No evidence for stratified exercise therapy being cost-effective compared to usual exercise therapy in patients with knee osteoarthritis: Economic evaluation alongside cluster randomized controlled trial

BackgroundA stratified approach to exercise therapy may yield superior clinical and economic outcomes, given the large heterogeneity of individuals with knee osteoarthritis (OA).ObjectiveTo evaluate the cost-effectiveness during a 12-month follow-up of a model of stratified exercise therapy compared to usual exercise therapy in patients with knee OA, from a societal and healthcare perspective.MethodsAn economic evaluation was conducted alongside a cluster-randomized controlled trial in patients with knee OA (n = 335), comparing subgroup-specific exercise therapy for a ‘high muscle strength subgroup’, ‘low muscle strength subgroup’, and ‘obesity subgroup’ supplemented by a dietary intervention for the ‘obesity subgroup’ (experimental group), with usual (‘non-stratified’) exercise therapy (control group). Clinical outcomes included quality-adjusted life years – QALYs (EuroQol-5D-5 L), knee pain (Numerical Rating Scale) and physical functioning (Knee Injury and Osteoarthritis Outcome Score in daily living). Costs were measured by self-reported questionnaires at 3, 6, 9 and 12-month follow-up. Missing data were imputed using multiple imputation. Data were analyzed through linear regression. Bootstrapping techniques were applied to estimate statistical uncertainty.ResultsDuring 12-month follow-up, there were no significant between-group differences in clinical outcomes. The total societal costs of the experimental group were on average lower compared to the control group (mean [95% confidence interval]: € 405 [-1728, 918]), albeit with a high level of uncertainty. We found a negligible difference in QALYs between groups (mean [95% confidence interval]: 0.006 [-0.011, 0.023]). The probability of stratified exercise therapy being cost-effective compared to usual exercise therapy from the societal perspective was around 73%, regardless of the willingness-to-pay threshold. However, this probability decreased substantially to 50% (willingness-to-pay threshold of €20.000/QALY) when using the healthcare perspective. Similar results were found for knee pain and physical functioning.ConclusionsWe found no clear evidence that stratified exercise therapy is likely to be cost-effective compared to usual exercise therapy in patients with knee OA. However, results should be interpreted with caution as the study power was lower than intended, due to the Coronavirus disease (COVID-19) pandemic.     

Photobiomodulation does not provide incremental benefits to patients with knee osteoarthritis who receive a strengthening exercises program: a randomized controlled trial

BackgroundThere is lack of agreement in the literature about the effectiveness of photobiomodulation (PBM) for reducing pain-related symptoms in patients with knee osteoarthritis (OA).ObjectiveTo evaluate whether PBM, when combined to exercises, provides incremental therapeutic benefits for pain, physical function, and quality of life (QoL) in patients with knee OA.MethodsA six-month double-blind placebo-controlled randomized trial was conducted. Patients with knee OA were randomly assigned to one of three treatment groups: Exercise, Exercise plus Active PBM, or Exercise plus Placebo PBM. Treatment was provided over an eight-week period, three times per week. The primary outcomes were pain at rest and upon movement, assessed by a visual analogue scale (VAS). WOMAC global score, QoL, and a core-set of performance-based tests were measured as secondary outcomes. All outcomes were collected at baseline, immediately after treatment, and after three- and six-month post-treatment.Results127 participants were allocated as follows: Exercise, N = 41; Exercise plus Active PBM, N = 44; and Exercise plus Placebo PBM, N = 42. There was no between-groups difference in improvement in pain, physical function, and QoL for all follow-up times. However, all groups presented significant, clinically relevant improvements in pain, physical function, and QoL immediately and three months after treatment compared with baseline measures.ConclusionPatients with knee OA who received a strengthening exercises program did not experience incremental benefits regarding pain, physical function, or QoL when adding PBM to their therapeutic exercises.     

