Faculty of Health Sciences
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Item A systematic review of non-invasive manual therapy in the management of rheumatoid arthritis patients(2022-05-13) Sclanders, Kyle Donald; Korporaal, Charmaine MariaBackground: Rheumatoid arthritis (RA) is a common, chronic, and progressive autoimmune condition manifesting in a polyarticular pattern, with an agnogenic pathophysiology. The progressive effect on physical function (e.g., pain, quality of life, funcaitonal impairment and disability) and the side effects of pharmaceutical interventions, have led to patients seeking adjunctive therapy. Complementary and alternative medicine (CAM) therapy, is thought to reduce pain, increase range of motion, and improve quality of life. Yet, the evidence base for CAM therapies is vague. This systematic review of studies relating to non-invasive manual therapy (vis. exercise, manipulation, mobilisation, and massage), determined the level of evidence available for their use, and provided a summation of the available evidence to support evidence-based clinical practice. Finally, the study provides recommendations for further investigations. Method: This mixed methods systematic review complying with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol and Cochrane Collaboration guidelines, required an electronic literature search (viz: Google Scholar and DUT Summons) using key terms including rheumatoid arthritis and variable combination one or more of the following: treatment, management, chiropractic, osteopathy, physiotherapy, physical therapy, massage, mobilization, manipulation, joint oscillation, and exercise. This along with hand search strategies and reviewer input produced 65 articles that were incorporated into the review (40 RCTs. 15 nRCTs, and 10 Cases). All selected articles were available in English in electronic format and represented RCTs, nRCTs and CR/CS (not limited to peer reviewed studies) and reflected interventions applied to adult, human subjects. The articles were reviewed by 13 reviewers, using as appropriate the PEDro, Newcastle-Ottawa or Liddle scales, to evaluate the methodological rigour (internal validity) of the studies, while qualitatively contextualizing these outcomes (external validity) to determine the impact of bias on the reported clinical outcomes. Thereafter an analysis of evidence per modality was completed utilising published grading systems. Results: The above evaluations and aggregated evidence available was then determined for the modalities. It was found that there is limited evidence available for manipulation, mobilisation, massage, and exercise in the treatment of the RA patient. The notable exceptions were the use of aerobic exercise with acetaminophen; exercise as part of an intervention programme in the treatment of the hands; and mixed exercise programme to improve bone mineral density and attaining muscular strength gains. Conclusion: Thus, excluding the exceptions, the reviewed interventions should be used cautiously in practice and patients should not be provided with expectations that are not confidently supported by available literature. The evidence suggests that for the most part, intervention by means of manipulation, mobilisation, soft tissue manipulation and massage, along with exercise, requires further research efforts to provide sufficient high-quality evidence for the practitioner to implement in clinical practice with confidenceItem The relative effectiveness of a non-steroidal anti-inflammatory medication (meloxicam) versus manipulation in the treatment of osteoarthritis of the knee(2001) Tucker, Mark L.; Myburgh, CorneliusThe purpose of this study was to evaluate the relative effectiveness of manipulation versus meloxicam (a Non-Steroidal Anti-Inflammatory Drug) to determine which is more beneficial in treating osteoarthritis of the knee. This was a prospective, randomized clinical trial consisting of a population of sixty voluntary subjects, diagnosed as suffering from osteoarthritis of the knee. The patients were divided equally into two groups of thirty, with Group A receiving chiropractic manipulative therapy on eight consultations over three weeks, and Group B receiving meloxicam 7,5mg tablets once daily for three weeks. Capturing of the subjective and objective data for both groups took place on the first, fourth and eighth consultations. Subjective data was captured using the Numerical Pain Rating scale-l 01, the Visual Analogue scale, as well as the Patient -Specific functional scale. Objective data was gathered from goniometric and pressure algometer measurements.Item The homoeopathic simillimum treatment of acute arthritis in primary gout in terms of the illness intrusiveness scale, blood uric acid levels using the uricase conversion method as well as the acupulse homeostat machine(2001) Smulders, Henriette; McDavid, G. M.The aim of this placebo-controlled study was to investigate the homoeopathic simillimum treatment of acute arthritis in primary gout in terms of the illness intrusiveness scale, blood uric acid levels using the uricase conversion method as well as the Acupulse Homeostat machine. For this study 30 patients suffering from primary gout were required. The patients were obtained by advertising in local newspapers and at retirement homes. Patients were included in the study if they presented with six of the seven criteria taken from the American Rheumatism Association's criteria for acute arthritis of primary gout. The patients were randomly divided into two groups: a treatment group, receiving homoeopathic simillimum treatment and a control group, receiving a placebo. Two follow-up consultations were scheduled at two week intervals. Data was obtained by means of a questionnaire (completed by the patient), readings from the Acupulse homeostat machine and a blood uric acid test. This data was collected at all three consultations. Data entry and analysis was done using the SPSS statistical package. Due to the small sample size, data obtained from the questionnaire was statistically analyzed using non-parametric methods. The Mann-Whitney Unpaired Test was done to compare the treatment and placebo groups. Results showed that there was no significant difference between the groups. The Wilcoxon's Signed Rank Test was done to compare data within groups. The only significant difference was found within the treatment group between the first and second consultations as well as the first and third consultations. There was significant improvement with regard to active recreation. The tests were performed at a = 5% level of significance. Data obtained from the Acupulse Homeostat machine as well as the blood tests were analyzed using parametric tests because of the fact that they were continuous variables (regardless of the small sample size per group). In the case of both variables, comparison between the treatment and placebo group was made using the Two-Sample Paired T-Test and comparison within groups