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Abstract Number: 2356

Comparison of Spa Therapy with or without Physical Rehabilitation for Knee Osteoarthritis: A Randomized Controlled Trial

Anne-Christine Rat1,2, Damien Loeuille3, Emmanuel Spitz4, Alexandra Desvignes5, Michel Boulange6, Jean Paysant7, Francis Guillemin8 and Isabelle Chary-Valckenaere9, 1Université de Lorraine, Apemac EA4360, Nancy, Nancy, France, 2Rheumatology Department, CHRU Nancy, Vandoeuvre-lès-Nancy, France, 3Rheumatology, CHRU Nancy, Vandoeuvre les Nancy, France, 4Rheumatology Strasbourg, Strasbourg, France, 5rheumatology, Hopital Simone Veil, Eaubonne, Eaubonne, France, 6Hydrologie et Climatologie Médicale, CHRU Nancy, Nancy, France, 7Institut de rééducaption et réadapattion Louis Pierquin, Nancy, France, 8CHRU Nancy, Clinical Epidemiology and Evaluation, Université de Lorraine, Paris Descartes University, APEMAC, EA 4360, Nancy, France, 9CHRU Nancy, Nancy, France

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Knee, osteoarthritis and rehabilitation

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Session Information

Date: Tuesday, November 15, 2016

Title: Osteoarthritis – Clinical Aspects - Poster II

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: To demonstrate the non-inferiority of “Active” compared to “Standard” spa therapy at 6 months in symptomatic knee osteoarthritis (KOA) care.

Methods: Prospective, randomized, monocenter, non-inferiority trial with community-based recruitment of KOA patients. Inclusion criteria were: KOA according to the ACR criteria, pain VAS> 3 on a 0-10 scale, and Kellgren and Lawrence (KL) grade ≥2.  “Standard” spa” comprised 18 days of standardized spa treatment, 6 days a week for 3 weeks. “Active spa” included iterative spa sessions, 3 days a week for 3 weeks, followed by a dedicated rehabilitation program, 3 days a week for 3 weeks. The primary endpoint was achievement of a minimal clinically important improvement (MCII) for pain VAS, and/or a MCII for function on WOMAC function subscale and no knee surgery, at 6 months (composite MCII). The secondary endpoints were composite MCII at 3 months and achievement of Patient Acceptable Symptoms States (PASS) for pain and function.

Results: Of 283 participants (mean age 64.3 (9.0) years, 181 (66.8%) women, 181(79.7%) bilateral OA, 151 (58.5%) KL grade III or IV), 145 were allocated to Standard spa and 138 to Active spa. Non inferiority could not be demonstrated for the primary endpoint at 6 months: difference of responders -0.01 90%CI [-0.18 to 0.02], p=0.14; number of patients achieving composite MCII: 86 (66.2%) and 66 (57.9%) in the Standard and Active spa group respectively. However, difference between the 2 groups was neither significant for the same criteria (p=0.18). At 3 months, active spa group was not inferior to standard spa group with composite MCII outcome criteria. The number of patients achieving PASS increased from baseline to 3 months and then decreased at 6 month (table). All the analyses using PASS criteria showed non-inferiority of the active spa group at six months.

Standard spa

N=145

Active spa

N=138

Difference of responders

P

(non -inferiority)

Definition of responder

N

(%)

N

(%)

[IC 90%]

3 months Composite MCII

76

(56.3)

75

(70.1)

0.14

(0.04 to 0.24)

 <.0001

6 months Composite MCII

86

(66.2)

66

(57.9)

-0.08

(-0.18 to 0.02)

0.14

Before Spa PASS for pain

13

(9.8)

18

(15.1)

0.05

(-0.02 to 0.12)

 <.0001

3 months PASS for pain

54

(44.6)

66

(66.0)

0.21

(0.11 to 0.32)

<.0001

6 months PASS for pain

51

(44.0)

47

(45.6)

0.02

(-0.09 to 0.13)

<.0001

Conclusion: Active spa can reasonably be proposed to patients with KOA. Such protocol could be more cost-effective while allowing benefiting spa therapy without absenteeism from work or avoiding accommodation costs for patients living close to the centre.


Disclosure: A. C. Rat, None; D. Loeuille, None; E. Spitz, None; A. Desvignes, None; M. Boulange, None; J. Paysant, None; F. Guillemin, None; I. Chary-Valckenaere, None.

To cite this abstract in AMA style:

Rat AC, Loeuille D, Spitz E, Desvignes A, Boulange M, Paysant J, Guillemin F, Chary-Valckenaere I. Comparison of Spa Therapy with or without Physical Rehabilitation for Knee Osteoarthritis: A Randomized Controlled Trial [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/comparison-of-spa-therapy-with-or-without-physical-rehabilitation-for-knee-osteoarthritis-a-randomized-controlled-trial/. Accessed .
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