The effect of orthotic devices on knee adduction moment,pain and function in medial compartment knee osteoarthritis: a literature review

Background Knee braces and foot orthoses are commonly used to improve knee adduction moment, pain and function in subjects with knee osteoarthritis (OA). However, no literature review has been performed to compare the effects of foot orthoses and knee braces in this group of patients. Purpose The aim of this review was to evaluate the effects of foot orthoses and knee braces on knee adduction moment, pain and function in individuals with knee OA. Study design Literature review. Method The search strategy was based on the Population Intervention Comparison Outcome method. A search was performed in PubMed, Science Direct, Google Scholar and ISI web of knowledge databases using the PRISMA method and based on selected keywords. Thirty-one related articles were selected for final evaluation. Results The results of the analysis of these studies demonstrated that orthotic devices reduce knee adduction moment and also improve pain and function in individuals with knee OA. Conclusion Foot orthoses may be more effective in improving pain and function in subjects with knee OA. Both knee braces and foot orthoses reduce the knee adduction moment in knee OA and consequently patients typically do not need to use knee braces for a long period of time. Also, foot orthoses and knee braces may be more effective for medial compartment knee OA patients due to the fact that this treatment helps improve pain and function.

• Implications for Rehabilitation

• Knee braces and foot orthoses are commonly used for improving knee adduction moment, pain and function in subjects with knee osteoarthritis (OA).

• Orthotic devices can reduce knee adduction moment, pain and improve function in knee OA.

• The combined use of a knee braces and foot orthoses can provide more improvement in knee adduction moment, reduced pain and increased function.

     

Changes in self-reported disability after performance-based tests in obese and non-obese individuals diagnosed with osteoarthritis of the knee

Abstract

Purpose: The purposes of this study are three-fold: (1) To examine whether the WOMAC questionnaire should be obtained before or after performance-based tests. (2) To assess whether self-reported disability scores before and after performance-based tests differ between obese and non-obese individuals. (3) To observe whether physical activity and BMI predict self-reported disability before and after performance based tests. Methods: A longitudinal study included thirty one participants diagnosed with knee osteoarthritis (OA) using the Kellgren-Lawrence Scale by an orthopedic surgeon. Results: All WOMAC scores were significantly higher after as compared to before the completion of performance-based tests. This pattern of results suggested that the WOMAC questionnaire should be administered to individuals with OA after performance-based tests. The obese OA was significantly different compared to the non-obese OA group on all WOMAC scores. Physical activity and BMI explained a significant proportion of variance of self-reported disability. Conclusion: Obese individuals with knee OA may over-estimate their ability to perform physical activities, and may under-estimate their level of disability compared to non-obese individuals with knee OA. In addition, self-reported physical activity seems to be a strong indicator of disability in individuals with knee OA, particularly for individuals with a sedentary life style.

• Implications for Rehabilitation

• Osteoarthritis is a progressive joint disabling condition that restricts physical function and participation in daily activities, particularity in elderly individuals.

• Obesity is a comorbidity commonly associated with osteoarthritis and it appears to increase self-reported disability in those diagnosed with osteoarthritis of the knee.

• In a relatively small sample, this study recommends that rehabilitation professionals obtain self-report questionnaires of disability after performance-based tests in obese individuals with osteoarthritis of the knee as they are more likely to give an accurate representation of their level of ability at this time.

     

Influences on individuals with osteoarthritis in deciding to undergo a hip or knee joint replacement: A qualitative study

Purpose. Osteoarthritis (OA) of the hip and knee is one of the major long-term health conditions. At the end-stage of the disease, a hip or knee replacement may be necessary. Yet, deciding to undergo a total joint replacement (TJR) due to OA may be a difficult decision for individuals. We conducted a study to elucidate the factors that influence whether or not individuals with OA decide to undergo a hip or knee replacement.

Method. A qualitative study nested within a longitudinal study (n = 268) that was exploring the management of OA. We interviewed a purposive sample of individuals (n = 27) with OA referred for consideration for TJR.

