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Han DS, Lee CH, Shieh YD, Chang KV, Lin SH, Chu YC, Wang JL, Chen CC. Involvement of ASIC3 and Substance P in Therapeutic Ultrasound-Mediated Analgesia in Mouse Models of Fibromyalgia. THE JOURNAL OF PAIN 2023; 24:1493-1505. [PMID: 37054767 DOI: 10.1016/j.jpain.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/10/2023] [Accepted: 04/04/2023] [Indexed: 04/15/2023]
Abstract
Therapeutic ultrasound (tUS) is widely used in chronic muscle pain control. However, its analgesic molecular mechanism is still not known. Our objective is to reveal the mechanism of the tUS-induced analgesia in mouse models of fibromyalgia. We applied tUS in mice that have developed chronic hyperalgesia induced by intramuscular acidification and determined the tUS frequency at 3 MHz, dosage at 1 W/cm2 (measured output as 6.3 mW/cm2) and 100% duty cycle for 3 minutes having the best analgesic effect. Pharmacological and genetic approaches were used to probe the molecular determinants involved in tUS-mediated analgesia. A second mouse model of fibromyalgia induced by intermittent cold stress was further used to validate the mechanism underlying the tUS-mediated analgesia. The tUS-mediated analgesia was abolished by a pretreatment of NK1 receptor antagonist-RP-67580 or knockout of substance P (Tac1-/-). Besides, the tUS-mediated analgesia was abolished by ASIC3-selective antagonist APETx2 but not TRPV1-selective antagonist capsazepine, suggesting a role for ASIC3. Moreover, the tUS-mediated analgesia was attenuated by ASIC3-selective nonsteroid anti-inflammation drugs (NSAIDs)-aspirin and diclofenac but not by ASIC1a-selective ibuprofen. We next validated the antinociceptive role of substance P signaling in the model induced by intermittent cold stress, in which tUS-mediated analgesia was abolished in mice lacking substance P, NK1R, Asic1a, Asic2b, or Asic3 gene. tUS treatment could activate ASIC3-containing channels in muscle afferents to release substance P intramuscularly and exert an analgesic effect in mouse models of fibromyalgia. NSAIDs should be cautiously used or avoided in the tUS treatment. PERSPECTIVE: Therapeutic ultrasound showed analgesic effects against chronic mechanical hyperalgesia in the mouse model of fibromyalgia through the signaling pathways involving substance P and ASIC3-containing ion channels in muscle afferents. NSAIDs should be cautiously used during tUS treatment.
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Affiliation(s)
- Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Beihu Branch, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan; Health Science and Wellness Center, National Taiwan University, Taipei, Taiwan
| | - Cheng-Han Lee
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Yih-Dar Shieh
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Beihu Branch, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shing-Hong Lin
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Ya-Cherng Chu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Jaw-Lin Wang
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chih-Cheng Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Taiwan Mouse Clinic, Biomedical Translational Research Center, Academia Sinica, Taipei, Taiwan; Neuroscience Program of Academia Sinica, Academia Sinica, Taipei, Taiwan
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Haghighat F, Arjomand S, Ghasemi S, Afkhami E, Montaseri H, Motealleh A. Effects of phonophoresis of Aloe vera gel and ultrasound on knee osteoarthritis: A randomized controlled trial. J Herb Med 2022. [DOI: 10.1016/j.hermed.2022.100606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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French HP, Abbott JH, Galvin R. Adjunctive therapies in addition to land-based exercise therapy for osteoarthritis of the hip or knee. Cochrane Database Syst Rev 2022; 10:CD011915. [PMID: 36250418 PMCID: PMC9574868 DOI: 10.1002/14651858.cd011915.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Land-based exercise therapy is recommended in clinical guidelines for hip or knee osteoarthritis. Adjunctive non-pharmacological therapies are commonly used alongside exercise in hip or knee osteoarthritis management, but cumulative evidence for adjuncts to land-based exercise therapy is lacking. OBJECTIVES To evaluate the benefits and harms of adjunctive therapies used in addition to land-based exercise therapy compared with placebo adjunctive therapy added to land-based exercise therapy, or land-based exercise therapy only for people with hip or knee osteoarthritis. SEARCH METHODS We searched CENTRAL, MEDLINE, PsycINFO, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro) and clinical trials registries up to 10 June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) or quasi-RCTs of people with hip or knee osteoarthritis comparing adjunctive therapies alongside land-based exercise therapy (experimental group) versus placebo adjunctive therapies alongside land-based exercise therapy, or land-based exercise therapy (control groups). Exercise had to be identical in both groups. Major outcomes were pain, physical function, participant-reported global assessment, quality of life (QOL), radiographic joint structural changes, adverse events and withdrawals due to adverse events. We evaluated short-term (6 months), medium-term (6 to 12 months) and long-term (12 months onwards) effects. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, and assessed risk of bias and certainty of evidence for major outcomes using GRADE. MAIN RESULTS We included 62 trials (60 RCTs and 2 quasi-RCTs) totalling 6508 participants. One trial included people with hip osteoarthritis, one hip or knee osteoarthritis and 59 included people with knee osteoarthritis only. Thirty-six trials evaluated electrophysical agents, seven manual therapies, four acupuncture or dry needling, or taping, three psychological therapies, dietary interventions or whole body vibration, two spa or peloid therapy and one foot insoles. Twenty-one trials included a placebo adjunctive therapy. We presented the effects stratified by different adjunctive therapies along with the overall results. We judged most trials to be at risk of bias, including 55% at risk of selection bias, 74% at risk of performance bias and 79% at risk of detection bias. Adverse events were reported in eight (13%) trials. Comparing adjunctive therapies plus land-based exercise therapy against placebo therapies plus exercise up to six months (short-term), we found low-certainty evidence for reduced pain and function, which did not meet our prespecified threshold for a clinically important difference. Mean pain intensity was 5.4 in the placebo group on a 0 to 10 numerical pain rating scale (NPRS) (lower scores represent less pain), and 0.77 points lower (0.48 points better to 1.16 points better) in the adjunctive therapy and exercise therapy group; relative improvement 10% (6% to 15% better) (22 studies; 1428 participants). Mean physical function on the Western Ontario and McMaster (WOMAC) 0 to 68 physical function (lower scores represent better function) subscale was 32.5 points in the placebo group and reduced by 5.03 points (2.57 points better to 7.61 points better) in the adjunctive therapy and exercise therapy group; relative improvement 12% (6% better to 18% better) (20 studies; 1361 participants). Moderate-certainty evidence indicates that adjunctive therapies did not improve QOL (SF-36 0 to 100 scale, higher scores represent better QOL). Placebo group mean QOL was 81.8 points, and 0.75 points worse (4.80 points worse to 3.39 points better) in the placebo adjunctive therapy group; relative improvement 1% (7% worse to 5% better) (two trials; 82 participants). Low-certainty evidence (two trials; 340 participants) indicates adjunctive therapies plus exercise may not increase adverse events compared to placebo therapies plus exercise (31% versus 13%; risk ratio (RR) 2.41, 95% confidence interval (CI) 0.27 to 21.90). Participant-reported global assessment was not measured in any studies. Compared with land-based exercise therapy, low-certainty evidence indicates that adjunctive electrophysical agents alongside exercise produced short-term (0 to 6 months) pain reduction of 0.41 points (0.17 points better to 0.63 points better); mean pain in the exercise-only group was 3.8 points and 0.41 points better in the adjunctive therapy plus exercise group (0 to 10 NPRS); relative improvement 7% (3% better to 11% better) (45 studies; 3322 participants). Mean physical function (0 to 68 WOMAC subscale) was 18.2 points in the exercise group and 2.83 points better (1.62 points better to 4.04 points better) in the adjunctive therapy plus exercise group; relative improvement 9% (5% better to 13% better) (45 studies; 3323 participants). These results are not clinically important. Mean QOL in the exercise group was 56.1 points and 1.04 points worse in the adjunctive therapies plus exercise therapy group (1.04 points worse to 3.12 points better); relative improvement 2% (2% worse to 5% better) (11 studies; 1483 participants), indicating no benefit (low-certainty evidence). Moderate-certainty evidence indicates that adjunctive therapies plus exercise probably result in a slight increase in participant-reported global assessment (short-term), with success reported by 45% in the exercise therapy group and 17% more individuals receiving adjunctive therapies and exercise (RR 1.37, 95% CI 1.15 to 1.62) (5 studies; 840 participants). One study (156 participants) showed little difference in radiographic joint structural changes (0.25 mm less, 95% CI -0.32 to -0.18 mm); 12% relative improvement (6% better to 18% better). Low-certainty evidence (8 trials; 1542 participants) indicates that adjunctive therapies plus exercise may not increase adverse events compared with exercise only (8.6% versus 6.5%; RR 1.33, 95% CI 0.78 to 2.27). AUTHORS' CONCLUSIONS Moderate- to low-certainty evidence showed no difference in pain, physical function or QOL between adjunctive therapies and placebo adjunctive therapies, or in pain, physical function, QOL or joint structural changes, compared to exercise only. Participant-reported global assessment was not reported for placebo comparisons, but there is probably a slight clinical benefit for adjunctive therapies plus exercise compared with exercise, based on a small number of studies. This may be explained by additional constructs captured in global measures compared with specific measures. Although results indicate no increased adverse events for adjunctive therapies used with exercise, these were poorly reported. Most studies evaluated short-term effects, with limited medium- or long-term evaluation. Due to a preponderance of knee osteoarthritis trials, we urge caution in extrapolating the findings to populations with hip osteoarthritis.
