Efficacia di un approccio di trattamento ayurvedico nell'osteoartrite del ginocchio - uno studio controllato randomizzato

Published in ARTICOLI SCIENTIFICI

Efficacia di un approccio di trattamento ayurvedico nell'osteoartrite del ginocchio - uno studio controllato randomizzato

C.S. Kessler1, K.S. Dhiman2, A. Kumar3, T. Ostermann4, S. Gupta5, A. Morandi6, M. Mittwede7, E. Stapelfeldt8, M. Spoo9, K. Icke10, A. Michalsen11, C.M.Witty12

Osteoarthritis and Cartilage  2018 Feb 7.
pii: S1063-4584(18)30082-7.
doi: 10.1016/j.joca.2018.01.022. [Epub ahead of print]

ABSTRACT

OBIETTIVO: L'Ayurveda è comunemente usata in Asia meridionale per trattare l'osteoartrite (OA) del ginocchio. Miravamo a valutare l'efficacia del trattamento ayurvedico rispetto alla cura conservativa convenzionale in pazienti con l'OA al ginocchio.     

METODO: Secondo i criteri dell'American College of Rheumatology (ACR) i pazienti con OA del ginocchio sono stati inclusi in un trial multicentrico randomizzato, controllato, aperto, e trattati in 2 cliniche ospedaliere e 2 cliniche private ambulatoriali in Germania. I partecipanti hanno ricevuto un trattamento ayurvedico multimodale o una terapia convenzionale multimodale con 15 trattamenti rispettivamente per 12 settimane. L'esito primario è stato il cambiamento dell'indice dell'Osteoartrite della Western Ontario e McMaster University (WOMAC) dopo 12 settimane. Gli esiti secondari includevano le sottoscale WOMAC; l'indice di disabilità del dolore e una scala di esperienza del dolore, scale di valutazione numerica per dolore e qualità del sonno, qualità della vita e dell'umore, uso di farmaci di salvataggio e problemi di sicurezza.

RISULTATI: Sono stati inclusi centocinquantuno partecipanti (Ayurveda n = 77, cure convenzionali n = 74). I cambiamenti dell'indice WOMAC dalla baseline a 12 settimane sono stati più pronunciati nel gruppo ayurvedico (differenza media 61,0 [IC 95%: 52,4; 69,6]) rispetto al gruppo convenzionale (32,0 [IC 95%: 21,4; 42,6]) risultanti in una significativa differenza tra i gruppi (p <0,001) e una dimensione dell'effetto clinicamente rilevante (d di Cohen 0,68 [IC 95%: 0,35; 1,01]). Tendenze simili sono state osservate per tutti gli esiti secondari alla settimana 12. Gli effetti sono stati mantenuti ai follow-up dopo 6 e 12 mesi.

CONCLUSIONE: I risultati suggeriscono che il trattamento ayurvedico è utile nel ridurre i sintomi dell’OA del ginocchio. Ulteriori studi dovrebbero essere condotti per confermare l'entità dell'effetto e per chiarire il ruolo dei diversi componenti del trattamento e degli effetti non specifici.

 

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Informazioni sugli Autori
Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany; Immanuel Hospital Berlin, Department for Complementary Medicine, Königstr. 63, 14109 Berlin, Germany. 
Ministry of AYUSH, AYUSH Bhawan, B Block, GPO Complex, INA, New Delhi 110023, India; Central Council for Research in Ayurvedic Sciences (CCRAS), Jawahar Lal Nehru Bhavan, No.61-65, Institutional Area, Janakpuri, New Delhi 110058, India.
3 Ministry of AYUSH, AYUSH Bhawan, B Block, GPO Complex, INA, New Delhi 110023, India; All India Institute of Ayurveda, Mathura Road, Gautampuri, Sarita Vihar, New Delhi 110076, India.
University of Witten Herdecke, Department of Psychology and Psychotherapy, Alfred-Herrhausen-Straße 50, Witten, Germany.
European Academy of Ayurveda, Forsthausstr. 6, 63633 Birstein, Germany; Department of Kaya Cikitsa, J.S. Ayurveda College & P.D. Patel Ayurveda Hospital, College Road, Nadiad 387001, India.
6 Ayurvedic Point, School of Ayurvedic Medicine, Corso Sempione 63, 20149 Milan, Italy.
7European Academy of Ayurveda, Forsthausstr. 6, 63633 Birstein, Germany; University of Frankfurt, Department of Religious Sciences, Grüneburgplatz 1, 60323 Frankfurt, Germany.
8 Immanuel Hospital Berlin, Department for Complementary Medicine, Königstr. 63, 14109 Berlin, Germany.
Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany.
10 Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany; Immanuel Hospital Berlin, Department for Complementary Medicine, Königstr. 63, 14109 Berlin, Germany. Electronic address: Questo indirizzo email è protetto dagli spambots. È necessario abilitare JavaScript per vederlo..
11 Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany; Institute of Complementary and Integrative Medicine, University Hospital and University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; University of Maryland School of Medicine, Center for Integrative Medicine, 520 W. Lombard Street, East Hall, Baltimore, MD 21201, USA.