Findings. Participants were aged 49 to 89 with hip or knee OA. Participants’ decision-making was influenced by (1) symptoms, in particular pain and effect on physical functioning; (2) the opinion of others; (3) a weighing up of risks with benefits and (4) information sources.

Conclusions. Participants with end-stage knee OA were less willing to undergo surgery than those with hip OA. There is a need to provide more treatment options and quality information and advice to individuals to enable informed decision-making.     

Biomechanical and clinical outcomes with shock-absorbing insoles in patients with knee osteoarthritis: immediate effects and changes after 1 month of wear

Turpin KM, De Vincenzo A, Apps AM, Cooney T, MacKenzie MD, Chang R, Hunt MA. Biomechanical and clinical outcomes with shock-absorbing insoles in patients with knee osteoarthritis: immediate effects and changes after 1 month of wear.ObjectivesTo examine the effectiveness of shock-absorbing insoles in the immediate reduction of knee joint load, as well as reductions in knee joint load, pain, and dysfunction after 1 month of wear, in individuals with knee osteoarthritis (OA).DesignPre-post design with participants exposed to 2 conditions (normal footwear, shock-absorbing insoles) with a 1-month follow-up.SettingUniversity laboratory for testing and general community for intervention.ParticipantsCommunity-dwelling individuals (N=16; 6 men, 10 women) with medial compartment knee OA.InterventionParticipants were provided with sulcus length shock-absorbing insoles to be inserted into their everyday shoes.Main Outcome MeasuresPrimary outcome measures included the peak, early stance peak, and late stance peak external knee adduction moment (KAM); the KAM impulse (positive area under the KAM curve); and peak tibial vertical acceleration. Secondary outcomes included walking pain, the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale and total score, and a timed stair climb task.ResultsThere was a significant reduction in the late stance peak KAM with shock-absorbing insoles (P=.03) during follow-up compared with the baseline test session. No other immediate or longitudinal significant changes (P>.05) in the other KAM parameters or peak tibial acceleration after use of a shock-absorbing insole were observed. However, significant improvements in all measures of pain and function (P<.05) were observed.ConclusionsShock-absorbing insoles produced significant reductions in self-reported knee joint pain and physical dysfunction with 1 month of wear in patients with knee OA despite no consistent changes in knee joint load. Further research using randomized controlled trials, with larger sample sizes and explorations into long-term use of shock-absorbing insoles and their effect on disease progression, is warranted.     

Factors related to the indecision of older adults with knee osteoarthritis about receiving physician-recommended total knee arthroplasty

Purpose: To explore factors related to the indecision of older adults with knee osteoarthritis (OA) about receiving physician-recommended total knee arthroplasty (TKA) and their needs during the decision-making process.

Method: Older outpatients with knee OA and undecided about physician-recommended TKA (N?=?26) were recruited by convenience from two medical centers and one regional hospital in northern Taiwan. Data were collected in individual interviews using a semi-structured guide and analyzed by thematic analysis.

Results: Participants’ indecision about receiving physician-recommended TKA was due to four major concerns: treatment-related concerns, physical condition-related concerns, surgery-related concerns, and postsurgical care concerns. The few participants (n?=?6) who expressed needs during the decision-making process wanted more information about preparing for surgery, postsurgical care, rehabilitation, and medicines.

Conclusions: Healthcare providers are challenged to respect the decision-making process of older adults with OA regarding recommended TKA while maintaining their quality of life. These adults need appropriate information not only about the relationship between OA suffering and quality of life, but also TKA. While these patients are deciding whether to undergo physician-recommended TKA, they also need information about preparations for surgery, postsurgical care, rehabilitation, and medicines.

• Implications for Rehabilitation

• Total knee arthroplasty (TKA) can significantly relieve pain and improve function for older adults with knee osteoarthritis (OA), but many are unwilling to receive the surgery.

• Our older adult participants with knee OA ascribed their indecision about receiving physician-recommended TKA to treatment-related, physical condition-related, surgery-related, and postsurgical care-related concerns.