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Affiliation(s)
- Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - J Haxby Abbott
- Orthopaedics: Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Jia L, Li D, Wei X, Chen J, Zuo D, Chen W. Efficacy and safety of focused low-intensity pulsed ultrasound versus pulsed shortwave diathermy on knee osteoarthritis: a randomized comparative trial. Sci Rep 2022; 12:12792. [PMID: 35896688 PMCID: PMC9329394 DOI: 10.1038/s41598-022-17291-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 07/22/2022] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to compare the efficacy and safety of focused low-intensity pulsed ultrasound (FLIPUS) with pulsed shortwave diathermy (PSWD) in subjects with painful knee osteoarthritis (OA). In a prospective randomized trial, 114 knee OA patients were randomly allocated to receive FLIPUS or PSWD therapy. The primary outcome was the change from baseline in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total scores. Secondary outcomes included the numerical rating scale (NRS) for pain assessment, time up and go (TUG) test, active joint range of motion (ROM) test, and Global Rating of Change (GRC) scale. Data were collected at baseline, 12 days, 12 weeks and 24 weeks. Patients receiving FLIPUS therapy experienced significantly greater improvements in the WOMAC total scores than patients receiving PSWD therapy at 12 days (mean difference, - 10.50; 95% CI - 13.54 to - 7.45; P = 0.000). The results of the NRS, TUG test, ROM test and GRC scale showed that participants treated with FLIPUS reported less pain and better physical function and health status than those treated with PSWD at 12 days (P = 0.011, P = 0.005, P = 0.025, P = 0.011, respectively). Furthermore, patients in the FLIPUS group showed significant improvements in the WOMAC total scores and NRS scores at 12 weeks (mean difference, - 7.57; 95% CI - 10.87 to - 4.26; P = 0.000 and - 1.79; 95% CI - 2.11 to - 1.47, respectively) and 24 weeks (mean difference, - 6.96; 95% CI - 10.22 to - 3.71; P = 0.000 and - 1.37; 95% CI - 1.64 to - 0.96; P = 0.000, respectively) of follow-up. There were no adverse events during or after the interventions in either group. This study concluded that both FLIPUS and pulsed SWD are safe modalities, and FLIPUS was more effective than PSWD in alleviating pain and in improving dysfunction and health status among subjects with knee OA in the short term.Trial registration: Chinese Clinical Trial Registry, ChiCTR2000032735. Registered 08/05/2020, http://www.chictr.org.cn/showproj.aspx?proj=53413 .
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Affiliation(s)
- Lang Jia
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Dongqian Li
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xia Wei
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinyun Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Deyu Zuo
- Department of Rehabilitation, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Wenzhi Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China. .,Clinical Center for Tumor Therapy, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Sedaghatnezhad P, Shams M, Karimi N, Rahnama L. Uphill treadmill walking plus physical therapy versus physical therapy alone in the management of individuals with knee osteoarthritis: a randomized clinical trial. Disabil Rehabil 2019; 43:2541-2549. [DOI: 10.1080/09638288.2019.1703146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Parisa Sedaghatnezhad
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohsen Shams
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Noureddin Karimi
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Leila Rahnama
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Wu Y, Zhu S, Lv Z, Kan S, Wu Q, Song W, Ning G, Feng S. Effects of therapeutic ultrasound for knee osteoarthritis: a systematic review and meta-analysis. Clin Rehabil 2019; 33:1863-1875. [PMID: 31382781 DOI: 10.1177/0269215519866494] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective: To assess the effectiveness and safety of therapeutic ultrasound with sham ultrasound on pain relief and functional improvement in knee osteoarthritis patients. As phonophoresis is a unique therapeutic ultrasound, we also compared the effects of phonophoresis with conventional non-drug ultrasound. Data sources: PubMed, EMBASE, and the Cochrane Library were systematically searched for randomized controlled trials from inception up to June 2019. Review methods: Randomized controlled trials comparing therapeutic ultrasound with sham ultrasound in knee osteoarthritis patients were included. Phonophoresis in the experimental and control groups were compared through conventional ultrasound, and corresponding trials were also included. Two reviewers independently identified eligible studies and extracted data. Risk of bias assessments and therapeutic ultrasound safety assessments were also performed. Results: Fifteen studies including three phonophoresis-related studies with 1074 patients were included. Meta-analyses demonstrated that therapeutic ultrasound significantly relieved pain ( P < 0.00001) and reduced the Western Ontario and McMaster Universities (WOMAC) physical function score ( P = 0.03). In addition, therapeutic ultrasound increased the active range of motion ( P < 0.00001) and reduced the Lequesne index ( P < 0.00001). Subgroup analysis of phonophoresis ultrasound illustrated significant differences on the visual analogue scale ( P = 0.009), but no significant differences on WOMAC pain subscales ( P = 0.10), and total WOMAC scores were observed ( P = 0.30). There was no evidence to suggest that ultrasound was unsafe treatment. Conclusions: Therapeutic ultrasound is a safe treatment to relieve pain and improve physical function in patients with knee osteoarthritis. However, phonophoresis does not produce additional benefits to functional improvement, but may relieve pain compared to conventional non-drug ultrasound.
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Affiliation(s)
- Yu Wu
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, P.R. China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, P.R. China
| | - Shibo Zhu
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, P.R. China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, P.R. China
| | - Zenghui Lv
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, P.R. China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, P.R. China
| | - Shunli Kan
- Department of Spine Surgery, Tianjin Union Medical Center, Tianjin, P.R. China
| | - Qiuli Wu
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, P.R. China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, P.R. China
| | - Wenye Song
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, P.R. China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, P.R. China
| | - Guangzhi Ning
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, P.R. China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, P.R. China
| | - Shiqing Feng
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, P.R. China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, P.R. China
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Ananías J, Ubilla D, Irarrázaval S, Ortiz-Muñoz L. Is pulsed ultrasound an alternative for osteoarthritis? Medwave 2017; 17:e7109. [DOI: 10.5867/medwave.2017.09.7109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/20/2017] [Indexed: 11/27/2022] Open
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Lizis P, Kobza W, Manko G. Extracorporeal shockwave therapy vs. kinesiotherapy for osteoarthritis of the knee: A pilot randomized controlled trial. J Back Musculoskelet Rehabil 2017; 30:1121-1128. [PMID: 28946535 DOI: 10.3233/bmr-169781] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Osteoarthritis (OA) of the knee is a degenerative, painful pathology, needing conservative treatment for symptoms' relief. OBJECTIVE Comparing the effects of Extracorporeal shockwave therapy (ESWT) and Kinesiotherapy (KIN) on perceived health and range of motion (ROM) of the affected knee. METHOD A pilot randomized controlled trial with concealed allocation, assessor blinding, intention-to-treat analysis. Forty participants, aged 40-75 with OA of the knee were randomized to an ESWT and a KIN groups. The ESWT group completed 5 interventions for 5 weeks, the KIN group completed the same number of interventions. All evaluations were performed at baseline and after the treatment for: perceived health (Western Ontario and McMaster Universities questionnaire - WOMAC), range of motion (ROM). RESULTS After the intervention the statistical significant between groups differences favoring the ESWT were found in the WOMAC with regard to pain (p< 0.000), stiffness (p= 0.018), physical function (p< 0.000), total score (p< 0.000), extension and flexion of the affected knee (p= 0.015, p< 0.000) respectively. CONCLUSIONS ESWT improves WOMAC and ROM better then KIN on the affected knee in patients with OA of the knee.
