The Effect of Therapeutic Ultrasound on Pain and Physical Function in Patients with Knee Osteoarthritis

Osteoartritis (OA) is one of the most frequent causes of pain, loss of function and disability in adults. The prevalence of OA is expected to increase substantially in the future. Knee OA is the most common subset of OA. Therapeutic ultrasound (US) is one of several physical therapy modalities suggested for the management of pain and loss of function due to OA. The purpose of our study was to investigate the efficacy of US therapy in reducing pain and functional loss and improving the quality of life in patients with knee OA in comparison to sham US therapy. The study involved 62 patients. The patients were randomly divided into two groups. The patients in group 1 (n = 30) were administered 1 W/cm², 1 MHz continuous US, and the patients in group 2 (n = 32) were administered sham US. The US treatment was applied for 8 min to each knee, 16 min in total, 5 d a wk, for a total of 10 sessions during 2 wk. The patients were evaluated immediately after treatment and 1 mo after therapy according to the visual analog scale (VAS), night pain, range of motion, morning stiffness, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne and Short Form-36 (SF-36) scales and 6 min walking distance. Improvement in pain and joint functions was observed in both groups according to the evaluation immediately after treatment and at 1 mo after the therapy. According to the evaluation results immediately after treatment, there was significant improvement in all pain scales (VAS, WOMAC, Lequesne, SF-36), morning stiffness and 6 min walking distance in patients receiving real US treatment (p < 0.05), but only in some pain scales (VAS, WOMAC) and functions in the group receiving sham US (p < 0.05). Significantly better improvement was observed in some pain scales (SF-36), functions (WOMAC, SF-36) and 6 min walking distance in the real US group. At 1 mo after therapy, no significant difference was observed between groups except for improvement in night pain in the real US group. In conclusion, US therapy has been found to be effective in reducing pain and improving physical function in the short term, but this positive effect was not persistent in the long term. However, we believe that the results of our study may contribute to ongoing research for the treatment of patients with knee OA, and further systematic investigation on larger patient populations may delineate the role of US in knee OA treatment.     

Manual physical therapy and perturbation exercises in knee osteoarthritis

Objectives:

Knee osteoarthritis (OA) causes disability among the elderly and is often associated with impaired balance and proprioception. Perturbation exercises may help improve these impairments. Although manual physical therapy is generally a well-tolerated treatment for knee OA, perturbation exercises have not been evaluated when used with a manual physical therapy approach. The purpose of this study was to observe tolerance to perturbation exercises and the effect of a manual physical therapy approach with perturbation exercises on patients with knee OA.

Methods:

This was a prospective observational cohort study of 15 patients with knee OA. The Western Ontario and McMaster Universities Arthritis Index (WOMAC), global rating of change (GROC), and 72-hour post-treatment tolerance were primary outcome measures. Patients received perturbation balance exercises along with a manual physical therapy approach, twice weekly for 4 weeks. Follow-up evaluation was done at 1, 3, and 6 months after beginning the program.

Results:

Mean total WOMAC score significantly improved (P = 0.001) after the 4-week program (total WOMAC: initial, 105; 4 weeks, 56; 3 months, 54; 6 months, 57). Mean improvements were similar to previously published trials of manual physical therapy without perturbation exercises. The GROC score showed a minimal clinically important difference (MCID)≥+3 in 13 patients (87%) at 4 weeks, 12 patients (80%) at 3 months, and 9 patients (60%) at 6 months. No patients reported exacerbation of symptoms within 72 hours following each treatment session.

Discussion:

A manual physical therapy approach that also included perturbation exercises was well tolerated and resulted in improved outcome scores in patients with knee OA.     

