title: A comparison of Kneipp hydrotherapy with conventional physiotherapy in the treatment of osteoarthritis of the hip or knee: protocol of a prospective randomised controlled clinical trial.
abstract: BACKGROUND
  The increasing age of the population, especially in the western world, means that the prevalence of osteoarthritis is also increasing, with corresponding socioeconomic consequences. Although there is no curative intervention at present, in accordance with US and European guidelines, pharmacotherapeutic and non-pharmacological approaches aim at pain control and the reduction of functional restriction.It has been established that hydrotherapy for osteoarthritis of the hip or knee joint using serial cold and warm water stimulation not only improves the range of movement but also reduces pain significantly and increases quality of life over a period of up to three months. Weight reduction is important for patients with osteoarthritis of the hip or knee. In addition, conventional physiotherapy and exercise therapy have both been shown, at a high level of evidence, to be cost-effective and to have long-term benefits for pain relief, movement in the affected joint, and patient quality of life.
  
  
  METHODS
  The study design consists of a prospective randomised controlled three-armed clinical trial, which will be carried out at a specialist clinic for integrative medicine, to investigate the clinical effects of hydrotherapy on osteoarthritis of the knee or hip joint, in comparison with conventional physiotherapy.One hundred and eighty patients diagnosed with osteoarthritis of hip or knee will be randomly assigned to one of three intervention groups: hydrotherapy, physiotherapy, and both physiotherapy and hydrotherapy of the affected joint. In the first group, patients will receive Kneipp hydrotherapy daily, with water applied in the form of alternate cold and warm thigh affusions (alternating cold and warm water stimulation is particularly relevant to the knee and hip regions).Patients in the second group will receive physiotherapy of the hip or knee joint three times a week. Patients in the physiotherapy-hydrotherapy combination group will receive both joint-specific physiotherapy three times a week and alternate cold and warm thigh affusions every day. Follow-up assessments will be on three levels: clinical assessment by the investigator; subjective patient assessment consisting of a patient diary, and questionnaires on admission and at the end of the treatment phase; and a final telephone assessment by the external evaluation centre. Assessments will be made at baseline, after two weeks of inpatient treatment, and finally after a further ten weeks of follow-up. The primary outcome measure will be pain intensity of the affected joint in the course of inpatient treatment, judged by the patient and the investigator. Secondary outcomes include health-related quality of life and joint-specific pain and mobility in the course of the study. Statistical analysis of the results will be on an intention-to-treat basis.
  
  
  CONCLUSIONS
  This study methodology has been conceived according to the standards of the CONSORT recommendations. The results will contribute to establishing hydrotherapy as a non-invasive, non-interventional, reasonably priced, therapeutic option with few side effects, in the concomitant treatment of osteoarthritis of the hip or knee.
  
  
  BACKGROUND
  
  
  
