A double-blind trial of clinical effects of therapeutic ultrasound in knee osteoarthritis

A randomized double blind clinical trial was conducted to determine the effectiveness of ultrasound (US) therapy in knee osteoarthritis (OA). Sixty-seven patients (mean age 54.8 +/-7) were randomized to receive either 1 MHz frequency or 1 watt/cm(2) power continuous ultrasound for 5 min (n = 34) or sham US (n = 33) as a placebo. Ten sessions of treatment were applied to the target knee of the patient. A blinded evaluation at baseline and after treatment was made. Primary outcome was pain on movement assessed by visual analog scale (VAS). Secondary outcomes consisted of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and 50 meters walking time. Both groups showed significant improvements in knee pain on movement. In the treatment group, the improvement in VAS score was statistically and significantly higher (p < 0.001) and more pronounced than in the placebo group. Pain reduction averaged 47.76% in the treatment group (p = 0.013). Secondary outcomes improved in both groups but reached statistical significance only in the treatment group: p = 0.006 for the mean change in total WOMAC scores and p = 0.041 for 50 meters walking time. Results suggest that therapeutic US is safe and effective treatment modality in pain relief and improvement of functions in patients with knee OA.     

高频彩色多普勒超声评价不同方法治疗膝关节骨性关节炎的疗效

目的 探讨高频超声评价不同方法治疗膝关节骨性关节炎(KOA)疗效的价值。方法 将60例KOA患者随机分为针刀治疗组和药物治疗组各30例,运用高频彩色多普勒超声分别测量两组治疗前、后关节腔积液、滑膜厚度,观察滑膜血供,并进行统计学分析。结果 60例KOA,治疗后关节腔积液减少、滑膜变薄、血供减少,与治疗前比较差异有统计学意义(P<0.05),且针刀治疗组较药物治疗组效果更明显(P<0.05)。结论 超声通过观察关节腔积液、滑膜厚度及血供情况,可为临床评价膝关节骨性关节炎治疗效果提供依据。     

Effects of combined application of progressive resistance training and Russian electrical stimulation on quadriceps femoris muscle strength in elderly women with knee osteoarthritis

[Purpose] The aim of this study was to investigate the effects of combined application of progressive resistance training and Russian electrical stimulation on quadriceps femoris muscle strength in elderly women with osteoarthritis of the knee. [Subjects] Thirty women over 65 years of age diagnosed with knee osteoarthritis participated in the present study. The subjects were randomly assigned to a control group (n=10), a progressive resistance training group (n=10), or a Russian electrical stimulation group (n=10). [Methods] Each group was treated 3 times weekly for 8 weeks, and each session lasted 45 minutes. Muscle strength was assessed by measuring the peak torque of the quadriceps femoris muscle. Outcome measurements were performed at baseline and at the fourth and eighth weeks of the treatment period. [Results] All groups showed significant intragroup differences in the quadriceps femoris muscle peak torque after the treatment intervention. There were significant intergroup differences between the Russian electrical stimulation group and the other groups. [Conclusion] The results of this study suggest that combined application of progressive resistance training and Russian electrical stimulation can be effective in strengthening the quadriceps femoris muscle in elderly women with knee osteoarthritis.Key words: Knee osteoarthritis, Progressive resistance training, Russian electrical stimulation     

超声治疗膝骨关节炎的疗效分析

目的 应用超声关节炎治疗仪治疗膝关节骨关节炎患者,探讨超声在治疗膝关节骨关节炎中的应用价值。方法 膝关节骨关节炎患者87例,病膝100例。将病膝随机分为超声关节炎治疗仪治疗组,即超声组（A组）50例和安慰剂组（B组）50例,即无超声治疗组。比较分析两组患者治疗前后的疼痛视觉模拟评分（VAS）评分和勒凯纳（Lequesne）评分。结果 A组单样本分析显示VAS疗效指数P=0．000,Lequesne疗效指数P=0．000。B组单样本分析显示VAS疗效指数P=0．000,Lequesne疗效指数P=0．024。A、B组独立样本t检验显示VAS疗效指数P=0．000,Lequesne疗效指数P=0．000。结论 超声治疗可明显减轻膝关节炎的局部症状,缓解关节肿胀,增加关节的活动度,减轻关节炎症,对膝骨关节炎有良好的治疗效果。     

