PAIN MANAGEMENT IN KNEE OSTEOARTHRITIS: BALNEOTHERAPY VERSUS CLASSIC REHABILITATION

Background Knee osteoarthritis presents a heavy financial burden due to disability and supported care. Gonalgia is the main symptom leading patients to consult. For some clinicians, this is a warning signal that correlates with the extent of joint degradation [1]. The management of pain in knee osteoarthritis is multidisciplinary comprising pharmacological and non-pharmacological means including classical rehabilitation and aquatic gymnastics. The objective of our work was to study the contribution of aquatic gymnastics compared to conventional rehabilitation in the management of pain in patients with knee osteoarthritis. Objectives The objective of our work was to study the contribution of aquatic gymnastics compared to conventional rehabilitation in the management of pain in patients with knee osteoarthritis. Methods Prospective, evaluative and comparative study about 120 patients with knee osteoarthritis carried out over 15 months (September 2016- December 2017) in the Department of Physical Medicine and Functional Rehabilitation. The patients were divided into two groups of 60. The first group (G1) benefited from a classic rehabilitation program, the second group (G2) benefited from aquatic gymnastics. The 2 programs were carried out at the rate of three sessions per week for two months. The study was based on the assessment of pain by the following scales: VAS pain and the Western Ontario and McMaster Universities’ Osteoarthritis Index (WOMAC) questionnaire for the lower limbs (pain section). Results The mean age of our patients was 57.2 ± 12.5 years in G1 vs 54.3 ± 7.1 years in G2 (p = 0.012). The sex ratio was 0.2 in G1 versus 0.37 in G2 (p = 0.011). The duration of knee osteoarthritis was 63.4 ± 4.5 months in G1 vs 56.2±7.5 months in G2 (p=0.172). The pain was mechanical in 89 % of cases. Positional nocturnal pain was noted in 72% of cases. Hydarthrosis was associated in 46% of cases. A daily intake of palliative I analgesics was noted in 56 % of patients. The mean pain VAS at rest of 33.4±18 in G1 vs 27.3±23.2 in G2 (p=0.13). On exertion, it was 72.3±19 in G1 vs 83.3±20 in G2 (p = 0.72). After the rehabilitation treatment, an improvement in the two groups was objectified, which was significantly more marked in G2: Resting VAS improved by 57 % for G1 and by 84% for G2 (p = 0.015). Exercise VAS improved 20% in G1 and 43% in G2 (p <0.001). The mean WOMAC pain score was 14.3 in G1 and 10.3 in G2 (p = 0.006). There was an improvement in the WOMAC pain score of 24% in G1 and 58% in G2 (p <0.001). Conclusion Functional rehabilitation in the water or in the dry has a marked effect on pain in gonarthrosis patients. The aquatic environment can also bring many benefits on pain by lightening the weight of the body and the analgesic effect of the heat. References [1]Trouvin A-P, Perrot S. Douleur dans l’arthrose : comprendre les mécanismes pour améliorer la prise en charge. Revue du Rhumatisme. 2018 Jun;85(4):324–30. Disclosure of Interests None declared