• Healthcare providers need to provide appropriate information to older adults with knee OA not only about the relationship between OA suffering and quality of life, but also about TKA.

• Healthcare providers should also provide these patients information about preparing for surgery, postsurgical care, rehabilitation, and medicines while they are deciding whether to undergo TKA.

     

Sex Differences in Patients With Different Stages of Knee Osteoarthritis

ObjectiveTo quantify the differences in physical impairments and in performance-based measures and patient-reported outcomes in men and women seeking nonoperative management of symptomatic moderate knee osteoarthritis (OA) and those with symptomatic end-stage knee OA scheduled for total knee arthroplasty compared with healthy controls.DesignCross-sectional analysis of individuals referred to physical therapy, community participants, and subjects from a 2-year longitudinal study.SettingUniversity research department.ParticipantsCross-sectional analysis of participants (N=289) consisting of a moderate OA group (n=83), a severe OA group (n=143), and a healthy control group (n=63).InterventionsNot applicable.Main Outcome MeasuresQuadriceps strength, timed Up and Go test, stair-climbing test, 6-minute walk test, Knee Outcome Survey–Activities of Daily Living Scale (KOS-ADLS), and Physical Component Summary (PCS) of the Medical Outcomes Study 36-Item Short-Form Health Survey.ResultsWomen had worse scores than men for physical impairment and performance-based measures (P<.001). In the moderate OA group, women had significantly lower KOS-ADLS (P=.007) and PCS (P=.026) scores than men, with no differences seen between sexes in the other 2 groups for patient-reported measures.ConclusionsDifferences between women and men with knee OA on physical impairments and performance-based measures are not echoed in the differences seen in patient-reported measures. These measures signal different domains of knee function in patients with knee OA and should be used as part of a comprehensive functional evaluation.     

Does acupuncture provide pain relief in patients with osteoarthritis knee? An overview of systematic reviews

BackgroundKnee osteoarthritis (OA) is the most common condition that causes pain and disability in adults over 50 years old. The application of acupuncture, as a method of complementary intervention, could be beneficial for pain relief and knee function in patients with knee OA.ObjectiveAnalyze the effectiveness of acupuncture versus control interventions in patients with knee OA.MethodsAn electronic search was performed in the MEDLINE (via PubMed), EMBASE, PEDro, Cochrane CENTRAL, CINAHL, Web of Science and LILACS databases. The eligibility criteria for selecting systematic reviews included clinical trials that compared acupuncture versus control interventions for pain intensity in patients with knee OA.ResultsA total of 15 systematic reviews met the eligibility criteria for the quantitative synthesis. In the short term, the mean difference (MD) for pain intensity was −0.32 cm (95% CI = −0.57 to −0.08, p = 0.01). There was a very low quality of evidence according to the GRADE rating. In the short term, the mean difference (MD) for knee function was −8.74 points (95% CI = −13.36 to −4.12, p ≤ 0.001). There was low quality of evidence according to the GRADE rating. All differences were in favor of acupuncture.ConclusionAt short-term, there was low to very low evidence and there were statistically significant differences in pain intensity and knee function in favor of acupuncture versus control interventions in patients with knee OA. However, these differences were not clinically important. For the acupuncture versus sham, in the short-term, no differences clinical neither statistically significant to favor of acupuncture in pain intensity and knee function.     

