title: Preferences for heat, cold, or contrast in patients with knee osteoarthritis affect treatment response.
abstract: OBJECTIVE
  This investigation assessed preferences for, and effects of, 5 days of twice daily superficial heat, cold, or contrast therapy applied with a commercially available system permitting the circulation of water through a wrap-around garment, use of an electric heating pad, or rest for patients with level II-IV osteoarthritis (OA) of the knee.
  
  
  METHODS
  We employed a within subject, randomized order design to study 34 patients receiving each treatment in 1-week blocks. A knee injury and osteoarthritis outcome score (KOOS) questionnaire and visual analog pain scale was completed at baseline, and twice each week. Treatment preferences were assessed in the last week of the study.
  
  
  RESULTS
  Treatment with the device set to warm was preferred by 48% of subjects. Near equal preferences were observed for cold (24%) and contrast (24%). Pain reduction and improvements in KOOS subscale measures were demonstrated for each treatment but responses were (P < 0.05) greater with preferred treatments. Most patients preferred treatment with the water circulating garment system over a heating pad.
  
  
  CONCLUSIONS
  We recommend that when superficial heat or cold is considered in the management of knee OA that patients experiment to identify the intervention that offers them the greatest relief and that contrast is a treatment option.
authors: Human Performance Laboratory and Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA. craig.denegar@uconn.edu
authors: Craig R
authors: CR
authors: Denegar
authors: Devon R
authors: DR
authors: Dougherty
authors: Jacob E
authors: JE
authors: Friedman
authors: Maureen E
authors: ME
authors: Schimizzi
authors: James E
authors: JE
authors: Clark
authors: Brett A
authors: BA
authors: Comstock
authors: William J
authors: WJ
authors: Kraemer
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000628:therapy*; D059408:Pain Management; D010147:Pain Measurement; D057240:Patient Preference; D016896:Treatment Outcome