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L'accord entre le Canada et l'Union européenne (<< À nous l'Europe >>, 1er avr. 2014), en augmentant la durée de protection des brevets pharmaceutiques, entraînera une hausse du prix des [...]

Background and PurposeOsteoarthritis (OA) affects a large and growing proportion of the population. The purpose of this project was to create guidelines for the use of therapeutic exercises and manual therapy in the management of adult patients (>18 years of age) with a diagnosis of OA. All stages of the disease were included in the analysis, and studies of patients who had recent surgery or other rheumatologic, musculoskeletal, or spinal problems or of subjects without known pathology or impairments were excluded. MethodsThe Ottawa Methods Group used Cochrane Collaboration methods to find and synthesize evidence from comparative controlled trials and then asked stakeholder groups to nominate representatives to serve on a panel of experts. The Ottawa Panel agreed on criteria for grading the strength of the recommendations and their supporting evidence. Of the 609 potential articles on therapeutic exercises for OA that were identified, 113 were considered potentially relevant, and 26 randomized controlled trials and controlled clinical trials were ultimately used. ResultsSixteen positive recommendations of clinical benefit were developed for therapeutic exercises, especially strengthening exercises and general physical activity, particularly for the management of pain and improvement of functional status. Manual therapy combined with exercises also is recommended in the management of patients with OA. Discussion and ConclusionThe Ottawa Panel recommends the use of therapeutic exercises alone, or combined with manual therapy, for managing patients with OA. There were a total of 16 positive recommendations: 13 grade A and 3 grade C+. The Ottawa Panel recommends the use of therapeutic exercises because of the strong evidence (grades A, B, and C+) in the literature.

Background and Purpose.The purpose of this project was to create guidelines for electrotherapy and thermotherapy interventions in the management of adult patients (>18 years of age) with a diagnosis of rheumatoid arthritis according to the criteria of the American Rheumatism Association (1987). Methods.Using Cochrane Collaboration methods, the Ottawa Methods Group identified and synthesized evidence from comparative controlled trials. The group then formed an expert panel, which developed a set of criteria for grading the strength of the evidence and the recommendation. Patient-important outcomes were determined through consensus, provided that these outcomes were assessed with a validated and reliable scale. Results.The Ottawa Panel developed 8 positive recommendations of clinical benefit. Lack of evidence meant that the panel could not gauge the efficacy of electrical stimulation. Discussion and Conclusion.The Ottawa Panel recommends the use of low-level laser therapy, therapeutic ultrasound, thermotherapy, electrical stimulation, and transcutaneous electrical nerve stimulation for the management of rheumatoid arthritis.

Background and Purpose.The purpose of this project was to create guidelines for the use of therapeutic exercises and manual therapy in the management of adult patients (>18 years of age) with a diagnosis of rheumatoid arthritis according to the 1987 American Rheumatism Association criteria. Methods.Evidence from comparative controlled trials was identified and synthesized using The Cochrane Collaboration methods. An expert panel was formed by inviting professional stakeholder organizations to each nominate a representative. This panel developed a set of criteria for grading the strength of both the evidence and the recommendation. Results.Six positive recommendations of clinical benefit were developed on therapeutic exercises. The efficacy of manual therapy interventions could not be determined for lack of evidence. Discussion and Conclusion.The panel recommends the use of therapeutic exercises for rheumatoid arthritis. Further research is needed to determine the efficacy of manual therapy in the management of this disease.