Conditional Recommendations:

Balance exercises are conditionally recommended for patients with knee and/or hip OA. These exercises improve patients’ ability to control and stabilize body position. To date, randomized controlled trials have not addressed the potential of balance-based exercises in reducing fall risk in patients with OA.

Yoga is conditionally recommended for patients with knee OA. Yoga combines physical postures with breathing techniques and meditation or relaxation. Although the practice is less studied than tai chi, yoga may provide similar benefits for patients with OA.

Cognitive behavioral therapy (CBT) is conditionally recommended for patients with knee, hip, and/or hand OA. A well-established body of literature supports the use of CBT for chronic pain conditions, with trials demonstrating improvements in pain, health-related quality of life, mood, fatigue, functional capacity, and disability. In OA, limited evidence suggests that CBT reduces pain; further research is needed to establish the benefits of CBT in OA.

Patellofemoral braces are conditionally recommended for patients with patellofemoral knee OA. Patients in whom disease in either 1 or both knees is causing a sufficiently large effect on ambulation, joint stability, or pain may warrant the need for an assistive device. This recommendation is conditional due to variability in results across currently published literature. Physicians should keep in mind that some patients may have difficulty tolerating the inconvenience and burden of braces.

Kinesiotaping is conditionally recommended for patients with knee and/or first CMC joint OA. This practice permits range of motion of the joint to which it is being applied, in contrast to braces. The evidence quality is limited owing to limitations in blinding when studying this practice.

Hand orthoses are conditionally recommended for patients with OA in other joints of the hand. A wide variety of mechanical supports are currently available, including digital orthoses, ring splints, and rigid or neoprene orthoses. Insufficient data are available to recommend 1 type of orthoses over another. Patients considering hand orthoses may benefit from evaluation by an occupational therapist.

Modified shoes are conditionally recommended against in patients with knee and/or hip OA. Although optimal footwear is of considerable importance for patients with OA, available studies do not define the best type of footwear to improve outcomes for either knee or hip OA.

Lateral and medial wedged insoles are conditionally recommended against in patients with knee and/or hip OA. Currently available literature does not demonstrate a clear efficacy of lateral or medial wedged insoles.

Acupuncture is conditionally recommended for patients with knee, hip, and/or hand OA. The efficacy of acupuncture remains a subject of controversy, due to issues with blinding, sham control validity, sample size, effect size, and prior expectations. The greatest number of positive trials with the largest effect sizes have been conducted in knee OA. Although the true magnitude of effect is unclear, the risk for harm is minor.

Thermal interventions (locally applied heat or cold) are conditionally recommended for patients with knee, hip, and/or hand OA. The delivery method for thermal interventions varies considerably in published literature, and both the modality heterogeneity and short duration of benefit have led to a conditional recommendation.

Paraffin, an additional method of heat therapy for the hands, is conditionally recommended for patients with hand OA.

Radiofrequency ablation is conditionally recommended for patients with knee OA. This recommendation is conditional because of the heterogeneity of techniques and controls and lack of long-term safety data.

Massage therapy is conditionally recommended against in patients with knee and/or hip OA. Studies of massage therapy have experienced high risk for bias, included small patient populations, and have not demonstrated OA-specific outcomes.

Manual therapy with exercise is conditionally recommended against vs exercise alone in patients with knee and/or hip OA. A limited number of studies have assessed manual therapy in addition to exercise vs exercise alone. Limited data demonstrate additional benefit for exercise alone in OA symptom management.

Iontophoresis is conditionally recommended against in patients with first CMC joint OA. Currently there are no published randomized controlled trials evaluating ionotophoresis for OA in any anatomic location.

Pulsed vibration therapy is conditionally recommended against in patients with knee OA. Few trials have addressed this practice and therefore it has been conditionally recommended.

This article originally appeared on Rheumatology Advisor