Effects of Swedish massage on gait spatiotemporal parameters in adult women with medial knee osteoarthritis: A randomized controlled trial

BackgroundPatients with knee osteoarthritis (OA) are always faced with functional limitations in daily activities due to knee pain. They are also at risk of falling because of compensatory kinetics and kinematics changes in walking, which is why they are seeking complementary therapies to deal with their problems.ObjectiveThe present research aimed to evaluate whether Swedish massage is effective in relieving the symptoms of knee OA and improving the gait spatiotemporal parameters of patients with knee OA.MethodsThirty adult women with knee OA participated in this study voluntarily. The intervention group (n = 15) received Swedish massage on their quadriceps for 20–30 min per session (12 sessions). During this period, the control group (n = 15) received their regular treatment. Osteoarthritis symptoms were evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index. The spatiotemporal parameters of gait were also captured by the motion analysis system during barefoot walking.ResultsThe intervention group demonstrated significantly more pain relief and improved function compared to the control group. A significant increase was observed in the gait speed, total support time, and single support time (P < 0.05). Moreover, there was a significant decrease in the step width and initial double support time of the patients after receiving Swedish massage (P < 0.05).ConclusionIt can be concluded that Swedish massage may positively affect pain relief and function improvement in patients with knee OA. Also, Swedish massage was found to improve the spatiotemporal parameters in the patients. This may have important clinical implications regarding the rehabilitation of patients with knee OA.     

Therapeutic exercise for knee osteoarthritis: considering factors that may influence outcome

While exercise has been shown to be beneficial for reducing pain and improving physical function in individuals with knee osteoarthritis (OA), there are still individuals who do not always respond well to this treatment approach. There are a number of factors that have been shown to influence either the degree of disability and/or the progression of disease in individuals with knee OA. These factors include quadriceps inhibition or activation failure, obesity, passive knee laxity, knee alignment, fear of physical activity and self efficacy. It may be possible that varying levels of these factors might also interfere with an individual's ability to participate in an exercise or physical activity program or minimize the benefits that can be achieved by such programs. This paper examines the influence of these factors on physical function and their potential for altering the outcome of exercise therapy programs for individuals with knee OA. Implications and suggestions for potential adjunctive interventions to address these factors in future research and clinical practice are also discussed.     

Assessment of Synvisc treatment in osteoarthritis

Background. Viscosupplementation is a relatively new method for the treatment of osteoarthritis (OA). The main goal of this project was to assess the safety and clinical utility of Hylan G-F20 (Synvisc(R)) in the treatment of pain associated with osteoarthritis of the knee. The type and frequency of additional therapies used during Synvisc(R) treatment were also assessed. It was a prospective project designed for monitoring Synvisc(R)-prescribing habits in usual medical care.
Material and method. One hundred ninety knee joints in 187 patients were studied (OA symptoms were bilateral in 3 women). Synvisc(R) was indicated for the local treatment of pain in osteoarthritis of the knee. After the diagnosis, Synvisc(R) therapy was started at the recommended dose of 2 ml per intra-articular injection once
a week (at 1-week intervals), three injections in total. The data collected, including medical history, physical examination, radiographic examination and treatment efficacy (overall assessment performed at each visit), were recorded on case report forms designed to facilitate statistical analysis. The physicians completed visual Analogue Scale (VAS) for overall assessment of OA pain at each visit. The clinical outcome was recorded after the end of therapy. The patient data were collected by physicians taking part in this project only.
Results. In 156 cases (82.1%) either a substantial improvement or subsidence of symptoms was observed. In 34 cases (17.9%) the improvement was small or there was no change in the patient's condition. There were local adverse reactions in 2 patients (1.07%). There was no need to cease the treatment, to hospitalise a patient or to start any additional treatment. In 167 patients (89.3%) there was no need to start any non-pharmacological concomitant treatment.
Conclusions. In summary, Synvisc(R) viscosupplementation should be rated among the safest and most effective methods for the treatment of OA, for it alleviates OA-related pain, thus reducing the need for NSAIDs and steroid injections. The use of Synvisc(R) in OA patients alleviates pain regardless of sex and age, the effect being the most pronounced in patients with low- and medium-grade radiographic changes.     

