1. Introduction
Physiotherapy is an integral part of the non-drug management of rheumatological conditions. She uses a variety of techniques designed to preserve joint function and maintain muscle strength through adaptive physical activity [1] . Studies have reported its effectiveness [2] [3] [4] [5] [6] as well as its ineffectiveness [7] . The objective was to evaluate the impact of physiotherapy in the management of rheumatological disorders.
2. Patients and Methods
This was a 6-month analytical case-control study from 15/12/2021 to 20/05/2022. We included patients with rheumatological conditions who received drug therapy and physiotherapy sessions in the case group. Age, sex and diagnosis-matched controls were patients with rheumatological conditions who received only drug therapy. We did not include patients with heart failure, respiratory failure or skin infection. Consent was required after explaining the procedure and purpose of the study. The following variables were collected: age, sex, occupation, level of education, origin, duration of illness, body mass index, diagnosis, duration of physiotherapy. The physiotherapy techniques used were physiotherapy, electrotherapy, massage therapy, passive and active joint mobilizations, posture work, axial traction, muscle strengthening, learning self-rehabilitation.
The Visual Analogue Scale (VAS) assessed the patient’s pain intensity on a scale from 0 to 10 at the start of physiotherapy and three (03) months after treatment. She described pain as absent pain for VAS = 0, mild pain for VAS = 1 to 3, moderate pain for VAS = 4 to 6, severe pain for VAS = 7 to 9, and extremely severe pain for VAS = 10. VAS was assessed before treatment (VAS1) and three months after treatment (VAS2). The following questionnaires and indices were used: WOMAC (Western Ontario McMaster) to assess osteoarthritis of the lower limbs [8] , EIFEL (Functional Disability Scale for the Assessment of Low Back Pain) to assess the functional disability of low back pain patients [9] , NDI (Neck Disability Index) to assess the functional impact of neck pain [10] , SPADI (Shoulder pain and disability index) to assess the functional impact of shoulder pain [11] . Satisfaction was sought in patients through self-reporting.
2.1. Data Analysis
Data collection was manual using a pre-set survey sheet embedded in the Kobocollect application.
Qualitative variables were expressed by frequency and percentage. Quantitative variables were expressed as the mean with their standard deviations. For the correlation between the dependent variable and the different independent variables, we used the Chi2 test (or Fisher’s exact test). The materiality threshold has been set at 5%.
2.2. Ethical Considerations
The protocol had been submitted and approved by a medical college of the CHU Ignace Deen. The information has been collected and treated confidentially with strict compliance with ethics.
3. Results
Three hundred and eighty-nine patients (56.8% women) had received physiotherapy. The mean age was 53.8 years ± 12.2 years (Ranges: 20 years and 89 years).
Gonarthrosis was found in 119 (30.6%). Cervical pathology (6.9%) was dominated by cervicarthrosis (2.5%). Shoulder pain was mainly related to omarthrosis and tendinopathies (6.7%). For low back pain, low back arthrosis was the leading cause (162; 41.7) followed by herniated discs (19; 4.9%). (Table 1)
Pre-treatment, pain intensity was similar in cases and controls (For patients with knee osteoarthritis, VAS1 = 6.2 ± 1.3 VS VAS2 = 6.1 ± 1.5. In cervical pathology, VAS1 = 6.2 ± 1.8 VS VAS2 = 6.1 ± 1.6. Shoulder pathology, VAS1 = 6.4 ± 1.1 VS VAS2 = 6.1 ± 1.2. Low back pain VAS1 = 7.4 ± 1.6 VS VAS2 = 7.6 ± 1.1).
After 3 months, pain was significantly reduced and abilities improved better in patients who received physiotherapy.
For patients with knee osteoarthritis treated with physiotherapy, the pain was significantly reduced VAS1 = 6.2 ± 1.3 VS VAS2 = 2.2 ± 1.6.
For neck pain, the intensity was reduced: VAS1 = 6.2 ± 1.8 VS. VAS2 = 1.7 ± 0.9.
For shoulder pain, the intensity was reduced: VAS1 = 6.4 ± 1.1 VS. VAS2 = 2.8 ± 1.3.