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Affiliation(s)
- Paweł Lizis
- Department of Education and Health Protection, Holycross College of Kielce, Kielce, Poland
| | | | - Grzegorz Manko
- Department of Ergonomics and Physiology of Physical Effort, Jagiellonian University of Cracow, Cracow, Poland
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Saal S, Beutner K, Bogunski J, Obermüller K, Müller M, Grill E, Meyer G. Interventions for the prevention and treatment of disability due to acquired joint contractures in older people: a systematic review. Age Ageing 2017; 46:373-382. [PMID: 28338811 DOI: 10.1093/ageing/afx026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Indexed: 11/14/2022] Open
Abstract
Background acquired joint contractures have significant effects on quality of life and functioning. Objective to determine the effects of interventions to prevent and treat disabilities in older people with acquired joint contractures. Methods systematic search (last 8/2016) via Cochrane Library, PubMed, EMBASE, PEDro, CINAHL, trial registries, reference lists of retrieved articles and scientific congress pamphlets. Controlled and randomised controlled trials in English or German comparing an intervention with another intervention or standard care were included. Two independent researchers performed the selection of publications, data extraction and critical appraisal. Results seventeen studies with 992 participants met the inclusion criteria: 16 randomised controlled trials and 1 controlled trial (nursing homes = 4, community settings = 13). The methodological quality of the studies varied. Splints were examined in four studies, stretching exercises in nine studies, and ultrasound, passive movement therapy, bed-positioning and group exercise were each examined in one study. Studies on splints revealed inconclusive results regarding joint mobility or spasticity. Five of seven studies that assessed active stretching programmes for healthy older people reported statistically significant effects on joint mobility in favour of the intervention. Pain, quality of life, activity limitations and participation restrictions were rarely assessed. Conclusion the evidence for the effectiveness of interventions to prevent and treat disability due to joint contractures is weak, particularly for established nursing interventions such as positioning and passive movement. Better understanding is required regarding the delivery of interventions, such as their intensity and duration. In addition to functional issues, activities and social participation should also be studied as outcomes.
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Affiliation(s)
- Susanne Saal
- Institute of Health and Nursing Science, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, Germany
| | - Katrin Beutner
- Institute of Health and Nursing Science, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, Germany
| | - Julia Bogunski
- Institute of Health and Nursing Science, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, Germany
| | - Kathrin Obermüller
- Ludwig-Maximilians-Universität München, Medical Faculty, Institute for Medical Information Processing, Biometrics and Epidemiology, München, Germany
| | - Martin Müller
- Ludwig-Maximilians-Universität München, Medical Faculty, Institute for Medical Information Processing, Biometrics and Epidemiology, München, Germany
- Hochschule Rosenheim, Faculty of Applied Health and Social Sciences, Rosenheim, Germany
| | - Eva Grill
- Ludwig-Maximilians-Universität München, Medical Faculty, Institute for Medical Information Processing, Biometrics and Epidemiology, München, Germany
- Ludwig-Maximilians-Universität München, German Center for Vertigo and Balance Disorders, München, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, Germany
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Efficacy of focused low-intensity pulsed ultrasound therapy for the management of knee osteoarthritis: a randomized, double blind, placebo-controlled trial. Sci Rep 2016; 6:35453. [PMID: 27748432 PMCID: PMC5066246 DOI: 10.1038/srep35453] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/28/2016] [Indexed: 12/30/2022] Open
Abstract
The aim of this study was to investigate the effects of focused low-intensity pulsed ultrasound (FLIPUS) therapy on the functional and health status of patients with knee osteoarthritis (KOA). A total of 106 subjects with bilateral KOA were randomized sequentially into two groups. Group I received FLIPUS + diclofenac sodium, and group II received sham FLIPUS + diclofenac sodium. The therapeutic effects of the interventions were evaluated by measuring changes in VAS pain, the WOMAC scores, and the LI scores after 10 days of treatment as well as changes in LI and VAS at follow-up, 4 and 12 weeks later. In addition, changes in the range of motion, ambulation speed, and the SF-36 in each group were recorded after 10 days of treatment. Compared with those in group II, patients in group Ishowed significant improvements in VAS, WOMAC, LI, ambulation speed, and most items in the SF-36 after 10 days of treatment. In addition, patients in group I showed significant improvements in LI and VAS at follow-up. There were no FLIPUS-related adverse events during and after the interventions. In conclusion, FLIPUS is a safe and effective treatment modality for relieving pain and improving the functions and quality of life of patients with KOA.
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Zhao J, Wang Q, Wu J, Shi X, Qi Q, Zheng H, Lang S, Yang L, Zhang D. Therapeutic effects of low-frequency phonophoresis with a Chinese herbal medicine versus sodium diclofenac for treatment of knee osteoarthritis:
a double-blind, randomized, placebo-controlled clinical trial. J TRADIT CHIN MED 2016; 36:613-7. [PMID: 29933529 DOI: 10.1016/s0254-6272(16)30080-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the therapeutic effects of low-frequency phonophoresis with a Chinese herbal
medicine (CHM) compared with sodium diclofenac (SD) for knee osteoarthritis (KOA). METHODS In this double-blind, randomized, placebo-controlled trial, 100 KOA patients were assigned
randomly to a placebo group, a CHM group, or SD group. Low-frequency phonophoresis was
used to improve the efficiency of drug delivery. Pain at rest [using a visual analog scale (VAS)], pain
on movement (VAS), and range of motion (degrees) in the three groups were evaluated using
the Western Ontario and McMaster Universities Osteoarthritis Index (WOMACAI) scores. Safety assessments
comprised emergency adverse events, as well as laboratory tests of blood biochemistry, creatinine,
blood urea nitrogen, alanine aminotransferase and aspartate aminotransferase. RESULTS Significant improvements were found after treatment in all outcome measures except stiffness
and range of motion in patients in the CHMP group and SDP group (P < 0.05). No significant differences
in all outcome measures were found between the CHMP group and SDP group. CONCLUSION CHMP and SDP can show good therapeutic effects for KOA in terms of relieving pain
and improving physical function.
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Lee PB, Kim YC, Lim YJ, Lee CJ, Choi SS, Park SH, Lee JG, Lee SC. Efficacy of Pulsed Electromagnetic Therapy for Chronic Lower Back Pain: A Randomized, Double-blind, Placebo-controlled Study. J Int Med Res 2016; 34:160-7. [PMID: 16749411 DOI: 10.1177/147323000603400205] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This randomized, double-blind, placebo-controlled clinical trial studied the effectiveness of pulsed electromagnetic therapy (PEMT) in patients with chronic lower back pain. Active PEMT ( n = 17) or placebo treatment ( n = 19) was performed three times a week for 3 weeks. Patients were assessed using a numerical rating scale (NRS) and revised Oswestry disability scores for 4 weeks after therapy. PEMT produced significant pain reduction throughout the observation period compared with baseline values. The percentage change in the NRS score from baseline was significantly greater in the PEMT group than the placebo group at all three time-points measured. The mean revised Oswestry disability percentage after 4 weeks was significantly improved from the baseline value in the PEMT group, whereas there were no significant differences in the placebo group. In conclusion, PEMT reduced pain and disability and appears to be a potentially useful therapeutic tool for the conservative management of chronic lower back pain.
