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Land- and water-based exercise therapies for musculoskeletal conditions

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This chapter summarizes current evidence from recently published systematic reviews of land- and water-based exercise therapies for musculoskeletal conditions. The aim is to present an overview of the evidence and highlight gaps where more research is still needed. This is not a systematic review, but a systematic search of the literature and a summary of results of the best, most recent systematic reviews evaluating interventions for musculoskeletal conditions. There have been two previous summaries of systematic reviews of evidence for exercise therapies in musculoskeletal conditions. We have updated these searches, and additionally considered the evidence for the clinical effectiveness of exercise in fibromyalgia and chronic widespread pain and of hydrotherapy and water-based exercise treatments on pain and disability.

Section snippets

Exercise

Exercise therapy is a management strategy that is widely used for common musculoskeletal conditions. It encompasses a broad range of specific interventions and approaches, and can include interventions ranging from specific strengthening exercises, balance and flexibility exercises on land and in water, as well as more general physical activity. Exercise can be prescribed and delivered by health professionals such as family doctors and physiotherapists, or it can be conducted by individuals

Clinical presentation

Making a clinical diagnosis is an essential component of deciding on appropriate exercise prescription and determining the likely outcome following exercise. In clinical trials of effectiveness of exercise approaches, case definition is important to describe the study population. Broad classification of conditions is preferred in trials because of the ability to recruit large numbers of participants, which enhances the generalizability of findings and ensures successful completion of the trial.2

Measurement of outcome

There has been an increased awareness of the importance of multi-dimensional assessment of outcome in musculoskeletal conditions. The International Classification of Functioning (ICF)4 and others5 encourage consideration of bio-psychosocial factors; it is less important that a specific exercise can increase range of movement of a knee joint by 10 degrees than that an older adult with knee pain is able to walk downstairs and outside their home as and when they want to.

The management of regional

Prediction of chronicity

Most musculoskeletal conditions are self-limiting.2 Others will wax and wane over months and possibly years before spontaneously settling, and a small proportion will become chronic.2, 8 Psychological distress and a lack of social support have been shown to be important predictors of poor functional outcome in subjects with spinal pain and work-related soft-tissue musculoskeletal injury.9 The role of psychological factors in predicting adherence to exercise therapy and the use of health-care

Evidence for the effectiveness of land- and water-based exercise therapies for musculoskeletal conditions

In recent years there has been an explosion in the number of well-conducted high-quality randomized controlled trials of interventions including exercise therapies, manual therapies and hydrotherapy. The difficulty for the practitioner is obtaining up-to-date and relevant evidence for use in day-to-day practice. Clinical guidelines are emerging as a useful way of summarizing the best available evidence from randomized controlled trials and systematic reviews. Clinical guidelines need to be

Summary

There have been two important summaries of systematic reviews of evidence for exercise therapies.*10, *11 These have shown that there is strong evidence for the effectiveness of therapeutic exercise for patients with osteoarthritis and subacute and chronic low back pain. There were indications that therapeutic exercise was effective for patients with neck pain, whiplash-associated disorders, shoulder pain, and patellofemoral pain. In 2005 Smidt et al10 concluded that there was insufficient

Acknowledgements

Thanks to Hilary Jones for help in preparing the manuscript, and Tracy Reynolds for assistance with obtaining articles. Nadine Foster is funded by a Primary Care Career Scientist Award from the Department of Health and NHS R&D.

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