The effects of therapeutic exercises on pain, muscle strength, functional capacity, balance and hemodynamic parameters in knee osteoarthritis patients: a randomized controlled study of supervised versus home exercises

The Influence of an Eight-Week Home Exercise Program on Spatiotemporal and Kinetic Characteristics of Gait and Knee Function in Women with Severe Knee Osteoarthritis Scheduled for Arthroplasty

Background and Objectives: The increased prevalence of knee osteoarthritis (OA) and need for total knee arthroplasty (TKA) indicate a growing need for effective prehabilitation. The effect of preoperative home exercise programs (HEPs) on gait in patients with severe knee OA is under-investigated. This study aimed to evaluate the influence of an 8-week preoperative HEP on gait characteristics, leg extensor muscle strength, knee function, and health status in women with severe knee OA scheduled for TKA and to compare them with healthy control data. Material and Methods: Eighteen women with severe knee OA (KOA, aged 61.8 ± 1.6 years) and ten age-matched healthy women (CON) participated in this study. The KOA group performed an HEP with 15 exercises aimed at improving lower limb muscle strength, motion, balance, and coordination. Gait spatiotemporal and kinetic characteristics during the loading response, isometric leg extensor strength, knee active range of motion (AROM), and The Western Ontario and McMaster Universities Arthritis Index (WOMAC) were investigated. Associations between characteristics were analyzed. Results: Improvements in ground reaction force (GRF) during the loading response of gait, leg extensor muscle strength, the knee AROM, and the WOMAC index were found post-HEP. The KOA group demonstrated lower (p < 0.05) spatiotemporal and GRF characteristics than the CON group. Knee extension moment (KEM) was lower pre-HEP (p < 0.05) but did not differ significantly from the CON group post-HEP. Gait characteristics and WOMAC were associated with leg extensor muscle strength and knee AROM and pain in the KOA group. Conclusions: An eight-week preoperative HEP improved GRF and KEM during the loading response of gait, muscle strength, knee function, and self-reported knee OA-related health status in women with severe knee OA. Preoperative HEP before TKA, focusing on leg extensor muscle strength, range of motion, and pain relief, is an effective alternative to supervised exercise therapy in women with severe knee OA.

Supervised or Home-Based? Exploring the Best Exercise Approach for Knee Osteoarthritis Management: A Systematic Review and Meta-Analysis

Background/Objective: Knee osteoarthritis (OA) is a common and debilitating condition affecting older adults, often progressing to advanced stages and requiring total joint replacement. Exercise therapy is widely recognized as the first-line approach for the prevention and initial management of OA. This systematic review assessed the effectiveness of home-based exercises (HBEs) compared to supervised exercises in alleviating pain and reducing disability among patients with knee OA. Methods: A systematic search of PubMed, Cochrane Library, and ScienceDirect identified randomized controlled trials (RCTs) published between January 2001 and October 2024. Methodological quality was evaluated using the Physiotherapy Evidence Database (PEDro) scale, and a meta-analysis was conducted to quantify the efficacy of these interventions. Results: Ten RCTs involving 917 patients were included, ranging in moderate to high methodological quality (PEDro score: 6.3 ± 1.2). Intervention durations ranged from 4 to 12 weeks. Both supervised and HBEs were found to be effective, but supervised exercises demonstrated statistically significant improvements in pain (SMD = -0.45 [95% CI -0.79; -0.11], p = 0.015) and disability (SMD = -0.28 [95% CI -0.42; -0.14], p < 0.001) compared to HBEs. Conclusions: Despite the superiority of supervised exercises over HBEs, considering the cost-effectiveness and ease of implementation of HBEs, we developed recommendations to create a hybrid rehabilitation program that combines both approaches to maximize clinical outcomes.

Home-based vs center-based exercise on patient-reported and performance-based outcomes for knee osteoarthritis: a systematic review with meta-analysis

Background

Home-based exercise (HBE) represents an alternative to increase the accessibility of rehabilitation programs and relieve the burden on the health care system for people with knee osteoarthritis.

Objectives

To summarize for the first time the effectiveness of HBE as compared to center-based exercise (CBE), both with and without HBE, on patient-reported and performance-based outcomes in people with KOA.

Methods

Searches were conducted on PubMed, Cochrane, Embase, Web of Science, and Scopus until March 10, 2023, without date or language restrictions. Randomized controlled trials investigating HBE versus CBE or HBE combined with CBE for people with KOA were eligible. The primary outcomes were patient-reported: pain, physical disability, and quality of life. The secondary outcomes were performance-based: walking ability, lower limb muscle strength, and balance function. Risk of bias was assessed with the Cochrane Risk of Bias tool and quality of evidence according to the GRADE.

Results

Eleven trials involving 956 participants were included. There was no difference in short-term pain (SMD, 0.22 [95% CI, -0.04 to 0.47], p = 0.09; I2 = 0%), physical disability (SMD, 0.17 [95% CI, -0.19 to 0.54], p = 0.35; I2 = 0%), walking ability (SMD, -0.21 [95% CI, -0.64 to 0.22], p = 0.33; I2 = 35%) and lower limb muscle strength (SMD, -0.24 [95% CI, -0.88 to 0.41], p = 0.47; I2 = 69%) between HBE and CBE. HBE combined with CBE has better benefits compared with HBE alone in short-term pain (SMD, 0.89 [95% CI, 0.60 to 1.17], p < 0.001; I2 = 11%) and physical disability (SMD, 0.25 [95% CI, 0.00 to 0.50], p = 0.05; I2 = 0%).