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Affiliation(s)
- P B Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
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Yıldırıım MA, Uçar D, Öneş K. Comparison of therapeutic duration of therapeutic ultrasound in patients with knee osteoarthritis. J Phys Ther Sci 2015; 27:3667-70. [PMID: 26834328 PMCID: PMC4713767 DOI: 10.1589/jpts.27.3667] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/02/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of study was to compare different durations of
ultrasound in patients with knee osteoarthritis. [Subjects and Methods] One hundred
patients diagnosed with bilateral knee osteoarthritis (OA) were enrolled in this study.
Patients were divided into two groups. The first group (G1) received 4 minutes of
ultrasound. The second group (G2) received the exact same treatment, but the duration of
ultrasound was longer at 8 minutes. Patients in both groups underwent a total of 10
ultrasound over 2 weeks. Following treatment, all patients provided self-evaluations of
pain via the Visual Analog Scale (VAS), overall physical function with WOMAC, disability
via the Lequesne index (Leq), and depressive symptoms with the Beck Depression Index
(BDI). [Results] There were no significant differences in VAS, WOMAC Leq, and BDI values
between groups 1 and 2. After treatment, VAS, WOMAC, Leq, and BDI values improved for both
treatment groups. However, following treatment, G2 had significantly greater values for
WOMAC functional and total scores than G1. No statistically significant differences were
observed for VAS scores while inactive, WOMAC pain and stiffness scores, and BDI values
after treatment between both groups. VAS pain scores while active and Leq index values
were significantly lower in G1 than G2. [Conclusion] Patients in both groups demonstrated
improved functionality, pain and psychological status following a consistent, 2-week
regimen of 4-minute or 8-minute treatments with ultrasound. Yet, patients that experienced
longer treatment durations of 8 minutes demonstrated better outcomes in pain and the
ability to carry out activities of daily living.
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Affiliation(s)
| | - Demet Uçar
- Istanbul Medeniyet University Göztepe Education and Research Hospital, Turkey
| | - Kadriye Öneş
- Istanbul Physical Therapy Rehabilitation, Education and Research Hospital, Turkey
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Effects of Whole-Body Cryotherapy in Comparison with Other Physical Modalities Used with Kinesitherapy in Rheumatoid Arthritis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:409174. [PMID: 26576422 PMCID: PMC4631852 DOI: 10.1155/2015/409174] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/24/2015] [Accepted: 09/30/2015] [Indexed: 12/20/2022]
Abstract
Whole-body cryotherapy (WBC) has been frequently used to supplement the rehabilitation of patients with rheumatoid arthritis (RA). The aim of this study was to compare the effect of WBC and traditional rehabilitation (TR) on clinical parameters and systemic levels of IL-6, TNF-α in patients with RA. The study group comprised 25 patients who were subjected to WBC (−110°C) and 19 patients who underwent a traditional rehabilitation program. Some clinical variables and levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were used to assess the outcomes. After therapy both groups exhibited similar improvement in pain, disease activity, fatigue, time of walking, and the number of steps over a distance of 50 m. Only significantly better results were observed in HAQ in TR group (p < 0.05). However, similar significant reduction in IL-6 and TNF-α level was observed. The results showed positive effects of a 2-week rehabilitation program for patients with RA regardless of the kind of the applied physical procedure.
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Zhang C, Xie Y, Luo X, Ji Q, Lu C, He C, Wang P. Effects of therapeutic ultrasound on pain, physical functions and safety outcomes in patients with knee osteoarthritis: a systematic review and meta-analysis. Clin Rehabil 2015; 30:960-971. [PMID: 26451008 DOI: 10.1177/0269215515609415] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/05/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To explore the effects of therapeutic ultrasound with sham or no intervention on pain, physical function and safety outcomes in patients with knee osteoarthritis. DATA SOURCES This systematic review was searched on CENTRAL, EMBASE, MEDLINE, CINAHL, Physiotherapy Evidence Database, Open Gray on 4 September 2015. Trials included randomized controlled trials that compared therapeutic ultrasound with a sham or no intervention in patients with osteoarthritis of the knee. REVIEW METHODS Eligible trials and extracted data were identified by two independent investigators. Standardized mean differences (SMDs) and 95% confidence interval (CI) were calculated for pain and physical function outcomes. Heterogeneity was assessed by the I2 test and inverse-variance random-effects analysis was applied to all trials. RESULTS Ten randomized controlled trials (645 patients) met the inclusion criteria. Therapeutic ultrasound showed a positive effect on pain (SMD = -0.93, 95%, CI = -1.22 to -0.64, p < 0.01, p for heterogeneity = 0.12, I2 = 42%). For physical function, therapeutic ultrasound was advantageous for reducingWestern Ontario and McMaster Universities physical function score (SMD = -0.37, 95% CI = -0.73 to -0.01, p = 0.04, p for heterogeneity = 0.94, I2 = 0%). In terms of safety, no occurrence of adverse events caused by therapeutic ultrasound was reported in any trial. CONCLUSION The authors suggested that therapeutic ultrasound is beneficial for reducing knee pain and improving physical functions in patients with knee osteoarthritis and could be a safe treatment.
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Affiliation(s)
- Chi Zhang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Peoples' Republic of China Rehabilitation Medicine Department, Luzhou Medical Colleage Affiliated Hosipital, Luzhou, Peoples' Republic of China
| | - Yujie Xie
- Rehabilitation Medicine Department, Luzhou Medical Colleage Affiliated Hosipital, Luzhou, Peoples' Republic of China
| | - Xiaotian Luo
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Peoples' Republic of China Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Peoples' Republic of China
| | - Qiaodan Ji
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Peoples' Republic of China Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Peoples' Republic of China
| | - Chunlan Lu
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Peoples' Republic of China Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Peoples' Republic of China
| | - Chengqi He
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Peoples' Republic of China Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Peoples' Republic of China
| | - Pu Wang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Peoples' Republic of China Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Peoples' Republic of China
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Khadilkar A, Phillips K, Jean N, Lamothe C, Milne S, Sarnecka J. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Post-Stroke Rehabilitation. Top Stroke Rehabil 2015; 13:1-269. [PMID: 16939981 DOI: 10.1310/3tkx-7xec-2dtg-xqkh] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this project was to create guidelines for 13 types of physical rehabilitation interventions used in the management of adult patients (>18 years of age) presenting with hemiplegia or hemiparesis following a single clinically identifiable ischemic or hemorrhagic cerebrovascular accident (CVA). METHOD Using Cochrane Collaboration methods, the Ottawa Methods Group identified and synthesized evidence from comparative controlled trials. The group then formed an expert panel, which developed a set of criteria for grading the strength of the evidence and the recommendation. Patient-important outcomes were determined through consensus, provided that these outcomes were assessed with a validated and reliable scale. RESULTS The Ottawa Panel developed 147 positive recommendations of clinical benefit concerning the use of different types of physical rehabilitation interventions involved in post-stroke rehabilitation. DISCUSSION AND CONCLUSION The Ottawa Panel recommends the use of therapeutic exercise, task-oriented training, biofeedback, gait training, balance training, constraint-induced movement therapy, treatment of shoulder subluxation, electrical stimulation, transcutaneous electrical nerve stimulation, therapeutic ultrasound, acupuncture, and intensity and organization of rehabilitation in the management of post stroke.