Quadriceps strengthening exercises may not change pain and function in knee osteoarthritis

It is believed that Quadriceps strength training may reduce pain and improve functional activity in patients with knee osteoarthritis (OA). This improvement is generally attributed to an increase in quadriceps strength. This study investigated whether quadriceps muscle strength increases with decreasing pain, improving functional activity in knee OA. Twenty-four patients with knee OA participated in an 8-week treatment protocol including traditional physical therapy and strength training 3 sessions per week. Measurements were conducted before and after the intervention and included the peak torque of quadriceps muscle, pain by visual analogue scale (VAS), short Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and functional activity by the 2 minute walking test (2MWT) and time up & go test (TUGT). After the intervention, analysis of data illustrated that changes in quadriceps muscle strength correlated with changes in VAS (r² = 0.310, p = 0.005), WOMAC (r² < 0.278, p < 0.008) and 2MWT (r² < 0.275, p < 0.009) significantly, although the correlation slope was negligible. No correlation was found between muscle strength and TUGT. However, the strength training significantly improved quadriceps muscle strength (p = 0.013), pain and functional activity (p = 0.000). This study showed that reduction in pain and improvement in functional activity occurs independently from an increase in quadriceps muscle strength in knee OA. It seems that increased quadriceps muscle strength may not be a cause of improvement in pain and functional activity in knee OA.     

Effects of orthopaedic manual therapy in knee osteoarthritis: a systematic review and meta-analysis

Objective

This systematic review to aimed to evaluate the effects of orthopaedic manual therapy (OMT) on pain, improving function, and physical performance in patients with knee osteoarthritis (OA).

Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program

BACKGROUND AND PURPOSE: Manual therapy and exercise have not previously been compared with a home exercise program for patients with osteoarthritis (OA) of the knee. The purpose of this study was to compare outcomes between a home-based physical therapy program and a clinically based physical therapy program. SUBJECTS: One hundred thirty-four subjects with OA of the knee were randomly assigned to a clinic treatment group (n=66; 61% female, 39% male; mean age [+/-SD]=64+/-10 years) or a home exercise group (n=68, 71% female, 29% male; mean age [+/-SD]=62+/-9 years). METHODS: Subjects in the clinic treatment group received supervised exercise, individualized manual therapy, and a home exercise program over a 4-week period. Subjects in the home exercise group received the same home exercise program initially, reinforced at a clinic visit 2 weeks later. Measured outcomes were the distance walked in 6 minutes and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: Both groups showed clinically and statistically significant improvements in 6-minute walk distances and WOMAC scores at 4 weeks; improvements were still evident in both groups at 8 weeks. By 4 weeks, WOMAC scores had improved by 52% in the clinic treatment group and by 26% in the home exercise group. Average 6-minute walk distances had improved about 10% in both groups. At 1 year, both groups were substantially and about equally improved over baseline measurements. Subjects in the clinic treatment group were less likely to be taking medications for their arthritis and were more satisfied with the overall outcome of their rehabilitative treatment compared with subjects in the home exercise group. DISCUSSION AND CONCLUSION: Although both groups improved by 1 month, subjects in the clinic treatment group achieved about twice as much improvement in WOMAC scores than subjects who performed similar unsupervised exercises at home. Equivalent maintenance of improvements at 1 year was presumably due to both groups continuing the identical home exercise program. The results indicate that a home exercise program for patients with OA of the knee provides important benefit. Adding a small number of additional clinical visits for the application of manual therapy and supervised exercise adds greater symptomatic relief.     

Disability in end-stage knee osteoarthritis

Objective. To examine the attributes of disability in end-stage knee osteoarthritis (OA) by analyzing the relationships between self-reported disability and objectively measured physical function after controlling pain, personal characteristic factors, and pathophysiological factors.

Methods. The present study adopted a cross-sectional design. The subjects (n=88, aged 60–80 years) were scheduled for primary unilateral total knee arthroplasty (TKA) due to knee OA. Self-reported disability and pain were measured with the Western Ontario and McMaster Universities OA Index (WOMAC) and the RAND 36-item Health Survey 1.0 (RAND-36). Physical performance tests included a 15-m walk test and stair performance. Knee isometric muscle strength was measured. A clinical examination included analyses of comorbidity, body mass index (BMI), and a detailed knee examination: The flexion range of motion (ROM) was measured; the presence of varus/valgus malalignments and antero-posterior laxity was assessed. Radiographs were analyzed with the Kellgren-Lawrence grading scale.