For low back pain, VAS1 = 7.4 ± 1.6 VS VAS2 = 2.9 ± 1.6. (Tables 2-5)
The WOMAC assessment of function found a significant improvement in the components of pain, stiffness and physical function (WOMAC 1 = 18.3 ± 7.3 VS WOMAC2 = 31.6 ± 9.7 (p = 0.03). (Table 6)
For neck pain, VAS1 = 1.7 ± 0.9 VS VAS2 = 4.4 ± 1.02, function was improved (NDI1 = 7.3 ± 4.1 VS NDI2 = 11.3 ± 6.4, p = 0.02) (Table 7)
For shoulders, pain was slightly reduced VAS 1 = 2.8 ± 1.3 VS VAS 2 = 3.6 ± 2.3, improved function SPADI 1 = 15.4 ± 7.3 VS SPADI 2 = 21.3 ± 9.7. (Table 8, Table 9)
Physiotherapy was significantly associated with patient satisfaction (p = 0.0004). Patients who received physiotherapy were 3 times more likely to be satisfied than controls (Table 10).
4. Discussion
We conducted a case-control study to investigate the effectiveness of physiotherapy
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Table 1. Distribution of 389 cases and 384 controls by diagnosis.
Patients received a median of 19 physiotherapy sessions. The average duration of the physiotherapy session was 53.4 ± 12.2 minutes.
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Table 2. Distribution of 119 cases and 126 controls diagnosed with knee osteoarthritis according to VAS before and 03 months after drug treatment plus physiotherapy.
Mean VAS for cases: 6.2 ± 1.3; Mean VAS for cases: 2.2 ± 1.6; Mean VAS for controls: 6.1 ± 1.5; Mean VAS for controls: 5.7 ± 1.2.
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Table 3. Distribution of 23 cases and 25 controls diagnosed with cervical pathologies according to VAS before and 3 months after drug treatment plus physiotherapy.
Mean VAS for cases: 6.2 ± 1.8; Mean VAS for cases: 1.7 ± 0.9; Mean VAS for controls: 6.1 ± 1.6; Mean VAS for controls: 4.4 ± 1.02.
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Table 4. Distribution of 27 cases and 29 controls diagnosed with shoulder pathologies according to VAS before and 03 months after drug treatment plus physiotherapy.
Mean VAS for cases: 6.4 ± 1.1; Mean VAS for cases: 2.8 ± 1.3; Mean VAS for controls: 6.1 ± 1.2; Mean VAS for controls: 3.6 ± 2.3.
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Table 5. Distribution of 220 cases and 204 controls diagnosed with lumbar pathology according to VAS before and 03 months after drug treatment plus physiotherapy.
Mean VAS for cases: 7.4 ± 1.6; Mean VAS for cases: 2.9 ± 1.6; Mean VAS for controls: 7.6 ± 1.1; Mean VAS for controls: 3.1 ± 1.01.
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Table 6. Distribution of 119 cases and 126 controls diagnosed with knee osteoarthritis according to WOMAC before and 03 months after drug treatment plus physiotherapy.
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Table 7. Distribution of the 23 cases and 25 controls diagnosed with cervical pathologies according to NDI (Neck disability index) before and 03 months after drug treatment plus physiotherapy.
Average NDI for cases: 25.9 ± 12.3 Average NDI for cases: 7.3 ± 4.1; Mean NDI for cases: 25.1 ± 11.8 Mean NDI for controls: 11.3 ± 6.4.
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Table 8. Distribution of the 27 cases and 29 controls diagnosed with shoulder pathologies according to SPADI (shoulder pain and disability index) before and 03 months after drug treatment plus physiotherapy.
Function was improved; EIFEL 1 = 6.9 ± 2.8 VS EIFEL 2 = 11.2 ± 4.1.
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Table 9. Distribution of 216 cases and 200 controls diagnosed with lumbar pathology according to EIFEL (Functional Disability Scale for the Assessment of Low Back Pain) before and 03 months after drug treatment plus physiotherapy.
Mean EIFEL for cases: 19.2 ± 9.7; Mean EIFEL for cases: 6.9 ± 2.8; Mean EIFEL for controls: 17.8 ± 9.1; Mean EIFEL for controls: 11.2 ± 4.1.