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Zeng C, Li H, Yang T, Deng ZH, Yang Y, Zhang Y, Ding X, Lei GH. Effectiveness of continuous and pulsed ultrasound for the management of knee osteoarthritis: a systematic review and network meta-analysis. Osteoarthritis Cartilage 2014; 22:1090-9. [PMID: 24999112 DOI: 10.1016/j.joca.2014.06.028] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/04/2014] [Accepted: 06/28/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND To investigate the efficacy of continuous and pulsed ultrasound (US) in the management of knee osteoarthritis (OA). DESIGN This systematic review and network meta-analysis covered 12 trials in total. Electronic databases including MEDLINE, Embase and Cochrane Library were searched through to identify randomized controlled trials comparing the two modes of US with control interventions (sham or blank) or with each other. Bayesian network meta-analysis was used to integrate both the direct and indirect evidences on treatment effectiveness. RESULTS Pulsed US (PUS) is more effective in both pain relief and function improvement when compared with the control group; but for continuous US (CUS), there is only a significant difference in pain relief in comparison with the control group. In addition, no matter in terms of pain intensity or function at the last follow-up time point, PUS always exhibited a greater probability of being the preferred mode. However, the evidence of heterogeneity and the limitation in sample size of some studies could be a potential threat to the validity of results. CONCLUSIONS Our findings indicated that PUS, with a greater probability of being the preferred mode, is more effective in both pain relief and function improvement when compared with the control group. However, CUS could only be considered as a pain relief treatment in the management of knee OA. The findings also confirmed that none of these modes is dangerous. LEVEL OF EVIDENCE Level II, systematic review and network meta-analysis of randomized controlled trials.
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Affiliation(s)
- C Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
| | - H Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - T Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Z-H Deng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Y Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Y Zhang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - X Ding
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - G-h Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
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Anwer S, Alghadir A. Effect of isometric quadriceps exercise on muscle strength, pain, and function in patients with knee osteoarthritis: a randomized controlled study. J Phys Ther Sci 2014; 26:745-8. [PMID: 24926143 PMCID: PMC4047243 DOI: 10.1589/jpts.26.745] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 12/14/2013] [Indexed: 12/22/2022] Open
Abstract
[Purpose] The aim of present study was to investigate the effects of isometric
quadriceps exercise on muscle strength, pain, and function in knee osteoarthritis.
[Subjects and Methods] Outpatients (N=42, 21 per group; age range 40–65
years; 13 men and 29 women) with osteoarthritis of the knee participated in the study. The
experimental group performed isometric exercises including isometric quadriceps, straight
leg raising, and isometric hip adduction exercise 5 days a week for 5 weeks, whereas the
control group did not performed any exercise program. The outcome measures or dependent
variables selected for this study were pain intensity, isometric quadriceps strength, and
knee function. These variables were measured using the Numerical Rating Scale (NRS),
strength gauge device, and reduced WOMAC index, respectively. All the measurements were
taken at baseline (week 0) and at the end of the trial at week 5. [Results] In
between-group comparisons, the maximum isometric quadriceps strength, reduction in pain
intensity, and improvement in function in the isometric exercise group at the end of the
5th week were significantly greater than those of the control group (p<0.05).
[Conclusion] The 5-week isometric quadriceps exercise program showed beneficial effects on
quadriceps muscle strength, pain, and functional disability in patients with
osteoarthritis of the knee.
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Affiliation(s)
- Shahnawaz Anwer
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia ; Padmashree Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Ahmad Alghadir
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
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Efficacy of Therapeutic Ultrasound for the Management of Knee Osteoarthritis. Am J Phys Med Rehabil 2014; 93:405-12. [DOI: 10.1097/phm.0000000000000033] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Öneş K, Tetik S, Tetik C, Öneş N. The effects of heat on osteoarthritis of the knee. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/156856906775249802] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Boyaci A, Tutoglu A, Boyaci N, Aridici R, Koca I. Comparison of the efficacy of ketoprofen phonophoresis, ultrasound, and short-wave diathermy in knee osteoarthritis. Rheumatol Int 2013; 33:2811-8. [PMID: 23832291 DOI: 10.1007/s00296-013-2815-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 06/21/2013] [Indexed: 10/26/2022]
Abstract
The present study aimed to compare the efficacy of three different deep heating modalities: phonophoresis (PH), short-wave diathermy (SWD), and ultrasound (US), in knee osteoarthritis. Patients who consented to participate in the study were randomly divided into the following three groups. Group 1 (n = 33) received PH, Group 2 (n = 33) received US, and Group 3 (n = 35) received SWD. These deep heating therapies were applied by the same therapist. Each therapy began with 20-min hot pack application. Each of the three physical therapy modalities was applied 5 days a week for 2 weeks (a total of 10 sessions). The patients were evaluated using visual analogue scale (VAS) at rest, 15-m walking time, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) both before and after the treatment. Moreover, at the end of the treatment, both the physician and the patient made an overall evaluation, by rating the treatment efficacy. The results of the study showed that VAS, 15-m walking time, and WOMAC parameters were improved with all three deep heating modalities, and all the three modalities were effective. However, there was no significant difference between the three modalities in terms of efficacy. There was also no significant difference between the three groups in terms of post-treatment general evaluation of the physician and the patient. The present study is the first to suggest that choosing one of PH/US/SWD therapy options would provide effective results and none of them are superior to the others, and we believe that these findings will be a basis for further studies.
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Affiliation(s)
- Ahmet Boyaci
- Department of Physical Medicine and Rehabilitation, Harran University Medical School, Yenisehir Kampusu, 63100, Sanliurfa, Turkey,
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Aguilera Eguía R, Gutiérrez Espinoza H. Ultrasound versus placebo for pain reduction in patients with knee osteoarthritis: Critical appraisal of a meta-analysis. Medwave 2012. [DOI: 10.5867/medwave.2012.09.5533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ulus Y, Tander B, Akyol Y, Durmus D, Buyukakıncak O, Gul U, Canturk F, Bilgici A, Kuru O. Therapeutic ultrasound versus sham ultrasound for the management of patients with knee osteoarthritis: a randomized double-blind controlled clinical study. Int J Rheum Dis 2012; 15:197-206. [PMID: 22462424 DOI: 10.1111/j.1756-185x.2012.01709.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIM The aim of this trial was to evaluate the short-term effectiveness of ultrasound (US) therapy on pain, physical function, ambulation activity, disability and psychological status in patients with knee OA. METHODS Forty-two inpatients with bilateral knee OA were randomized by an independent researcher not involved in the data assessment, to receive either therapeutic continuous US (group 1) or sham US (group 2). A 1-MHz US head was used, set to an intensity of 1 W/cm(2) for 10 min. All patients received 20 min of hot packs, 10 min of interferential current, and 15 min of quadriceps isometric exercise of both knees. Patients in each group received treatments five times weekly for 3 weeks. Patients were evaluated at baseline and at the end of the treatment sessions. Outcome measures included visual analogue scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), 50-m walking speed, Lequesne index, Hospital Anxiety and Depression Scale (HADS). RESULTS The patients with knee OA had significant improvements in pain, stiffness, functional activity, walking time, disability, depression and anxiety scores with therapeutic US and sham US (P < 0.05). The improvement in pain VAS scores, WOMAC scores, Lequesne index and HADS scores were not significantly different in patients treated with US and sham US (P > 0.05). No side-effects were reported during or after the US treatment periods. CONCLUSION US therapy is safe but use of US in addition to conventional physical therapy programs seems to have no further significant effect in people with knee OA.
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Affiliation(s)
- Yasemin Ulus
- Department of Physical Medicine and Rehabilitation, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
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Tascioglu F, Kuzgun S, Armagan O, Ogutler G. Short-term effectiveness of ultrasound therapy in knee osteoarthritis. J Int Med Res 2010; 38:1233-42. [PMID: 20925995 DOI: 10.1177/147323001003800404] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
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.
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Affiliation(s)
- F Tascioglu
- Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Meselik Campus, Osmangazi University, 26480 Eskisehir, Turkey.