Results. In the linear regression model the WOMAC pain score, antero-posterior laxity of the knee, age, and BMI accounted for 54.8% of the variance in the WOMAC function score. In the bivariate analyses the WOMAC function score had a positive correlation with the 15-m walk (r_s=0.32, p=0.003), stairs up (r_s=0.40, p=0.001), and stairs down (r_s=0.38, p=0.001) tests, and a negative correlation with RPT extension (r_s=?0.45, p < 0.001) and RPT flexion (r_s=?0.39, p=0.001) of the affected side and RPT flexion (r_s=?0.39, p <0.001) of the contralateral side. The results of the physical performance tests also correlated with the RAND-36 Physical function (PF) score. Comorbid diseases and pain deteriorated the results of the physical performance tests and self-reported disability. Female gender deteriorated the results of the physical performance tests and the RAND-36 PF, but not the WOMAC function score. Malalignments, restriction in the flexion ROM of the knee, and the radiologic severity of knee OA did not affect self-reported disability.

Conclusion. Pain, BMI, and antero-posterior laxity of the knee joint were major attributes of self-reported disability. The negative effect of comorbid diseases and female gender on health-related quality of life was significant. The results of objectively measured physical performance tests correlated with self-reported disability.     

Physical function in men with and without hip osteoarthritis

OBJECTIVES: To assess the subjective joint pain and function and the objective physical function of lower extremities in men with hip osteoarthritis (OA), to compare the results with those from age- and sex-matched controls, and to evaluate the reproducibility of the functional tests. DESIGN: A cross-sectional study. SETTING: Rehabilitation clinic in a university hospital. PARTICIPANTS: Twenty-seven volunteer men (age range, 47-64 y) with hip OA and 30 randomly selected, healthy age-matched men. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, passive range of motion (ROM) of the hip joint measured with a standard goniometer, and physical functioning evaluated with a test battery. RESULTS: The function and the composite scores of the WOMAC correlated (P<.05) with the degree of radiographically estimated severity of OA. The hips of the control subjects were 13% to 52% more flexible (P range, <.0001-.001) than those of the OA patients. The more the hip was deteriorated, the lower the ROM of the hip was in abduction and in both internal and external rotations. The reproducibility of marching on-the-spot and walking up and down stairs was good in both groups, but in other functional tests the reproducibility was poorer. The controls were significantly (P range, <.05-.01) better at marching, ascending and descending stairs, performing a 25-m walk, and in flexion-extension and abduction-adduction movements compared with the hip OA patients. Most of the WOMAC items were significantly (P<.05) related to the performance tests. CONCLUSIONS: The WOMAC and the ROM can be considered useful hip OA indicators. Marching on-the-spot and walking up and down stairs are the most reproducible physical functioning tests and can thus be recommended for use for patients with hip OA.     

Exercise on balance and function for knee osteoarthritis: A randomized controlled trial

Objectives

To assess balance and function of symptomatic and asymptomatic subjects with knee osteoarthritis (OA) and investigate the influence of physical exercise.

The use and reported effects of mobilization with movement techniques in low back pain management; a cross-sectional descriptive survey of physiotherapists in Britain