  BACKGROUND
  NCT 00950326.
authors.affiliation: Kneipp Clinic (Sebastianeum & Kneippianum) Bad Wörishofen, Bad Wörishofen, Germany. naturedoc@web.de
authors.forename: Martin
authors.initials: M
authors.lastname: Schencking
authors.forename: Adriane
authors.initials: A
authors.lastname: Otto
authors.forename: Tobias
authors.initials: T
authors.lastname: Deutsch
authors.forename: Hagen
authors.initials: H
authors.lastname: Sandholzer
mesh_terms: D002985:Clinical Protocols; D006801:Humans; D006875:Hydrotherapy; D015207:Osteoarthritis, Hip / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011788:Quality of Life; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012107:Research Design; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
references.citation: J Rheumatol Suppl. 2000 Oct;60:6-8
references.pmid: 11032095
references.citation: Cochrane Database Syst Rev. 2008 Oct 08;(4):CD004376
references.pmid: 18843657
references.citation: Med Health R I. 2004 Jun;87(6):176-9
references.pmid: 15344672
references.citation: Ann Rheum Dis. 2009 Apr;68(4):490-6
references.pmid: 18467514
references.citation: Rehabilitation (Stuttg). 1996 Aug;35(3):XVII-XXVII; quiz XXVII-XXIX
references.pmid: 8975342
references.citation: Br J Clin Pharmacol. 1978 Jul;6(1):15-24
references.pmid: 666944
references.citation: Phys Ther. 2008 Jan;88(1):123-36
references.pmid: 17986496
references.citation: Best Pract Res Clin Rheumatol. 2007 Feb;21(1):59-76
references.pmid: 17350544
references.citation: Physiother Res Int. 2008 Jun;13(2):94-106
references.pmid: 18288773
references.citation: Fortschr Med. 1977 Jun 2;95(21):1371-2
references.pmid: 873417
references.citation: Z Rheumatol. 1994 Jul-Aug;53(4):243-9
references.pmid: 7975936
references.citation: Ann Rheum Dis. 2003 Dec;62(12):1162-7
references.pmid: 14644853
references.citation: Ann Intern Med. 2004 Dec 21;141(12):901-10
references.pmid: 15611487
references.citation: Hippokrates. 1961 Feb 15;32:92-4
references.pmid: 13701390
references.citation: Forsch Komplementarmed Klass Naturheilkd. 2001 Apr;8(2):80-4
references.pmid: 11340314
references.citation: Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005523
references.pmid: 17943863
references.citation: BMC Geriatr. 2007 Jul 04;7:17
references.pmid: 17610735
references.citation: Cochrane Database Syst Rev. 2003;(4):CD000518
references.pmid: 14583923
references.citation: Hippokrates. 1959 Mar 15;30(5):201-5
references.pmid: 13640494
references.citation: Phys Ther. 2008 Jan;88(1):12-21
references.pmid: 17986497
references.citation: Rejuvenation Res. 2004 Summer;7(2):134-45
references.pmid: 15312300
references.citation: Cochrane Database Syst Rev. 2003;(4):CD004522
references.pmid: 14584019
references.citation: Dtsch Med Wochenschr. 1977 Nov 11;102(45):1625-30
references.pmid: 72641
references.citation: Baillieres Best Pract Res Clin Rheumatol. 2000 Dec;14(4):731-49
references.pmid: 11092799
references.citation: Forsch Komplementmed. 2007 Jun;14(3):158-66
references.pmid: 17596696
references.citation: Osteoarthritis Cartilage. 2007 Oct;15(10):1128-33
references.pmid: 17512222
references.citation: Clin Orthop Relat Res. 2004 Oct;(427 Suppl):S6-15
references.pmid: 15480076
references.citation: J Clin Rheumatol. 2007 Feb;13(1):3-11
references.pmid: 17278941
references.citation: Ann Rheum Dis. 2004 May;63(5):549-54
references.pmid: 15082486
references.citation: Reumatismo. 2001;53(4):316-322
references.pmid: 12089627
references.citation: Presse Med. 2004 May 22;33(9 Pt 2):S4-6
references.pmid: 15226681
references.citation: Z Orthop Ihre Grenzgeb. 2002 Jul-Aug;140(4):452-9
references.pmid: 12183798
references.citation: Z Rheumatol. 2005 May;64(4):255-64
references.pmid: 15909086
references.citation: Med Klin. 1960 Jan 29;55:185-8
references.pmid: 14410463
references.citation: BMJ. 2008 Nov 11;337:a2390
references.pmid: 19001484
references.citation: J Rheumatol. 2003 Oct;30(10):2268-74
references.pmid: 14528528
references.citation: Clin J Pain. 2004 May-Jun;20(3):179-85
references.pmid: 15100594
references.citation: Arthritis Rheum. 2008 Oct 15;59(10):1488-94
references.pmid: 18821647
references.citation: Pain. 1997 Aug;72(1-2):95-7
references.pmid: 9272792
references.citation: Arthritis Rheum. 2008 Feb 15;59(2):247-54
references.pmid: 18240191