Conclusion

Based on limited evidence, HBE is as effective as CBE on short-term pain, physical disability, walking ability, and lower limb muscle strength in people with knee osteoarthritis. Furthermore, combining HBE with CBE may enhance the overall efficacy of the intervention.

Systematic review registration

PROSPERO, CRD42023416548.

Supervised exercises have superior effects compared to home-based exercises for patients with knee osteoarthritis following platelet-rich plasma injection

The purpose of the study was to compare the effectiveness of physiotherapist-supervised and home-based exercises after platelet-rich-plasma (PRP) injection in knee osteoarthritis (OA). Thirty women (mean age = 57.83 ± 7.26 years; mean weight = 72.13 ± 15.54 kg; mean height = 158.40 ± 4.49 cm; mean body mass index = 28.75 ± 6.18 kg/m2) were included. Patients randomized either supervised or home-basedexercise-group after PRP. Both groups performed 6-week (3 times/week) exercise. Pain, hip and knee muscle strength, and knee functions were assessed before and after exercise. The median improvement in the pain from baseline to 6th week was 3.80 (2.85-5.55) point in-supervised-exercise-group while it was 0.60 (-0.10-2.55) point in home-based-exercise-group (p = 0.002). The median improvement in knee function was 22.91 (13.02-30.20) in supervised-exercise-group overtime (p < 0.001). There was no improvement in knee function following home-based exercises (p = 1.000). The supervised-exercise-group revealed a significant improvement in hip (median difference = 32.00 (8.30-88.95), p = 0.011); quadriceps (median difference = 32.10 (21.65-60.05), p = 0.001) and hamstring (median difference = 27.90 (7.95-37.65), p = 0.022) strength overtime. The physiotherapist-supervised exercises after PRP had better effects on pain and knee function than the home-based exercises.

Effectiveness of Mulligan Mobilization Technique and Core Stabilization Exercises in Female Patients With Knee Osteoarthritis: A Randomized Controlled Single-Blind Study

OBJECTIVES

The aim of this study was to compare the effectiveness of the Mulligan mobilization (MM) technique and Core stabilization (CS) exercises added to the conventional physiotherapy (CP) program in female patients with knee osteoarthritis (KOA).

METHODS

The study included 42 female patients diagnosed with bilateral KOA. Participants were randomly divided into 3 groups as CP group (mean age: 57.79 ± 7.43 years), MM group (mean age: 56.14 ± 6.95 years), and CS group (mean age: 54.36 ± 6.56 years). They were divided into 3 groups and treated 3 sessions per week for 4 weeks. Pain intensity, range of motion (ROM), and muscle strength were evaluated with visual analog scale, universal goniometer, and handheld dynamometer, respectively. Balance, aerobic capacity, and functional level were assessed with 30-second sit-to-stand test, 6-minute walk test, and Western Ontario and McMaster Universities Osteoarthritis Index. The quality of life of the participants was evaluated with the Nottingham Health Profile.

RESULTS

After treatment, significant improvement was achieved in the all parameters evaluated in the groups (P < .05). CS was found to be more effective in reducing resting pain intensity than the other two treatment approaches (P = .001). It was observed that MM technique increased knee flexion ROM more (P = .001). There was no superiority of MM group and CS group over each other in balance, functional level, aerobic capacity, and quality of life assessments (P > .05).

CONCLUSION

Our study showed that CP, MM technique, and CS exercises were effective treatment approaches in the management of KOA in female patients. Results revealed that the MM technique was more effective in increasing knee flexion ROM, and the CS exercise was more effective in reducing resting pain intensity in female patients with KOA.

Effects of basic body awareness therapy on pain, balance, muscle strength and functionality in knee osteoarthritis: a randomised preliminary trial

PURPOSE

This study aimed to investigate the effects of basic body awareness therapy (BBAT) on pain, balance, muscle strength, and functionality in knee OA.

METHODS

Forty patients (mean age: 55.20 ± 6.40 years) with knee OA were randomly assigned to experimental and control groups. Both groups participated in a home-based exercise programme. The home-based exercise programme was performed daily for 6 weeks. In addition to the home-based programme, patients in the experimental group participated in BBAT 3 days a week for 6 weeks. The visual analogue scale, fall risk assessment, single-leg stability test, knee extension muscle strength, five times sit-to-stand test, joint range of motion assessment, Western Ontario and McMaster Universities Osteoarthritis Index, 6-minute walk test, and stair climb test were performed at baseline and after 6 weeks.

RESULTS

All outcomes in the experimental group significantly improved after 6 weeks (p < 0.05). There were significant differences between the two groups in terms of the experimental group in muscle strength (p = 0.018, η2= 0.191), five times sit-to-stand test (p < 0.001, η2= 0.510), and the stair climbing test (p = 0.012, η2=0.212).