Manual therapy is the most commonly used approach in the management of low back pain (LBP) and encompasses a wide range of techniques. The aims of this study were to investigate the current use of mobilizations with movement (MWM) for LBP management in Britain and to inform future clinical research exploring their effects.A postal survey of a random sample of 3295 practising physiotherapists in Britain was conducted. A response rate of 72.1% (n=2357) was obtained. Of these, 48.2% (n=1136) reported treating LBP, of whom 41.1% (n=467) reported using MWMs in LBP management. Therefore, the sample applicable for analysis consisted of these 467 therapists currently treating LBP and using MWMs. Most respondents (51.4%) worked in a national health service setting. Over half of the respondents used MWMs on at least a weekly basis, with 61.9% using MWMs primarily for mechanical LBP. The most commonly reported changes seen immediately after the application of MWMs were increases in range of movement (ROM) (54.4%) and pain relief (27.5%). This was also reflected in the outcomes chosen to evaluate improvement. On average, two spinal levels were mobilized using 2-3 sets of 4-5 repetitions. The lower lumbar levels were treated more often. Most therapists indicated using a combination of other treatment approaches together with MWMs when treating LBP patients.In conclusion, this study is the first to describe the current practice of MWMs by physiotherapists in Britain, and the results will be used to inform the design of a clinical trial exploring the effects of MWMs for LBP.     

Sex and body mass index correlate with Western Ontario and McMaster Universities Osteoarthritis Index and quality of life scores in knee osteoarthritis

Elbaz A, Debbi EM, Segal G, Haim A, Halperin N, Agar G, Mor A, Debi R. Sex and body mass index correlate with Western Ontario and McMaster Universities Osteoarthritis Index and quality of life scores in knee osteoarthritis.

Objective

To examine the associations of sex, body mass index (BMI), and age with knee osteoarthritis (OA) symptomatic severity.

Design

A cross-sectional retrospective analysis.

Setting

Patients completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Data were acquired from a stored database of a private therapy center.

Participants

Patients (N=1487) with symptomatic knee OA were evaluated.

Interventions

Not applicable.

Main Outcome Measures

WOMAC questionnaire and SF-36.

Results

BMI correlated significantly with worse knee OA symptoms for all WOMAC and SF-36 subcategories (all P≤.001). Age correlated significantly with worse symptoms only for WOMAC function and SF-36 physical functioning (P=.001 and P=.009, respectively). A significant difference across BMI quintiles was found for all WOMAC and SF-36 subcategories (all P≤.01). Women showed worse knee OA symptoms in all WOMAC and SF-36 subcategories (all P≤.001). There was a significant interaction of sex by BMI in WOMAC pain and WOMAC function (P=.01 and P=.02, respectively).

Conclusions

Based on the results of this analysis, it can be concluded that women and patients with a higher BMI with knee OA are at a greater risk for worse symptoms.     

Mulligan动态关节松动术联合动态干扰电治疗颈型颈椎病的研究

目的 探讨Mulligan动态关节松动术联合动态干扰电治疗颈型颈椎病的效果。方法 回顾性选取颈型颈椎病患者42例,根据治疗方法将其分为观察组（采用Mulligan动态关节松动术联合动态干扰电治疗,21例）与对照组（仅采用动态干扰电治疗,21例）,比较2组治疗前、治疗结束时、治疗结束后1个月及3个月的疼痛视觉模拟评分法（VAS）、颈椎功能障碍指数量表（NDI）、汉密尔顿焦虑量表（HAMA）及匹兹堡睡眠质量指数（PSQI）评分的差异。结果 与治疗前比较,2组患者接受治疗后在不同随访时间点上述指标均有明显改善（P均<0.05）。观察组治疗结束时的VAS评分低于对照组（P <0.05）。观察组治疗结束时、治疗结束后1个月及3个月时的HAMA及PSQI评分均低于对照组（P均<0.05）。结论 除能缓解颈部疼痛及改善颈椎功能外,Mulligan动态关节松动术联合动态干扰电还有助于改善颈型颈椎病患者的焦虑及睡眠质量。     

Effectiveness of platelet-rich plasma in the treatment of moderate knee osteoarthritis: a randomized prospective study