Efficacy of core exercises in patients with osteoarthritis of the knee: A randomized controlled clinical trial

Trial designRandomized, evaluator blinded, controlled, parallel group.MethodsThis trial was conducted between July 2011 and January 2015 at a public hospital in Argentina. Patients older than 40 years with a medical diagnosis of osteoarthritis (OA) were randomly assigned to the experimental group (EG) or control group (CG). Both groups performed conventional exercises 3 times a week for 12 weeks and core exercises were added to the EG intervention.The objective was to compare the efficacy of conventional treatment combined with core muscle strengthening exercises, with conventional treatment alone in terms of short- and medium-term pain reduction and physical function in patients with knee OA.The primary outcome was knee pain assessed using a visual analog scale and the secondary outcome was physical function assessed at baseline, week 8 and 12, and 2 follow-up visits held 1 month and 3 months after the end of treatment.Results113 patients were randomized to a CG (n = 60) or EG (n = 53). 66 patients were eliminated and 25 patients in the EG and 22 in the CG were analyzed.Both pain reduction and improved physical function were observed throughout the intervention in both groups. At the end of the treatment, a statistically and clinically significant pain reduction was observed in the EG. No adverse effects were reported.ConclusionThe combination of core muscle activation exercises and conventional treatment was more effective in short-term pain reduction in patients with knee OA.     

What are the unsupervised exercise adherence rates in clinical trials for knee osteoarthritis? A systematic review

BackgroundExercise is an effective intervention for knee osteoarthritis (OA), and unsupervised exercise programs should be a common adjunct to most treatments. However, it is unknown if current clinical trials are capturing information regarding adherence.ObjectiveTo summarize the extent and quality of reporting of unsupervised exercise adherence in clinical trials for knee OA.MethodsReviewers searched five databases (PubMed, CINAHL, Medline (OVID), EMBASE and Cochrane). Randomized controlled trials where participants with knee OA engaged in an unsupervised exercise program were included. The extent to which exercise adherence was monitored and reported was assessed and findings were subgrouped according to method for tracking adherence. The types of adherence measurement categories were synthesized. A quality assessment was completed using the Physiotherapy Evidence Database (PEDro) scores.ResultsOf 3622 abstracts screened, 176 studies met criteria for inclusion. PEDro scores for study quality ranged from two to ten (mean=6.3). Exercise adherence data was reported in 72 (40.9%) studies. Twenty-six (14.8%) studies only mentioned collection of adherence. Adherence rates ranged from 3.7 to 100% in trials that reported adherence. For 18 studies (10.2%) that tracked acceptable adherence, there was no clear superiority in treatment effect based on adherence rates.ConclusionsClinical trials for knee OA do not consistently collect or report adherence with unsupervised exercise programs. Slightly more than half of the studies reported collecting adherence data while only 40.9% reported findings with substantial heterogeneity in tracking methodology. The clinical relevance of these programs cannot be properly contextualized without this information.     

Factors associated with stair climbing ability in patients with knee osteoarthritis and knee arthroplasty: a systematic review

Abstract

Purpose: People with knee osteoarthritis (OA) report ongoing limitations in climbing stairs, even after total knee arthroplasty (TKA). The aim of this systematic review was to synthesise the available evidence of factors affecting stair climbing ability in patients with knee OA before and after TKA. Method: A systematic search was conducted of common electronic databases. All English language abstracts where stair-climbing was assessed in patients with either knee OA or at least 6 months after TKA, and a relationship to any physical, psychological or demographic factors was reported. Results: Thirteen studies were included in the final review, nine investigated a knee OA population, and four investigated a TKA population. For patients with knee OA there was consistent and convincing evidence that greater stair-climbing ability was related to stronger lower limb muscles and less knee pain. For patients with TKA there was much less research, and no conclusions could be reached. Conclusions: For people with knee OA there is evidence that some physical, demographic and psychosocial factors are related to stair-climbing ability. However, the evidence for similar relationships in the TKA population is scarce and needs more extensive research.

• Implications for Rehabilitation

• People with knee osteoarthritis experience difficulty when climbing stairs, and this remains challenging even after knee replacement.