等速离心训练对膝关节骨关节炎患者的影响

目的探讨等速离心肌力训练对膝关节骨关节炎患者的康复疗效。方法运用Cybex-6000型等速肌力测试及训练系统对40例膝关节骨关节炎患者(共70个患膝)进行为期4周、每周3次的等速离心肌力训练。分别于训练前、后测定患者在60°/s、120°/s及180°/s等速运动时的峰力矩、单次最大作功量、平均功率及力矩加速能量;并将训练前、后患膝疼痛程度及下肢功能评分进行比较。结果患者经训练后,其患膝屈、伸肌群各项功能参数均有显著改善,并以屈膝肌各项功能参数的改善尤为显著;患膝疼痛及功能性行为能力评分亦均较治疗前有显著改善。结论等速离心训练能有效改善膝关节骨关节炎患者屈、伸肌群的各项功能参数(其中以屈膝肌的改善尤为显著);同时还能缓解患者疼痛,显著提高其功能性行为能力。     

Short-term effectiveness of ultrasound therapy in knee osteoarthritis

This randomized, placebo-controlled, double-blind study was designed to investigate the short-term efficacy of ultrasound therapy in 90 patients with knee osteoarthritis (OA). Patients were randomly assigned to three groups: group 1 received continuous ultrasound, group 2 received pulsed ultrasound, and group 3 received a 'sham' (placebo) ultrasound for 5 min each session. All treatments were applied once a day for 5 days a week for 2 weeks, i.e. a total treatment duration of 10 days. Compared with baseline, significant improvements were observed in the visual analogue scale pain scores and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores in all three groups. The reductions in pain and WOMAC scores were significantly higher in patients treated with pulsed ultrasound than in the placebo group. In conclusion, pulsed ultrasound therapy is a safe and effective treatment modality in patients with knee OA. Further research is required to investigate the long-term efficacy of pulsed ultrasound therapy in knee OA.     

Relationship between knee alignment and the electromyographic activity of quadriceps muscles in patients with knee osteoarthritis

[Purpose] We evaluated the relationship between knee alignment and the electromyographic (EMG) activity of the vastus medialis (VM) to the vastus lateralis (VL) muscles in patients with knee osteoarthritis (OA) in a cross-sectional study. [Subjects and Methods] Forty subjects with knee OA were assessed by anatomic radiographic knee alignment and the VM/VL ratio was calculated. Surface EMG from both the VM and VL muscles were evaluated during maximal isometric contraction at 60° knee flexion. Simultaneously, peak quadriceps torque was assessed using an isokinetic dynamometer. Subjects were categorized into low, moderate, and high varus groups according to knee malalignment. The peak quadriceps torque and VM/VL ratio across groups, and their relationships with varus malalignment were analyzed. [Results] All subjects had medial compartment OA and the VM/VL ratio of all subjects was 1.31 ± 0.28 (mean ± SD). There were no significant differences in the peak quadriceps torque or VM/VL ratios across the groups nor were there any significant relationships with varus malalignment. [Conclusion] The VM/VL ratio and peak quadriceps torque were not associated with the severity of knee varus malalignment.Key words: Malalignment, Knee, Quadriceps     

丹参和透明质酸钠恢复膝关节功能的对比研究

目的通过对丹参和透明质酸钠注射液关节腔内注射治疗膝骨关节炎临床疗效的比较,客观评价中药丹参治疗膝骨关节炎的疗效。方法将68例(85膝)膝骨关节炎患者,随机分为两组,分别在膝关节内注射丹参和透明质酸钠注射液,并在用药后5周和随后12个月内观察疗效。结果在治疗5周后两组在膝关节疼痛和功能等评分方面均有明显改善(P<0.05)。12个月随访期间,丹参组和透明质酸钠组分别有37膝(84.1%)和34膝(82.9%)一直未出现关节疼痛;两组分别有33膝(75.0%)和31膝(75.6%)未出现任何不适。在短期效果和疗效维持方面两组间差异无显著性意义(P>0.05)。结论两组在早期治疗膝骨关节炎方面同样有良好的疗效,且12月连续随访也有较好的疗效维持。丹参膝关节腔内注射治疗膝骨关节炎,具有安全、有效、方便和廉价的优点,值得临床推广应用。     

Effects of proprioceptive circuit exercise on knee joint pain and muscle function in patients with knee osteoarthritis