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Efficacy of ultrasound therapy for the management of knee osteoarthritis: a systematic review with meta-analysis. Osteoarthritis Cartilage 2010; 18:1117-26. [PMID: 20637297 DOI: 10.1016/j.joca.2010.06.010] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 06/10/2010] [Accepted: 06/17/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the efficacy of ultrasound therapy (US) for decreasing pain and improving physical function, patient-perception of disease severity, and cartilage repair in people with knee osteoarthritis (OA). METHODS We conducted a systematic review (to February 2009) without language limits in MEDLINE, EMBASE, Cochrane Library, LILACS, MEDCARIB, CINAHL, PEDro, SPORT-discus, REHABDATA, and World Health Organization Clinical Trial Registry. We included randomized controlled trials of people with knee OA comparing the outcomes of interest for those receiving US with those receiving no US. Two reviewers independently selected studies, extracted relevant data and assessed quality. Pooled analyses were conducted using inverse-variance random effects models. MAIN RESULTS Six small trials (378 patients) were included. US improves pain [Standardized Mean Difference (SMD) (95% confidence interval (CI))=-0.49 (-0.79, -0.18), P=0.002], and tends to improve self-reported physical function [SMD (CI)=-0.54 (-1.19, 0.12), P=0.11] along with walking performance [SMD (CI)=0.81 (-0.09, 1.72), P=0.08]. Results from two trials (128 patients), conducted by the same group, show a positive effect of US on pain [SMD (CI)=-0.77 (-1.15, -0.39), P<0.001], self-reported physical function [SMD (CI)=-1.25 (-1.69, -0.81), P<0.001], and walking performance [SMD (CI)=1.47 (1.06, 1.88), P<0.001] at 10 months after the intervention concluded. Heterogeneity observed between studies regarding the effect of US on pain was explained by US dose, mode and intensity. The quality of evidence supporting these effect estimates was rated as low. CONCLUSIONS US could be efficacious for decreasing pain and may improve physical function in patients with knee OA. The findings of this review should be confirmed using methodologically rigorous and adequately powered clinical trials.
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Köybaşi M, Borman P, Kocaoğlu S, Ceceli E. The effect of additional therapeutic ultrasound in patients with primary hip osteoarthritis: a randomized placebo-controlled study. Clin Rheumatol 2010; 29:1387-94. [DOI: 10.1007/s10067-010-1468-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 03/31/2010] [Accepted: 04/09/2010] [Indexed: 01/22/2023]
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Abstract
BACKGROUND Osteoarthritis is the most common form of joint disease and the leading cause of pain and physical disability in the elderly. Therapeutic ultrasound is one of several physical therapy modalities suggested for the management of pain and loss of function due to osteoarthritis (OA). OBJECTIVES To compare therapeutic ultrasound with sham or no specific intervention in terms of effects on pain and function safety outcomes in patients with knee or hip OA. SEARCH STRATEGY We updated the search in CENTRAL, CINAHL, EMBASE, MEDLINE and PEDro up to 23 July 2009, checked conference proceedings, reference lists, and contacted authors. SELECTION CRITERIA Studies were included if they were randomised or quasi-randomised controlled trials that compared therapeutic ultrasound with a sham intervention or no intervention in patients with osteoarthritis of the knee or hip. DATA COLLECTION AND ANALYSIS Two independent review authors extracted data using standardized forms. Investigators were contacted to obtain missing outcome information. Standardised mean differences (SMDs) were calculated for pain and function, relative risks for safety outcomes. Trials were combined using inverse-variance random-effects meta-analysis. MAIN RESULTS Compared to the previous version of the review, four additional trials were identified resulting in the inclusion of five small sized trials in a total of 341 patients with knee OA. No trial included patients with hip OA. Two evaluated pulsed ultrasound, two continuous and one evaluated both pulsed and continuous ultrasound as the active treatment. The methodological quality and the quality of reporting was poor and a high degree of heterogeneity among the trials was revealed for function (88%). For pain, there was an effect in favour of ultrasound therapy, which corresponded to a difference in pain scores between ultrasound and control of -1.2 cm on a 10-cm VAS (95% CI -1.9 to -0.6 cm). For function, we found a trend in favour of ultrasound, which corresponded to a difference in function scores of -1.3 units on a standardised WOMAC disability scale ranging from 0 to 10 (95% CI -3.0 to 0.3). Safety was evaluated in two trials including up to 136 patients; no adverse event, serious adverse event or withdrawals due to adverse events occurred in either trial. AUTHORS' CONCLUSIONS In contrast to the previous version of this review, our results suggest that therapeutic ultrasound may be beneficial for patients with osteoarthritis of the knee. Because of the low quality of the evidence, we are uncertain about the magnitude of the effects on pain relief and function, however. Therapeutic ultrasound is widely used for its potential benefits on both knee pain and function, which may be clinically relevant. Appropriately designed trials of adequate power are therefore warranted.
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Affiliation(s)
- Anne Ws Rutjes
- Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, Bern, Switzerland, 3012
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Erworbene Kontrakturen der Gelenke im höheren Lebensalter. Z Gerontol Geriatr 2010; 43:147-57. [PMID: 20069303 DOI: 10.1007/s00391-009-0089-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 08/18/2009] [Indexed: 10/20/2022]
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Ozgönenel L, Aytekin E, Durmuşoglu G. A double-blind trial of clinical effects of therapeutic ultrasound in knee osteoarthritis. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:44-49. [PMID: 18829151 DOI: 10.1016/j.ultrasmedbio.2008.07.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Revised: 06/20/2008] [Accepted: 07/24/2008] [Indexed: 05/26/2023]
Abstract
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.
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Affiliation(s)
- Levent Ozgönenel
- Department of Physical Medicine & Rehabilitation, S.B. Istanbul Education and Research Hospital, Istanbul, Turkey.
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31
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Srbely JZ, Dickey JP, Lowerison M, Edwards MA, Nolet PS, Wong LL. Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: a randomized controlled study. Pain 2008; 139:260-266. [PMID: 18508198 DOI: 10.1016/j.pain.2008.04.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 03/28/2008] [Accepted: 04/15/2008] [Indexed: 10/22/2022]
Abstract
Musculoskeletal pain affects a significant proportion of the general population. The myofascial trigger point is recognized as a key factor in the pathophysiology of musculoskeletal pain. Ultrasound is commonly employed in the treatment and management of soft tissue pain and, in this study, we set out to investigate the segmental antinociceptive effect of ultrasound. Subjects (n=50) with identifiable myofascial trigger points in the supraspinatus, infraspinatus and gluteus medius muscles were selected from an outpatient rehabilitation clinic and randomly assigned to test or control groups. Test subjects received a therapeutic dose of ultrasound to the right supraspinatus trigger point while control groups received a sham (null) exposure. Baseline pain pressure threshold (PPT) readings were recorded at the ipsilateral infraspinatus and gluteus medius trigger-point sites prior to ultrasound exposure. The infraspinatus point was chosen due to its segmental neurologic link with the supraspinatus point; the gluteus medius acted as a segmental control point. Following the ultrasound intervention, PPT readings were recorded at 1, 3, 5, 10 and 15 min intervals at both infraspinatus and gluteus medius trigger points; the difference between infraspinatus and gluteus medius PPT values, PPT seg, represents the segmental influence on the PPT. The ultrasound test group demonstrated statistically significant increases in PPT seg (decreased infraspinatus sensitivity) at 1, 3 and 5 min, when compared with PPT seg in the sham ultrasound group. These results establish that low-dose ultrasound evokes short-term segmental antinociceptive effects on trigger points which may have applications in the management of musculoskeletal pain.
