BMJ  2006;332:853 (8 April), doi:10.1136/bmj.332.7545.853

Letter

Physical treatments have valuable role in osteoarthritis

The first 150 words of the full text of this article appear below.

EDITOR—Hunter and Felson deliver a consistent and seemingly thorough clinical review about managing knee osteoarthritis for primary care doctors.¹ We commend them for promoting the role of non-pharmacological interventions and for highlighting the problem of inadequate funding because of "lucrative opportunities for drug development." However, one striking omission in their review was an appraisal of physical treatments, which are widely used in primary care. A cursory search of the literature identified at least 26 randomised placebo controlled trials and six systematic reviews of physical interventions for knee osteoarthritis in Medline indexed journals and the Cochrane Library.

One of the few examples where the efficacy of physical treatments was tested against drugs is a good quality independently funded trial, in which electroacupuncture showed better pain relief than non-steroidal anti-inflammatory drugs (diclofenac).² A Cochrane review of transcutaneous electrical nerve stimulation (TENS) calculated the effect size for TENS v sham TENS . . . [Full text of this article]

Department of Public Health and Primary Health Care, University of Bergen, 5018 Bergen, Norway Jan.Bjordal@hib.no

Institute of Biomedicine, Pharmacology Department, University of Sao Paulo, Sao Paulo, Brazil

Bergen Deaconal Hospital, Ulriksdal 10, 5009 Bergen

Faculty of Health, Leeds Metropolitan University, Leeds LS1 3HE

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Relevant Article

Osteoarthritis

David J Hunter and David T Felson
BMJ 2006 332: 639-642. [Extract] [Full Text] [PDF]