Effectiveness of an Ayurveda treatment approach in knee osteoarthritis - a randomized controlled trial.

C.S. Kessler1, K.S. Dhiman2, A. Kumar3, T. Ostermann4, S. Gupta5, A. Morandi6, M. Mittwede7, E. Stapelfeldt8, M. Spoo9, K. Icke10, A. Michalsen11, C.M.Witty12

Osteoarthritis and Cartilage  2018 Feb 7.
pii: S1063-4584(18)30082-7.
doi: 10.1016/j.joca.2018.01.022. [Epub ahead of print]

 

ABSTRACT

OBJECTIVE: Ayurveda is commonly used in South Asia to treat knee osteoarthritis (OA). We aimed to evaluate the effectiveness of Ayurvedic treatment compared to conventional conservative care in patients with knee OA.

METHOD: According to American College of Rheumatology (ACR) criteria knee OA patients were included in a multicenter randomized, controlled, open-label trial and treated in 2 hospital clinics and 2 private outpatient clinics in Germany. Participants received either a multi-modal Ayurvedic treatment or multimodal conventional care with 15 treatments over 12 weeks respectively. Primary outcome was the change on the Western Ontario and McMaster University Osteoarthritis (WOMAC) Index after 12 weeks. Secondary outcomes included WOMAC subscales; the pain disability index and a pain experience scale, numeric rating scales for pain and sleep quality, quality-of-life and mood, rescue medication use, and safety issues.

RESULTS: One hundred fifty-one participants (Ayurveda n = 77, conventional care n = 74) were included. Changes of the WOMAC Index from baseline to 12 weeks were more pronounced in the Ayurveda group (mean difference 61.0 [95%CI: 52.4;69.6]) than in the conventional group (32.0 [95%CI: 21.4;42.6]) resulting in a significant between-group difference (p < 0.001) and a clinically relevant effect size (Cohen's d 0.68 [95% CI:0.35;1.01]). Similar trends were observed for all secondary outcomes at week 12. Effects were sustained at follow-ups after 6 and 12 months.

CONCLUSION: Results suggest that Ayurvedic treatment is beneficial in reducing knee OA symptoms. Further studies should be conducted to confirm the magnitude of the effect and to clarify the role of different treatment components and non-specific effects.

 

 

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Author information
Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany; Immanuel Hospital Berlin, Department for Complementary Medicine, Königstr. 63, 14109 Berlin, Germany. 
Ministry of AYUSH, AYUSH Bhawan, B Block, GPO Complex, INA, New Delhi 110023, India; Central Council for Research in Ayurvedic Sciences (CCRAS), Jawahar Lal Nehru Bhavan, No.61-65, Institutional Area, Janakpuri, New Delhi 110058, India.
3 Ministry of AYUSH, AYUSH Bhawan, B Block, GPO Complex, INA, New Delhi 110023, India; All India Institute of Ayurveda, Mathura Road, Gautampuri, Sarita Vihar, New Delhi 110076, India.
University of Witten Herdecke, Department of Psychology and Psychotherapy, Alfred-Herrhausen-Straße 50, Witten, Germany.
European Academy of Ayurveda, Forsthausstr. 6, 63633 Birstein, Germany; Department of Kaya Cikitsa, J.S. Ayurveda College & P.D. Patel Ayurveda Hospital, College Road, Nadiad 387001, India.
6 Ayurvedic Point, School of Ayurvedic Medicine, Corso Sempione 63, 20149 Milan, Italy.
7European Academy of Ayurveda, Forsthausstr. 6, 63633 Birstein, Germany; University of Frankfurt, Department of Religious Sciences, Grüneburgplatz 1, 60323 Frankfurt, Germany.
8 Immanuel Hospital Berlin, Department for Complementary Medicine, Königstr. 63, 14109 Berlin, Germany.
Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany.
10 Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany; Immanuel Hospital Berlin, Department for Complementary Medicine, Königstr. 63, 14109 Berlin, Germany. Electronic address: Questo indirizzo email è protetto dagli spambots. È necessario abilitare JavaScript per vederlo..
11 Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany; Institute of Complementary and Integrative Medicine, University Hospital and University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; University of Maryland School of Medicine, Center for Integrative Medicine, 520 W. Lombard Street, East Hall, Baltimore, MD 21201, USA.

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