[Purpose] This study applied proprioceptive circuit exercise to patients with degenerative knee osteoarthritis and examined its effects on knee joint muscle function and the level of pain. [Subjects] In this study, 14 patients with knee osteoarthritis in two groups, a proprioceptive circuit exercise group (n = 7) and control group (n = 7), were examined. [Methods] IsoMed 2000 (D&R Ferstl GmbH, Hemau, Germany) was used to assess knee joint muscle function, and a Visual Analog Scale was used to measure pain level. [Results] In the proprioceptive circuit exercise group, knee joint muscle function and pain levels improved significantly, whereas in the control group, no significant improvement was observed. [Conclusion] A proprioceptive circuit exercise may be an effective way to strengthen knee joint muscle function and reduce pain in patients with knee osteoarthritis.Key words: Proprioceptive circuit exercise, Muscle function, Pain     

Aerobic exercise improves oxidant-antioxidant balance in patients with rheumatoid arthritis

[Purpose] Although oxidative stress is known to be present in rheumatoid arthritis (RA), the effects of exercise on oxidative parameters are unknown. The aim of this study was to investigate the effects of acute aerobic exercise on serum oxidant and antioxidant levels in patients with RA. [Subjects and Methods] Sixteen patients with RA and 10 age-matched healthy volunteers participated in this study. All participants wore polar telemeters and walked on a treadmill for 30 minutes at a speed eliciting 60–75% of maximal heart rates. Blood samples were obtained before, immediately and 24 hours after exercise and malondialdehyde (MDA) and total sulfhydrile group (RSH) levels were measured. [Results] Both groups had similar heart rates during the test but the treadmill speed of the RA patients was significantly lower than that of the healthy volunteers. Serum MDA levels were lower than in both groups immediately after exercise, with greater decrements in the RA patients than controls. MDA levels returned to baseline 24 hours after the exercise only in the controls; they remained low in the RA patients. There was a slight increase in serum RSH levels after exercise compared to baseline in both groups. [Conclusion] Moderate intensity treadmill exercise did not have any adverse effect on the oxidant-antioxidant balance. The results suggest that such an exercise may be safely added to the rehabilitation program of RA for additional antioxidant effects. Morever, this antioxidant environment is maintained longer in RA patients.Key words: Aerobic exercise, Oxidative status, Rheumatoid arthritis     

超声评分对膝骨性关节炎患者病变特点的评估价值

目的 探讨超声评分对膝骨性关节炎患者病情严重度的诊断价值。方法 回顾性收集我院收治的膝骨性关节炎患者52例,同期收集50例健康成人,分析超声评分与膝骨性关节炎患者病情严重度的相关性。结果 膝骨性关节炎患者超声评分显著高于健康成人(6.93±1.76 vs. 1.73±0.56,P=0.000)。膝骨性关节炎患者超声评分与髌上囊液体深度、髌下囊液体深度、关节腔液体深度、滑膜厚度显著正相关(r=0.265、0.216、0.310和0.255,P=0.004、0.035、0.000和0.012),与Lyshsolm显著负相关(r=-0.381,P=0.000)。与增生滑膜内血管阴性的患者相比,增生滑膜内血管阳性的患者超声评分显著增加(7.43±1.61 vs. 5.58±1.42, P=0.000)。结论 超声评分与膝骨性关节炎患者病情严重度相关。     

聚焦超声辅助治疗对膝关节骨关节炎患者近期膝关节功能及炎性因子水平的影响

目的 分析聚焦超声波辅助治疗对膝关节骨关节炎患者近期膝关节功能及炎性因子水平的影响。方法 选取膝关节骨关节炎患者80例,根据随机数字表法分为常规组与研究组,每组各40例。常规组给予药物干预联合功能锻炼,研究组在常规组治疗的基础上加用聚焦超声波辅助治疗。两组患者均治疗4周。比较两组患者的膝关节功能、疼痛程度以及关节液白介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)、IL-6水平。结果 治疗2、4周后,研究组VAS评分均低于常规组(P＜0.05);治疗4周后,研究组关节僵硬、关节肿胀、关节压痛、运动时痛、休息时痛以及总分均低于常规组(P＜0.05);研究组膝关节屈曲度、伸直度以及屈伸弧度均高于常规组(P＜0.05);研究组关节液IL-1、TNF-α以及IL-6均低于常规组(P＜0.05)。结论 聚焦超声波辅助治疗改善了膝关节骨关节炎患者近期膝关节功能,减轻了疼痛程度,降低了炎性因子水平,值得临床重视。     

Reliability and responsiveness of algometry for measuring pressure pain threshold in patients with knee osteoarthritis