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Affiliation(s)
- John Z Srbely
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ont., Canada N1G 2W1 Centre for the Genetic Improvement of Livestock, University of Guelph, Guelph, Ont., Canada N1G 2W1 Academic Services, University of Guelph, Guelph, Ont., Canada N1G 2W1 Church Lane Rehabilitation Clinic, Guelph, Ont., Canada N1H 2W6 Biomedical Sciences, University of Guelph, Guelph, Ont., Canada N1G 2W1
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32
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Management of mild-to-moderate osteoarthritis: Effective intervention by the nurse practitioner. J Nurse Pract 2008. [DOI: 10.1016/j.nurpra.2007.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Akbari A, . HM, . AM, . RN. The Effect of Therapeutic Ultrasound and Duration of Stretching of the Hamstring Muscle Group on the Passive Knee Extension. JOURNAL OF MEDICAL SCIENCES 2006. [DOI: 10.3923/jms.2006.968.973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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34
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Allen RJ. Physical agents used in the management of chronic pain by physical therapists. Phys Med Rehabil Clin N Am 2006; 17:315-45. [PMID: 16616270 DOI: 10.1016/j.pmr.2005.12.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Evidence supporting the use of specific physical agents in the management of chronic pain conditions is not definitive; it is largely incomplete and sometimes contradictory. However, the use of agents in chronic pain management programs is common. Within the broad use of physical agents, they are rarely the sole modality of treatment. A 1995 American Physical Therapy Association position statement asserts that "Without documentation which justifies the necessity of the exclusive use of physical agents/modalities, the use of physical agents/modalities, in the absence of other skilled therapeutic or educational intervention, should not be considered physical therapy". Physical agents may serve as useful adjunctive modalities of pain relief or to enhance the effectiveness of other elements in therapy geared toward resolution of movement impairments and restoration of physical function. Given that a conclusive aggregate of findings is unlikely to exist for all permutations of patient conditions, combined with interacting therapeutic modalities, an evidence-based approach to pain management is not always possible or beneficial to the patient. In the face of inconclusive evidence, a theory-based approach may help determine if the therapeutic effect ofa given physical agent has the possibility of being a useful clinical tool in the context of treating a particular patient's mechanism of pain generation. Until controlled efficacy findings are definitive, careful individual patient response monitoring of thoughtful theoretical application of adjunctive physical agents may be a prudent approach to the management of chronic pain.
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Affiliation(s)
- Roger J Allen
- Department of Physical Therapy, University of Puget Sound, 1500 North Warner, CMB 1070, Tacoma, WA 98416, USA.
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Di Domenica F, Sarzi-Puttini P, Cazzola M, Atzeni F, Cappadonia C, Caserta A, Galletti R, Volontè L, Mele G. Physical and rehabilitative approaches in osteoarthritis. Semin Arthritis Rheum 2006; 34:62-9. [PMID: 16206961 DOI: 10.1016/j.semarthrit.2004.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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Abstract
Physical therapy is part of guidelines and recommendations in the treatment of osteoarthritis. Different methods of physical therapy are used in osteoarthritis. There is evidence that manual physical therapy and exercise improve function and reduce pain in osteoarthritic joints. Thermal modalities are employed for short-term pain relief and change the intraarticular temperature. Electrotherapy, therapeutic ultrasound and balneotherapy show positive therapeutic effects. Based on studies and clinical experience, physical therapy must be recommended in the therapy of osteoarthritis.
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Affiliation(s)
- B Kladny
- Fachklinik Herzogenaurach, In der Reuth 1, 91074 Herzogenaurach.
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Atamaz F, Kirazli Y, Akkoc Y. A comparison of two different intra-articular hyaluronan drugs and physical therapy in the management of knee osteoarthritis. Rheumatol Int 2006; 26:873-8. [PMID: 16416102 DOI: 10.1007/s00296-005-0096-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Accepted: 11/25/2005] [Indexed: 10/25/2022]
Abstract
The aim of this study was to compare the effects of physical therapy agents (PTA) and two different intra-articular hyaluronan drugs (sodium hyaluronate (NaHA) and hylan G-F 20) on knee osteoarthritis (OA). The randomised, single-blind study, with 12 months of follow-up, was performed on 80 patients diagnosed as knee OA. The patients were randomly divided into two treatment groups: patients in group 1 were given weekly intra-articular hyaluronan treatment which consisted of either hylan G-F 20 or NaHA during the first 3 weeks and in the sixth month; PTA was applied to each patient in group 2 five times a week for 3 weeks with a series of infrared, short-wave diathermy-pulsed patterns and interferential therapy. Clinical assessments for each patient were made at 1, 3, 6, 9 and 12 months using the following measures: spontaneous pain, pain at rest, pain at night, pain on touch, pain on movement, 15 m walking time, range of motion, short form 36 (SF-36), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) global assessment. There was significant improvement in all variables measured in both groups during the follow-up except the WOMAC-stiffness and range of the motion. The improvement of pain (at night, at rest, SF-36) and SF-36 social functioning subscales was greater in the PTA group. Consequently, in the subgroup analyses, there was no difference between PTA and hylan groups for this improvement. In the comparison of two drugs, the reduction of pain on touch and WOMAC-function was greater in hylan group than that of NaHA. No serious local or systemic effects were observed following injections. Although all patients had improvement, PTA was superior to hyaluronan group for no activity-related pain and functional performance. On the other hand, this study supports the preferential use of hylan over NaHA in patients with knee OA.
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Affiliation(s)
- Funda Atamaz
- Department of Physical Medicine and Rehabilitation, Medical Faculty of Ege University, 35100, Bornova-Izmir, Turkey
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Lee PB, Kim YC, Lee SC. Efficacy of Pulsed ElectroMagnetic Therapy for Chronic Lower Back Pain: a Double-Blind, Randomized, Placebo-Controlled Study. Korean J Pain 2005. [DOI: 10.3344/kjp.2005.18.1.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Pyung Bok Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong Chul Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
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Flipo RM, Conrozier T. [Therapeutic management of osteoarthritis in the beginning of the third millennium. Part II: non pharmacological strategies]. Rev Med Interne 2003; 24:243-52. [PMID: 12706781 DOI: 10.1016/s0248-8663(02)00820-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
COMMENT Osteoarthritis represents one of the most frequent pathologies today, and its current management requires the combination of pharmaceutical and non pharmacological strategies. Moreover, osteoarthritis constitutes one of the main diseases leading to the requirement to the alternative medicines. NEWS AND KEY POINTS This overview resumes the main recommendations in the light of recent controlled clinical trials concerning the not medicinal coverage of osteoarthritis : importance of the information and the education of the patient, the importance of the establishment of programs of physical exercises, the need for a reduction of the weight excess for knee osteoarthitis. Some controlled studies tried to estimate the symptomatic efficiency of acupuncture, homoeopathy or the contribution of minerals, vitamins. The appeal to the alternative said medicines is approached on this review. PERSPECTIVES AND PROJECTS If certain not medicinal strategies have a sufficient proof of efficiency today, on the other hand number of propositions still have not, at the moment, demonstrated by superiority and by efficiency versus placebo. Numerous controlled studies should be organized to confirm or exclude the place of treatments such as homoeopathy, minerals.
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Affiliation(s)
- R-M Flipo
- Service de rhumatologie, hôpital Roger-Salengro, centre hospitalier et universitaire de Lille, 59037 cedex, Lille, France.
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40
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Hanada EY. Efficacy of rehabilitative therapy in regional musculoskeletal conditions. Best Pract Res Clin Rheumatol 2003; 17:151-66. [PMID: 12659826 DOI: 10.1016/s1521-6942(02)00096-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This chapter reviews the best evidence for the rehabilitation of regional musculoskeletal conditions. Evidence-based efficacy of different modalities for treatment of musculoskeletal pain is presented, and the value of the patient's active participation in the rehabilitation programme is emphasized. The following modalities are commonly included in the holistic approach to patient-centred care and are reviewed: exercise therapy, thermotherapy, transcutaneous electrical nerve stimulation (TENS), and alternative therapies such as acupuncture, massage and yoga. A review of cognitive-behavioural strategies in pain management to prevent or treat fear-avoidance behaviour is also presented. Furthermore, the application of biomechanics in treating and preventing musculoskeletal disorders is illustrated. Moreover, the evidence for pain self-management to improve symptoms, health status and decrease the utilization of health care resources and cost is outlined. Finally, an overview will be presented, concerning the application of the evidence for treatment modalities to patient care, with focus on patient-centred, holistic treatment in a supportive setting. The following key questions/issues are addressed. What are the relevant therapeutic modalities for musculoskeletal pain disorders? What is the evidence of efficacy of these modalities in regional musculoskeletal conditions? What is the importance of understanding biomechanics? What is the importance of understanding fear-avoidance beliefs? What is the evidence for 'alternative' therapies such as acupuncture, massage or yoga? What is the evidence for 'pain self-management?' How does one apply the evidence for rehabilitation in regional musculoskeletal conditions into clinical practice?
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Affiliation(s)
- Edwin Yoshiyuki Hanada
- Department of Rehabilitation Medicine, Mount Sinai Hospital, 600 University Avenue, Room 1171, Toronto, Ontario, Canada M5G 1X5.