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Table 10. Correlation between physiotherapy and patient satisfaction after treatment.
in the management of rheumatic diseases. The study was carried out in the rheumatology department alone. The relatively high cost of physiotherapy sessions and the non-compliance of some patients with follow-up appointments were the main difficulties in data collection. However, the results we have achieved have made it possible to assess the impact of physiotherapy in the management of rheumatological conditions.
Of the 773 patients, 389 benefited from physiotherapy sessions in addition to drug treatment. The female predominance of rheumatological conditions was similar to Togolese and Congolese data [12] [13] . Similarly, the mean age (53.8 years ± 12.2 years) was consistent with Ivorian data [14] . Osteoarthritis was the most commonly diagnosed rheumatic disease in our patients with a frequency of 65.2%. This supports data from the literature that reports that osteoarthritis is the leading rheumatological condition in the general population [15] .
The site of the rheumatological disease was in (55.1%) of cases of the lumbar spine followed by the knee in (31.7%) of all patients. This found frequency has been reported in several African series by Ouédraogo and al. [16] in Burkina Faso and Rakotomalala and al. [17] in Madagascar. This could be related to the arduousness of daily life and being overweight, which is perceived as a sign of well-being. Parameters assessing functional impact (WOMAC, SPADI, NDI, and EIFEL) and pain intensity (VAS) were similar in both groups before treatment. For example, diagnosed cases of osteoarthritis of the knee had a mean difference of 13.3 points on the WOMAC index and 3.5 points on the VAS scale three months after treatment compared to controls. These results corroborate those of Gail and al. [18] in the United States and Deniz and al. [19] in Turkey, who reported a mean difference of 18.8 points on the WOMAC scale and 3.3 points on the VAS scale, respectively.
This difference in score could be explained by the techniques used in the physiotherapy management of knee osteoarthritis which contribute to muscle strengthening, to the increase of muscle mass, thus reducing pain and disability and then leading to an increase in functional capacity [20] .
In patients diagnosed with cervical pathology, there was a significant improvement in pain (cases 2.1 ± 0.9 Vs controls 4.4 ± 1.02) and functional disability (cases 7.3 ± 4.1 Vs controls 11.3 ± 6.4) in cases compared to controls with a mean difference of 2.3 points for the VAS scale and 4 points for the NDI functional disability score. This result can be superimposed on that of Sherman KJ [21] in the United States, who reported a significant improvement in functional disability with a mean difference of 2.3 points, 10 weeks after physiotherapy sessions. This could be related to the mobilization and use of a cervical neck brace that allowed our patients to regain the range of motion of the cervical spine. However, this result differs from that of KL Brennan and al [22] who showed a total reduction in pain and functional disability in patients. This discrepancy could be explained by the fact that the latter in their study combined electrotherapy with acupuncture. Our results are consistent with those of the literature that reported a benefit of physical exercise combined with massage therapy for chronic neck pain [23] .
Patients diagnosed with shoulder pathology showed a mean difference of 6.3 points compared to controls. Littlewood C [24] and Mueller MJ [25] in their studies had reported higher mean scores of the SPADI index of 12.4 and 13 points, respectively. Such a difference could be explained by contextual factors, such as the patient population, the treating physiotherapist and the content of the overall sessions. Mohamed AA et al. [26] . The decrease in assessment scores observed in cases could be attributed to the decrease in stiffness of the musculotendinous complex and the adhesions formed as a result of prolonged immobilization between the scapula and the thorax as improvement progresses.
In patients with low back pain, there was a significant reduction in pain in both groups and a mean difference of 4.3 points in the EIFEL index. Facci and al. [27] reported a significant decrease in disability scores after electrotherapy sessions. Similarly, Hahn et al. [28] showed that the rate of pain reduction in an exercise group combined with electrotherapy was significantly higher than in the electrotherapy group alone. In our study, the addition of electrotherapy to exercise warranted further improvement in cases. This would explain why physical exercise has fundamental and structural effects on the body. Also, electrotherapy would cause the activation of inhibitory interneurons in the dorsal horn of the spinal cord, which would prevent nociceptive impulses from passing to the central nervous system.
5. Conclusion
Physiotherapy for rheumatological conditions significantly reduced pain and improved functional capacity. Satisfaction was noted in 82.5% of patients and was significantly associated with physiotherapy.