[Purpose] This study aimed to establish the intrarater reliability and responsiveness of a clinically available algometer in patients with knee osteoarthritis as well as to determine the minimum-detectable-change and standard error of measurement of testing to facilitate clinical interpretation of temporal changes. [Subjects] Seventy-three patients with knee osteoarthritis were included. [Methods] Pressure pain threshold measured by algometry was evaluated 3 times at 2-min intervals over 2 clinically relevant sites—mediolateral to the medial femoral tubercle (distal) and lateral to the medial malleolus (local)—on the same day. Intrarater reliability was estimated by intraclass correlation coefficients. The minimum-detectable-change and standard error of measurement were calculated. As a measure of responsiveness, the effect size was calculated for the results at baseline and after treatment. [Results] The intrarater reliability was almost perfect (intraclass correlation coefficient = 0.93–0.97). The standard error of measurement and minimum-detectable-change were 0.70–0.66 and 1.62–1.53, respectively. The pressure pain threshold over the distal site was inadequately responsive in knee osteoarthritis, but the local site was responsive. The effect size was 0.70. [Conclusion] Algometry is reliable and responsive to assess measures of pressure pain threshold for evaluating pain patients with knee osteoarthritis.Key words: Pressure pain threshold, Reliability, Responsiveness     

Relationships among foot position,lower limb alignment,and knee adduction moment in patients with degenerative knee osteoarthritis

[Purpose] The aim of this study was to determine the relationships among the foot progression angle, foot rotation angle, lower limb alignment, and knee adduction moments in patients with degenerative knee osteoarthritis (OA). [Subjects] Forty-eight patients diagnosed with degenerative knee OA (Kellgren-Lawrence grades 2 and 3) were included. [Methods] To assess the lower extremity alignment and weight-bearing ratio, static radiographic measurement was used. Foot progression angle, foot rotation angle, and knee adduction moments were measured by using a three-dimensional motion analysis system. [Results] The results of this study were as follows: the foot progression angle in the early and late stance phase was significantly correlated with the first and second peak knee adduction moments; the weight-bearing ratio was significantly correlated with the first and second peak knee adduction moments; and the tibiofemoral angle was significantly correlated with the first and second peak knee adduction moments. [Conclusion] The results of the present study indicated that as the foot progression angle and the foot lateral rotation angle increased, the knee adduction moment decreased. The weight-bearing ratio and tibiofemoral angle assessment with mechanical axis alignment were correlated with the knee adduction moments. These parameters may be helpful for selecting therapeutic options for patients with degenerative knee OA.Key words: Knee osteoarthritis, Knee adduction moment, Foot rotation angle     

Biomechanical,neuromuscular and knee pain effects following therapeutic knee taping among patients with knee osteoarthritis during walking gait

BackgroundKnee osteoarthritis is one of the most debilitating diseases associated with aging, and is estimated to affect 9% of men and 18% of women over 65 years of age. Knee osteoarthritis affects the condylar surfaces of the joint and if left untreated generally leads to the slow and painful degeneration of the joint and surrounding structures. With few non-invasive treatment options for osteoarthritis patients, this study investigated the effect of therapeutic taping on knee pain in combination with spatiotemporal, kinematic, kinetic and muscle activation measures.MethodsFifteen participants (10 male, 5 female) with radiographic diagnosed knee osteoarthritis attended a single testing session and walked along at a self-selected pace under three different conditions (no tape, sham tape, therapeutic tape). The conditions were randomised within each testing session. Knee pain, lower limb biomechanics and muscle activation were analysed using a one-way repeated measures ANOVA to determine if any differences existed between the three taping conditions (α = 0.05).FindingsTherapeutic knee taping was shown to significantly reduce the self-reported levels of knee joint pain during straight line walking. No significant differences in spatiotemporal, knee kinetic, knee kinematic or lower limb muscle activation variables were observed between the taping conditions.InterpretationThere is evidence supporting the use of therapeutic knee taping for the management of osteoarthritis related knee pain. Future research is recommended to better understand the complex acute neuro-musculoskeletal adaptations that explain these positive knee pain findings.     