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Abstract
Several nonpharmacologic interventions for osteoarthritis are in different stages of development, investigation, and application. Such interventions capitalize on current knowledge of the causes of symptoms, disease progression, and disability in patients with osteoarthritis. Many nonpharmacologic interventions are low in cost and incorporate self-management approaches or home-based activities and, as such, may ultimately have substantial public health impact. Recent studies and reviews of exercise, weight loss, education, inserts, footwear, bracing, therapeutic ultrasound, acupuncture, and pulsed electromagnetic field therapy will be highlighted in this review. For many of these interventions, further investigation will be necessary to define their place in the management of osteoarthritis.
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Affiliation(s)
- Leena Sharma
- Department of Medicine, Northwestern University Medical School, Chicago, Illinois 60611, USA.
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42
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Dosage and treatment response in randomized clinical trials of therapeutic ultrasound. Phys Ther Sport 2002. [DOI: 10.1054/ptsp.2002.0107] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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43
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44
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Hurley M, Walsh N. Physical, functional and other non-pharmacological interventions for osteoarthritis. Best Pract Res Clin Rheumatol 2001; 15:569-81. [PMID: 11567540 DOI: 10.1053/berh.2001.0174] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Non-pharmacological interventions are frequently and widely used in the management of patients with osteoarthritis (OA). However, there is little evidence that most of these interventions are efficacious (i.e. that they work under ideal circumstances) owing to the paucity of research studies on these interventions and the fundamental methodological flaws in published studies. Moreover, the clinical effectiveness of non-pharmacological interventions (i.e. their efficacy under the conditions prevailing in clinical practice) is unknown, and cost-analysis of these interventions has not been carried out. If evidence-based management guidelines were to be constructed solely from firm research studies few could be recommended. Established and developing research methodologies and techniques should be employed to construct and conduct research programmes that appropriately evaluate the clinical and cost effectiveness of these complex non-pharmacological healthcare interventions. Establishing clinical effectiveness will ensure that we have practice-based evidence and are administering relevant, effective and optimal healthcare for patients with OA, maximizing the efficient use of healthcare resources.
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Affiliation(s)
- M Hurley
- Physiotherapy Division, King's College, London, UK
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Welch V, Brosseau L, Peterson J, Shea B, Tugwell P, Wells G. Therapeutic ultrasound for osteoarthritis of the knee. Cochrane Database Syst Rev 2001:CD003132. [PMID: 11687038 DOI: 10.1002/14651858.cd003132] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Therapeutic ultrasound is one of several physical therapy modalities suggested for the management of pain and loss of function due to OA. OBJECTIVES To assess the effectiveness of therapeutic ultrasound therapy for treating OA. SEARCH STRATEGY We searched the Cochrane Musculoskeletal Group trials register, and MEDLINE, up to the end of December 2000, using the sensitive search strategy developed by the Cochrane Collaboration. The search was complemented with bibliography searching of the reference list of the trials retrieved from the electronic search. Key experts in the area were contacted for further published and unpublished articles. SELECTION CRITERIA All randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing therapeutic ultrasound against placebo or another active intervention in patients with OA were selected. DATA COLLECTION AND ANALYSIS Two reviewers determined the studies to be included based on inclusion and exclusion criteria (LB, VW). Data were independently abstracted by two reviewers (VW, LB), and checked by a third reviewer (BS) using a pre-developed adapted form for the OA sub-group of the Cochrane Musculoskeletal Group. The same two reviewers, using a validated scale, assessed the methodological quality of the RCTs and CCTs independently. OA outcome measures were extracted from the publications. The pooled analysis was performed using weighted mean differences (WMDs) for joint counts, pain, global and functional assessments. A chi-square test was used to assess heterogeneity among trials. Fixed effects models were used throughout and random effects for outcomes showing heterogeneity. MAIN RESULTS Three trials, including 294 patients with knee OA were included. Only one trial (n=74) compared therapeutic ultrasound to placebo. This trial showed no difference in range of motion, pain or gait velocity after 4 weeks of therapeutic ultrasound. Two trials compared therapeutic ultrasound to an active therapy (n=220). These trials showed no statistical difference between galvanic current or short wave diathermy for the outcomes of pain and patient-assessed improvement. REVIEWER'S CONCLUSIONS Ultrasound therapy appears to have no benefit over placebo or short wave diathermy for patients with knee OA. These conclusions are limited by the poor reporting of the characteristics of the device, of the population, of the OA,and therapeutic application of the ultrasound and low methodological quality of the trials included. No conclusions can be drawn about the use of ultrasound in smaller joints such as the wrists or hands.
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Affiliation(s)
- V Welch
- Clinical Epidemiology Unit, Ottawa Hospital - Civic Campus - F6, 1053 Carling Avenue, Ottawa, Ontario, Canada, K1Y-4E9.
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Stucki G, Kroeling P. Physical therapy and rehabilitation in the management of rheumatic disorders. Best Pract Res Clin Rheumatol 2000; 14:751-71. [PMID: 11092800 DOI: 10.1053/berh.2000.0111] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Medical interventions focus on causation and disease processes, while rehabilitation, including most elements of physical therapy, is concerned with the consequences of disease. Its goals are to reduce symptoms, improve function and minimize disability. In rheumatology, the rehabilitation perspective mainly concerns patients with back pain, soft tissue and age-related musculoskeletal problems. In inflammatory diseases, anatomical and functional rehabilitation management includes joint protection, the maintenance of physical fitness and the prevention of impairment. This chapter will focus on essential therapeutic options and strategies in the rehabilitation of rheumatic disorders. It includes the evidence-based description of measurement instruments, joint mobilization, muscle techniques and physical modalities.
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Affiliation(s)
- G Stucki
- Department of Physical Medicine and Rehabilitation, Ludwig-Maximilians-University Munich, Marchionini-Strasse 15, D-81366 München, Germany
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47
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48
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Trock DH. Electromagnetic fields and magnets. Investigational treatment for musculoskeletal disorders. Rheum Dis Clin North Am 2000; 26:51-62, viii. [PMID: 10680193 DOI: 10.1016/s0889-857x(05)70119-8] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Certain pulsed electromagnetic fields (PEMF) affect the growth of bone and cartilage in vitro, with potential application as an arthritis treatment. PEMF stimulation is already a proven remedy for delayed fractures, with potential clinical application for osteoarthritis, osteonecrosis of bone, osteoporosis, and wound healing. Static magnets may provide temporary pain relief under certain circumstances. In both cases, the available data is limited. The mechanisms underlying the use of PEMF and magnets are discussed.
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Affiliation(s)
- D H Trock
- Yale University School of Medicine, New Haven, Connecticut, USA
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49
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Abstract
Therapeutic modalities are useful adjuncts in the rehabilitation of many patients commonly seen by hand surgeons. Therapeutic heat, cold, electrical stimulation, and laser and magnetic field treatments are evaluated for their respective mechanisms of action, indications, contraindications, and clinical results. The majority of therapeutic modalities have been extensively investigated and relevant basic science and randomized well-controlled clinical studies addressing the efficacy of therapeutic modalities are emphasized.
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Affiliation(s)
- J H Bissell
- Department of Physical Medicine and Rehabilitation, Centura Rehabilitation, St Mary Corwin Medical Center, Pueblo, CO 81004, USA
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50
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Minor MA, Sanford MK. The role of physical therapy and physical modalities in pain management. Rheum Dis Clin North Am 1999; 25:233-48, viii. [PMID: 10083966 DOI: 10.1016/s0889-857x(05)70062-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This article provides an overview to arthritis care of the common physical modalities (heat, cold, transcutaneous electrical nerve stimulation, low-energy laser, topical applications, and external devices). The rationale for use and effectiveness of the various physical modalities are discussed. Exercise is presented in terms of mode and effect of range of motion, muscle conditioning, and aerobic exercise.
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Affiliation(s)
- M A Minor
- Department of Physical Therapy, School of Health Related Professions, University of Missouri School of Medicine, Columbia, USA
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