[Purpose] To assess the effects of different numbers of platelet-rich plasma (PRP) applications on pain and physical function in grade 3 knee osteoarthritis (OA). [Subjects and Methods] A total of 102 patients with grade 3 knee OA were randomly divided into three groups: Group 1 received a single injection of PRP, Group 2 received two injections of PRP two weeks apart, Group 3 received three injections of PRP at 2-weeks intervals. All patients were evaluated with a visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and the Timed-Up and Go test (TUG) before the treatment and at 1, 3 and 6 months after the treatment. [Results] Ninety-eight patients (15 males, 83 females) completed the study. The mean ages of the patients were 53.5±6.6, 54.9±5.3, and 55.1±5.6 years in Group 1, Group 2, and Group 3, respectively. Statistically significant improvements were noted in all of the evaluated measures in all of the groups. The mean differences of Group 1-Group 2 and Group 1-Group 3 WOMAC total, WOMAC pain, WOMAC stiffness, and WOMAC function scores were statistically significant. [Conclusion] PRP is an effective treatment for functional status and pain in moderate knee osteoarthritis and a minimum of two injections is appropriate.Key words: Platelet-rich plasma effectiveness, Moderate, Knee osteoarthritis     

远程康复指导对全膝关节置换术后膝关节功能的影响

目的:探讨远程指导的家庭康复治疗对全膝关节置换(TKA)术后患者膝关节功能恢复的影响。方法:TKA术后患者120例,随机分成观察组和对照组各60例,2组患者在住院期间均进行早期康复治疗,对照组出院后在家中继续延续院内训练方式自行训练。观察组患者在家通过远程家庭康复指导进行康复,两组患者均由同一康复治疗师在治疗前、术后1、3、6、9和12周,分别采用骨关节指数(WOMAC)、关节活动度(ROM)进行膝关节功能评定。结果:治疗1、3、6、9及12周后,2组WOMAC指数(疼痛,功能障碍,僵硬程度)均较治疗前明显下降(P0.05),2组膝关节主、被动ROM均较治疗前明显提高(P0.05);且观察组在出院后(治疗6、9及12周后),WOMAC指数(膝关节疼痛、功能障碍和僵硬程度)较对照组下降更显著(P0.05),膝关节主、被动ROM较对照组提高更显著(P0.05)。结论:远程指导的家庭康复治疗对TKA术后患者膝关节功能具有较好的疗效,值得临床推广。     

膝骨关节炎患者膝关节功能与生存质量的研究

目的：探讨膝骨关节炎（OA）患者膝关节功能对生存质量(QOL)的影响。方法：选取膝OA患者40例,分别采用Lequesne指数,Lysholm膝关节评分量表（LKSS）、目测类比定级法（VAS）及量角器评定膝关节功能状况、疼痛程度和关节活动度（ROM）。采用关节炎影响测定量表（AIMS）评价患者的QOL。结果：女性膝OA患者的AIMS、Lequesne及VAS评分显著高于男性,LKSS评分显著低于男性（P<0.05）。膝OA患者AIMS评分与Lequesne指数、VAS评分及膝关节活动受限程度呈正相关,与LKSS评分呈负相关（P<0.05）。结论：女性OA患者的膝关节功能及QOL较男性差。膝关节疼痛、活动度减小及功能减退在一定程度上影响了OA患者的QOL,应通过健康教育和临床治疗改善膝关节功能,提高其QOL。     

Effects of footwear on medial compartment knee osteoarthritis

This pilot study investigated whether lateral-wedge insoles inserted into shock-absorbing walking shoes altered joint pain, stiffness, and physical function in patients with symptomatic medial compartment knee osteoarthritis (OA). Twenty-eight subjects wore full-length lateral-wedge insoles with an incline of 4 degrees in their walking shoes for 4 weeks. Pain, stiffness, and functional status were measured with the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index at baseline and 4 weeks postintervention. Significant improvements were observed in all three WOMAC subscales (pain, stiffness, and function). Pain scores were significantly reduced for the most challenging activity-stair climbing. Subjects wore insoles daily and tolerated them well. The results of this study indicated that lateral-wedge insoles inserted into shock-absorbing walking shoes are an effective treatment for medial compartment knee OA.     

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.     

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.