• For people with knee osteoarthritis, a range of physical, demographic and psychosocial factors contribute to stair-climbing ability, however, evidence for similar relationships in the TKA population is scarce.

• Rehabilitation that is multi-faceted may be the best approach to improve stair-climbing in people with knee osteoarthritis.

     

Long term effect of the Pilates method in a reconstructed knee with osteoarthritis: A case report

BackgroundOsteoarthritis (OA) is one of the most debilitating diseases, and a patient with a reconstructed knee could develop it early and lives with this condition for an average of 30-years. Furthermore, most studies focus on short-term results, not long-term. The purpose of this article is to show how a patient with reconstructed knees and OA improved clinical outcomes using the Pilates Method (PM) in the long term.Methods and materialsThe patient was treated with common medical treatment for 10 years and then treated with the PM for 15 years. Authors used the biomechanics-based approaches, radiographic examination of the knees, magnetic resonance imaging, the numeric pain rating scale, range of motion (ROM), the Polestar fitness screening test (PFST), the knee injury and osteoarthritis outcome score questionnaire (KOOS), and the physical function performance-based tests (PFPBT) recommended by Osteoarthritis Research Society International (OARSI).ResultsThere was an improvement in the evaluated outcomes when using the PM in the long term: a decrease in pain-related scores (constant pain = - 4; worst pain = - 5), improved ROM in 15°, improved stability in both knees (right Lackman Test (LT) = −1; left LT = - 2). When comparing the patient with healthy women in the middle age through the PFPBT her scores are above average, with no restrictions in performing daily activities and a good quality of life according with the KOOS questionnaire.ConclusionThis case study suggests that long-term Pilates training may be useful for the treatment of pain, stiffness, and function in patients with reconstructed knees and OA.     

A comparison of two manual physical therapy approaches and electrotherapy modalities for patients with knee osteoarthritis: A randomized three arm clinical trial

A broad spectrum of physical therapy exercise programs provides symptom relief and functional benefit for patients with knee OA. Manual physical therapy, including tailored exercise programs provide relatively higher level benefit that persists to one year. It is currently unknown if there are important differences in the effects of different manual physical therapy techniques for patients with knee OA and there are virtually no studies comparing manual physical therapy and electrotherapy modalities. The aim of the study was to compare long-term results between three treatment groups (mobilization with movements [MWMs], passive joint mobilization [PJM], and electrotherapy) to determine which treatment is most effective in patients with knee OA. A single-blind randomized clinical trial with parallel design was conducted in patients with knee OA. Seventy-two consecutive patients (mean age 56.11 ± 6.80 years) with bilateral knee OA were randomly assigned to one of three treatment groups: MWMs, PJM, and electrotherapy. All groups performed an exercise program and received 12 sessions. The primary outcome measures of the functional assessment were the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and Aggregated Locomotor Function (ALF) test scores. The secondary outcome measures were pain level, measured using a pressure algometer and a visual analogue scale (VAS), range of motion (ROM), measured using a digital goniometer, and muscle strength, evaluated with a handheld dynamometer. Patients were assessed before treatment, after treatment and after 1 year of follow-up. Patients receiving the manual physical therapy interventions consisting of either MWM or PJM demonstrated a greater decrease in VAS scores at rest, during functional activities, and during the night compared to those in the electrotherapy group from baseline to after the treatment (p < 0.05). This improvement continued at the 1-year follow-up (p < 0.05). The MWMs and PJM groups also showed significantly improved WOMAC and ALF scores, knee ROM and quadriceps muscle strength compared to those in the electrotherapy group from baseline to 1-year follow-up (p < 0.05). In the treatment of patients with knee OA, manual physical therapy consisting of either MWM or PJM provided superior benefit over electrotherapy in terms of pain level, knee ROM, quadriceps muscle strength, and functional level.     