Effects of neck exercises on swallowing function of patients with stroke

[Purpose] This study examined the effects of neck exercises using PNF on the swallowing function of stroke patients with dysphasia. [Subjects and Methods] A total of 26 study subjects were selected and randomly divided into an experimental group of 13 subjects, who received the PNF-based short neck flexion exercises, and a control group of 13 subjects, who received the Shaker exercise. [Results] The experimental group showed statistically significant improvements in premature bolus loss, residue in the valleculae, laryngeal elevation, epiglottic closure, residue in the pyriform sinuses, and coating of the pharyngeal wall after swallowing, and improvements in pharyngeal transit time, and aspiration on both the new VFSS scale and the ASHA NOMS scale. [Conclusion] PNF-based short neck flexion exercises appear to be effective at improving swallowing function of stroke patients with dysphagia.Key words: Proprioceptive neuromuscular facilitation, Dysphagia, Stroke     

Effect of shoulder girdle strengthening on trunk alignment in patients with stroke

[Purpose] This study investigated the effect of shoulder girdle strengthening, particularly the scapular muscles, on poststroke trunk alignment. [Subjects and Methods] The study involved 30 patients with residual hemiparesis following cerebrovascular stroke. Patient assessment included measuring shoulder muscle peak torque, scapular muscles peak force, spinal lateral deviation angle, and motor functional performance. Patients were randomly allocated either to the control group or the study group and received an 18-session strengthening program including active resisted exercises for shoulder abductors and external rotators in addition to trunk control exercises. The study group received additional strengthening exercises for the scapular muscles. [Results] The two groups showed significant improvement in strength of all shoulder and scapular muscles, with higher improvement in the study group. Similarly, the lateral spinal deviation angles significantly improved in both groups, with significantly higher improvement in the study group. Transfer activity, sitting balance, upper limb functions, and hand movements significantly improved in the two groups, with higher improvement in the latter two functions in the study group. [Conclusion] Strengthening of shoulder girdle muscles, particularly scapular muscles, can significantly contribute to improving the postural alignment of the trunk in patients with poststroke hemiparesis.Key words: Stroke, Scapular muscles strengthening, Lateral trunk alignment     

Comparison of the therapeutic efficacy of TENS versus intra-articular hyaluronic acid injection in patients with knee osteoarthritis: A prospective randomized study

Knee osteoarthritis (OA) is perceived as a major public health problem, and today, various treatment modalities are used to manage this condition. The purpose of this study was to assess and compare the efficacy of transcutaneous electrical nerve stimulation (TENS) and intra-articular hylan G-F 20 (Synvisc; Genzyme Corporation, Ridgefield, NJ) in patients with symptomatic knee OA. A total of 60 patients with primary knee OA were randomized into 2 treatment groups. TENS was applied for 3 weeks in the first group, and in the second group, hylan G-F 20 was injected intra-articularly once a week for 3 weeks. Patients were then followed for 6 months. Disease severity was measured with the Lequesne Index. Efficacy in terms of pain, functional status, and quality of life was assessed through analysis of changes in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and short Form 36 Health Survey (SF-36) scores. Adverse events were monitored throughout the study. WOMAC pain scores were improved at the first control visit in the TENS group and in the viscosupplementation group; this improvement was statistically significant. WOMAC stiffness scores showed a statistically significant decrease in the TENS group at the first control visit. Stiffness did not decrease during the first month in the second group; however, these patients exhibited improvement during the sixth month after injection. Physical function scores and SF-36 total scores did not change in either group after treatment. Pain relief was observed at the first month and continued throughout the 6-month follow-up period in both groups. Stiffness decreased by the sixth month in both groups. Improvement in WOMAC physical function scores was greater in the intra-articular hylan group than in the TENS group at the end of follow-up; however, quality of life was not improved in either group. These therapies used in combination may alleviate symptoms in patients with OA.     

高频超声诊断膝关节骨性关节炎的临床价值

目的探讨高频超声对膝关节骨性关节炎(KOA)的诊断价值。方法纳入2016年6月至2019年6月就诊的86例疑似KOA患者,所有患者均行X线与高频超声检查,比较分析两种检查方法对KOA病变的检出率。以关节镜检结果为准,计算X线、高频超声诊断KOA的灵敏度、特异度及准确度。结果86例疑似KOA患者经关节镜检确诊78例。高频超声对肌腱病变、关节腔积液、滑膜增生、软骨退行性病变及腘窝囊肿的检出率均高于X线(P<0.05)。高频超声对关节边缘骨质增生、关节面下骨囊性变及关节间隙狭窄的检出率均低于X线(P<0.05)。高频超声诊断KOA的灵敏度和准确度均高于X线(P<0.05)。结论高频超声对非骨性结构KOA病变显示效果较好,对KOA的诊断效能高,可作为首选诊断方法。