[Modified Western Ontario and McMaster University Osteoarthritis Index Scale used in patients with knee osteoarthritis]

Effect of acupuncture for patients with knee osteoarthritis: study protocol for a double-dummy randomized controlled trial

BACKGROUND

Acupuncture has been used to relieve chronic pain in patients with knee osteoarthritis (KOA), but the evidence is contradictory. Therefore, we carefully designed a double-dummy randomized controlled trial (RCT) to explore the therapeutic effect of acupuncture for KOA.

METHODS/DESIGN

A total of 138 eligible participants with KOA who consent to participate will be randomly divided into Groups A, B, and C in a ratio of 1:1:1. Participants in Group A will receive verum acupuncture and placebo gel, while those in Groups B and C will be treated with diclofenac diethylammon gel and sham acupuncture, sham acupuncture and placebo gel, respectively. The patients will receive 4 weeks of treatment, five times a week, including acupuncture treatment once a day for 30 min and gel treatment three times a day. The primary outcome will be the change of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at week 4. The secondary outcomes will include visual analog scale (VAS), Arthritis Quality of Life Measurement Scale Simplified Scale (AIMS2-SF), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Credibility/Expectancy Questionnaire. The evaluation will be performed at baseline, week 4, 8, and 12 after randomization.

DISCUSSION

This double-dummy RCT used diclofenac diethylammon gel as a positive control, and the completion of this trial will provide detailed and accurate evidence of the efficacy and safety of acupuncture for KOA.

TRIAL REGISTRATION

China Clinical Trials Registry No.ChiCTR2100043947. Registered on September 24, 2020. https://www.chictr.org.cn/showproj.html?proj=122536 .

Cross-Culturally Adapted Versions of Patient Reported Outcome Measures for the Lower Extremity

Background

A large number of patient reported outcome measures (PROMs) have been developed in the English language for various lower extremity orthopaedic pathologies. Twenty different PROMs were recommended for 15 specific musculoskeletal lower extremity pathologies or surgeries. However, the availability of cross-culturally adapted versions of these recommended PROMs is unknown.

Purpose

The purpose of this study was to identify the cross-culturally adapted versions of recommended PROMs for individuals experiencing orthopedic lower extremity pathologies or undergoing surgeries, and to identify the psychometric evidence that supports their utilization.

Study design

Literature Review.

Methods

PubMed, Embase, Medline, Cochrane, CINAHL, SPORTDisucs and Scopus were searched for cross-culturally adapted translated studies through May 2022. The search strategy included the names of the 20 recommended PROMs from previous umbrella review along with the following terms: reliability, validity, responsiveness, psychometric properties and cross-cultural adaptation. Studies that presented a non-English language version of the PROM with evidence in at least one psychometric property to support its use were included. Two authors independently evaluated the studies for inclusion and independently extracted data.

Results

Nineteen PROMS had cross-culturally adapted and translated language versions. The KOOS, WOMAC, ACL-RSL, FAAM, ATRS, HOOS, OHS, MOXFQ and OKS were available in over 10 different language versions. Turkish, Dutch, German, Chinese and French were the most common languages, with each language having more than 10 PROMs with psychometric properties supporting their use. The WOMAC and KOOS were both available in 10 languages and had all three psychometric properties of reliability, validity, and responsiveness supporting their use.

Conclusion

Nineteen of the 20 recommended instruments were available in multiple languages. The PROM most frequently cross-culturally adapted and translated were the KOOS and WOMAC. PROMs were most frequently cross-culturally adapted and translated into Turkish. International researchers and clinicians may use this information to more consistently implement PROMs with the most appropriate psychometric evidence available to support their use.

Level of evidence

3a.

Efficacy of manual acupuncture, electro-acupuncture, and warm acupuncture for knee osteoarthritis: study protocol for a randomized controlled trial

Background

Acupuncture is one of the most popular complementary and alternative treatments for knee osteoarthritis (KOA). There are many methods of acupuncture in the treatment of KOA, and the effects are different. According to our clinical observations and researches, it is found that manual acupuncture (MA), electro-acupuncture (EA), and warm acupuncture (WA) are used more frequently in the treatment of KOA, and the curative effects are satisfactory. However, there is currently a lack of efficacy comparison of efficacy between different acupuncture treatments, as well as a lack of standardized clinical research on the acupuncture treatment of KOA. Therefore, we will carry out a high-quality clinical randomized controlled trial to research the effect laws of MA, EA, and WA on KOA.

Methods/design

A total of 200 eligible participants with KOA will be randomly assigned to group A, B, C, or D in a ratio of 1:1:1:1. Patients in group A will receive MA, while those in group B, group C, and group D will be treated with EA, WA, and sham acupuncture (SA), respectively. Patients will be treated with acupuncture once a day, 30 min per session, 5 sessions per week for 4 weeks. The primary outcome is the change of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at week 4. The secondary outcomes include WOMAC, visual analog scale (VAS), Arthritis Quality of Life Measurement Scale Simplified Scale (AIMS2-SF), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Credibility/Expectancy Questionnaire. The evaluation will be performed at baseline and weeks 4, 8, and 12 respectively after randomization.

Discussion

This is a randomized controlled trial. We will observe the clinical effect of MA, EA, and WA on KOA to research the effect laws of these three acupuncture treatments on KOA and set up standardized treatment programs for acupuncture for KOA.

Trial registration

China Clinical Trials Registry ChiCTR2100049526. Registered on August 2, 2021

Gap balancing improve squat function and knee function: a randomized controlled trial comparing gap balancing and measured resection

OBJECTIVE

We compared the measured resection (MR) technique and the gap balancing (GB) technique in patients with knee osteoarthritis after primary total knee arthroplasty (TKA) in China to understand the effects of the two techniques on knee function and squat function.

METHODS

From March 2017 to September 2019, a prospective randomized controlled trial was conducted with 96 patients with knee osteoarthritis undergoing primary TKA from March 2017 to September 2019 randomized to GB group (n = 48) and MR group (n = 48). Intraoperative indicators (operation time, osteotomy volume of medial and lateral of posterior femoral condyles, external rotation angle) were recorded during operation. At 1, 3, 6, and 12 months after surgery, all the patients came to the hospital for review and underwent the pain severity, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), knee joint range of motion, Oxford Knee Score (OKS), and American Knee Society Score (AKSS) tests. All patients were followed up for more than 1 year.

RESULTS

The osteotomy volume of the medial femoral condyle in the GB group was higher than that in the MR group (P<0.05), and the operation time in the GB group was shorter than that in the MR group (P<0.05). At 1, 3, 6, and 12 months after surgery, the pain severity in the GB group was lower than that in the MR group (P<0.05), the knee range of motion in the GB group was larger than that in the MR group (P<0.05), the WOMAC of the GB group was lower than that of the MR group (P<0.05), the OKS of the GB group was higher than that of the MR group (P<0.05), the AKSS of the GB group was higher than that of the MR group. The incidence of postoperative complications in the GB group (4.17%) was significantly lower than that in the MR group (18.75%) (P<0.05).

CONCLUSION

The GB technique can effectively shorten the operation time, relieve pain, improve knee range of motion, improve squat function and knee function, reduce osteoarthritis index, and reduce the occurrence of complications, which is worthy of clinical popularization and application.