Short-term effects of 890-nanometer radiation on pain, physical activity, and postural stability in patients with knee osteoarthritis: a double-blind, randomized, placebo-controlled study

Hsieh R-L, Lo M-T, Liao W-C, Lee W-C. Short-term effects of 890-nanometer radiation on pain, physical activity, and postural stability in patients with knee osteoarthritis: a double-blind, randomized, placebo-controlled study.ObjectiveTo investigate the effects of short-term light therapy with 890-nm radiation on pain, physical activity, and postural stability in patients with knee osteoarthritis (OA).DesignA double-blind, randomized, placebo-controlled study.SettingRehabilitation clinic.ParticipantsWomen (n=62) and men (n=10) with a mean age of 61.2 years (range, 40–88y). All patients fulfilled the combined clinical and radiographic criteria for knee OA as established by the American College of Rheumatology, and all had obtained a Kellgren-Lawrence score of 2 or more.InterventionsParticipants received 6 sessions, lasting 40 minutes each, of active or placebo radiation treatment over the knee joints for 2 weeks (wavelength, 890nm; radiant power output, 6.24W; power density, 34.7mW/cm² for 40 minutes; total energy, 41.6J/cm² per knee per session).Main Outcome MeasuresParticipants were assessed weekly over 4 weeks using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain, stiffness, and physical function. Physical activity (timed stair climbing, 10-m fast-speed walking, and chair-rising time) and postural stability (using the postural stability evaluation system) were also assessed. The pain score on WOMAC was the primary outcome variable. Data were analyzed by repeated-measures analysis of covariance.ResultsCompared with baseline, no significant improvement was observed between groups for pain (P=.546), stiffness (P=.573), or physical function (P=.904). No significant improvement was noted for physical activity including the 10-m fast-speed walking time (P=.284), stair-climbing time (P=.202), stair-descending time (P=.468), chair-rising time (P=.499), or postural stability (P=.986) at the 4 follow-up assessments. Follow-up assessments were conducted after 1 week of treatment (thus, after 3 treatments); after 2 weeks of treatment (thus, after 6 treatments); and 1 and 2 weeks, respectively, after treatment was terminated. Although we found a significant time effect for the 10-m fast-speed walking time (P<.001) in the 2 groups, and a significant group effect in the improvement of stair-climbing time in the treatment group (P=.032), the group × time interaction effects were not significant.ConclusionsShort-term 890-nm radiation therapy for patients with knee OA provided no beneficial effect in improving pain, physical activity, and postural stability.     

Gait differs between unilateral and bilateral knee osteoarthritis

Creaby MW, Bennell KL, Hunt MA. Gait differs between unilateral and bilateral knee osteoarthritis.ObjectivesTo compare walking biomechanics in the most painful leg, and symmetry in biomechanics between legs, in individuals with (1) unilateral pain and structural osteoarthritis (OA), (2) unilateral pain, but bilateral structural OA, and (3) bilateral pain and structural OA and in (4) an asymptomatic control group.DesignCohort study.SettingLaboratory based.ParticipantsParticipants with symptomatic and/or radiographic medial tibiofemoral OA in one or both knees (n=91), and asymptomatic control participants (n=31).InterventionsNot applicable.Main Outcome MeasureThe peak knee adduction moment, peak knee flexion moment, knee varus-valgus angle, peak knee flexion angle, toe-out, and trunk lean were computed from 3-dimensional analysis of walking at a self-selected speed.ResultsAfter controlling for walking speed, greater trunk lean toward the more painful knee and reduced flexion in the more painful knee were observed in all OA groups compared with the control group. Between-knee asymmetries indicating greater varus angle and a lower external flexion moment in the painful knee were present in those with unilateral pain and either unilateral or bilateral structural OA. Knee biomechanics were symmetrical in those with bilateral pain and structural OA and in the pain free control group.ConclusionsThe presence of pain unilaterally appears to be associated with asymmetries in knee biomechanics. Contrary to this, bilateral pain is associated with symmetry. This suggests that the symptomatic status of both knees should be considered when contemplating unilateral or bilateral biomechanical interventions for medial knee OA.