in both knee and hip patients
• Weight loss – Effective
– Weight loss groups improved over weight
stable group
(All studies had statistically significant results on the scales discussed earlier)
8. Pharmaceutical therapy
• Indicated for mild, moderate, and severe
• NSAIDS – Very common
• Transdermal Fentanyl
– Indicated when NSAIDS, weak opiods don’t work
• Glucosamine
– Improves repair process and formation of cartilage
(All studies had statistically significant results on the scales discussed earlier)
9. Various Procedures
• Hyaluronic acids
– Injected into the joint capsule to reduce
friction and improves articulation (act as
synovial fluid)
11. Various Procedures
• Acupuncture
– No difference seen in patients who exercised
and advice when compared to patients who
exercised, had advice, and acupuncture.
13. Conclusion
• Treatment is different with every individual
• Think about severity of osteoarthritis
symptoms when considering treatment
options
• Consider patients goal for treatment (pain
free vs. being able to perform activities)
14. References
• Arthritis Foundation, Disease Center: Osteoarthritis, Available at:
http://ww2.arthritis.org/conditions/DiseaseCenter/OA/oa_epidemiology.asp, November 23, 2007
• Cochrane T, Davey RC, Matthes Edwards SM. Randomised controlled trial of the cost-effectiveness of water-based therapy
for lower limb osteoarthritis. Health Technology Assessment. 2005 Aug; 9(31).
• Dawson J, Linsell L, Doll H, Zondervan K, Rose P, et al. Assessment of the Lequesne index of severity for osteoarthritis of
the hip in an elderly population. Osteoarthritis and Cartilage. 2005; 13(10): 854-60.
• de Jong ORW, Hopman-Rock M, Tak ECPM, Klazinga NS. An implementation study of two evidence-based exercise and
health education programmes for older adults with osteoarthritis of the knee and hip. Health Education Research. 2004;
19(3): 316-25.
• Foster NE, Thomas E, Barlas P, Hill JC, Young J, Mason E, et al. Acupuncture as an adjunct to exercise based
physiotherapy for osteoarthritis of the knee: randomised controlled trial. BMJ. 2007; 335: 436-48; originally published online
15 Aug 2007.
• Fregly BJ, Reinbolt JA, Rooney KL, Mitchell KH, Chmielewski TL. Design of patient-specific gait modifications for knee
osteoarthritis rehabilitation. IEEE Transactions on Biomedical Engineering. 2007 Sep; 54(9): 1687-95.
• Gould D, Kelly D, Goldstone L, Gammon J. Examining the validity of pressure ulcer risk assessment scales: developing and
using illustrated patient simulations to collect the data. Journal of Clinical Nursing. 2001; 10:697-706.
• Hunter DJ, Felson DT. Osteoarthritis. BMJ. 2006 Mar; 18(332): 639-42.
• Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JWJ, Dieppe P, et al. EULAR Recommendations 2003: an
evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for
International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003; 62: 1145–55.
• Juni P, Reichenbach S,Trelle S, Tschannen B, Wandel S, Jordi B, et al. Efficacy and safety of intraarticular hylan or
hyaluronic acids for osteoarthritis of the knee. Arthritis & Rheumatism. 2007 Nov; 56(11): 3610-19.
• Langford R, McKenna F, Ratcliffe S, Vojtassa´k J, Richarz U. Transdermal Fentanyl for Improvement of Pain and
Functioning in Osteoarthritis: A Randomized, Placebo-Controlled Trial. Arthritis & Rheumatism. 2006 Jun; 54(6): 1829-37.
• Loyd M, Rublee D, Jacobs P. An economic model of long-term use of celecoxib in patients with
• osteoarthritis. BMC Gastroenterology. 2007; 7(25).
• Mikesky AE, Mazzuca SA, Brandt KD, Perkins SM, Damush T, Land KA. Effects of Strength Training on the Incidence and
Progression of Knee Osteoarthritis. Arthritis & Rheumatism (Arthritis Care & Research). 2006 Oct 15; 55(5): 690-99.
• Miller GD, Nicklas BJ, Davis C, Loeser RF, Lenchik L, Messier SP. Intensive Weight Loss Program Improves Physical
Function in Older Obese Adults with Knee Osteoarthritis. Obesity. 2006 Jul; 14(7): 1219-30.
• Orthoteers Organization, WOMAC, Available at:
http://www.orthoteers.org/(S(qmyfg0ribj51evba5wm1y1z2))/content/contentnoframeset.aspx?article=367&c=1, February 16,
2008
• Reginster JY, Bruyere O, Fraikin G, Henrotin Y. Current Concepts in the Therapeutic Management of Osteoarthritis with
Glucosamine. Bulletin of the Hospital for Joint Diseases. 2005; 63(1&2): 31-36.
• Rowe, PJ, Myles CM, Nutton R. The effect of total knee arthroplasty on joint movement during functional activities and joint
range of motion with particular regard to higher flexion users. Journal of Orthopaedic Surgery. 2005; 13(2): 131-138.
• Google images