CONCLUSION

This study showed that BBAT, in addition to a home-based exercise programme, can improve muscle strength and functionality in patients with knee OA.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04165187.

Effectiveness of balance training on pain and functional outcomes in knee osteoarthritis: A systematic review and meta-analysis

Background: Knee osteoarthritis (OA) is a musculoskeletal disorder that causes pain and increasing loss of function, resulting in reduced proprioceptive accuracy and balance. Therefore, the goal of this systematic review and meta-analysis is to evaluate the effectiveness of balance training on pain and functional outcomes in knee OA. Methods: "PubMed", "Scopus", "Web of Science", "Cochrane", and "Physiotherapy Evidence Database" were searched for studies conducted between January 2000 and December 2021. Randomized controlled trials (RCTs) that investigated the effectiveness of balance training in knee OA, as well as its effects on pain and functional outcome measures, were included. Conference abstracts, case reports, observational studies, and clinical commentaries were not included. Meta-analysis was conducted for the common outcomes, i.e., Visual Analog Scale (VAS), The Timed Up and Go (TUG), Western Ontario and McMaster Universities Arthritis Index (WOMAC). The PEDro scale was used to determine the quality of the included studies. Results: This review includes 22 RCTs of which 17 articles were included for meta-analysis. The included articles had 1456 participants. The meta-analysis showed improvement in the VAS scores in the experimental group compared to the control group [ I 2= 92%; mean difference= -0.79; 95% CI= -1.59 to 0.01; p<0.05] and for the WOMAC scores the heterogeneity ( I 2) was 81% with a mean difference of -0.02 [95% CI= -0.44 to 0.40; p<0.0001]. The TUG score was analyzed, the I 2 was 95% with a mean difference of -1.71 [95% CI= -3.09 to -0.33; p<0.0001] for the intervention against the control group. Conclusions: Balance training significantly reduced knee pain and improved functional outcomes measured with TUG. However, there was no difference observed in WOMAC. Although due to the heterogeneity of the included articles the treatment impact may be overestimated. Registration: The current systematic review was registered in PROSPERO on 7th October 2021 (registration number CRD42021276674).

Evaluation of the effect of high-intensity laser therapy (HILT) on function, muscle strength, range of motion, pain level, and femoral cartilage thickness in knee osteoarthritis: randomized controlled study

This study was designed as a double-blind randomized placebo-controlled study. The aim of this study was to evaluate the effects of high-intensity laser therapy (HILT) on pain, range of motion, function, muscle strength, and femoral cartilage thickness in patients with knee osteoarthritis. Sixty patients who were admitted between November 2021 and April 2022 and diagnosed with knee osteoarthritis based on anamnesis, physical examination, and imaging methods were included in the study. The patients observed during the research were randomly divided into two groups with 30 patients in each group. Hotpack, transcutaneous electrical nerve stimulation (TENS), exercise (5 days a week for a total of 15 sessions), and HILT (analgesic mode with a power of 10.0 w, energy density of 12 j/cm2, and 2 min for every 25 cm2, biostimulant mode with a power of 5.0 W, energy density of 120 j/cm2, and 10 min for each 25 cm2; total 9 sessions 3 days a week) were applied for 3 weeks for the first group, and hot pack, TENS, exercise (5 days a week for a total of 15 sessions), and sham laser treatment (0 W total 9 sessions 3 days a week) was applied for 3 weeks for the second group. The patients were evaluated with the determined scales before the treatment, at the end of the treatment, and at the third month. A goniometer was used to measure joint range of motion measurement, a visual analog scale (VAS) for pain, WOMAC Osteoarthritis Index to assess pain and function, Biodex System 3 isokinetic device for knee flexion-extension muscle strength measurement, and ultrasonography to measure femoral cartilage thickness. There was no statistically significant difference in VAS, range of motion, WOMAC, muscle strength, and femoral cartilage thickness measurement between the groups, whether before treatment, after treatment or at the third-month follow-up (p > 0.05). There was a statistically significant decrease in pain intensity, an increase in flexion range of motion, WOMAC, and femoral cartilage thickness in both groups (p < 0.005). A statistically significant increase was found in the average peak torque flexion muscle strength measurements at isokinetic 60°/s angular velocities in the post-treatment and third-month checkup compared to the pre-treatment analysis in both groups (p < 0.05). In conclusion, there was no statistically significant difference between HILT + exercise and placebo laser + exercise observed. However, the exercise program performed under the supervision of a physiotherapist has been shown to be effective in improving all parameters.

The effectiveness of exercise with behavior change techniques in people with knee osteoarthritis: A systematic review with meta-analysis

OBJECTIVE

The purpose of this systematic review with meta-analysis was to examine the effectiveness of exercise with behavior change techniques (BCTs) on core outcome sets in people with knee osteoarthritis.

LITERATURE SURVEY

We searched randomized controlled trials (RCTs) in eight databases (MEDLINE, Embase, CENTRAL, CINAHL, PsycINFO, PEDro, ICTRP, and ClinicalTrials.gov) up to November 4, 2021.

METHODOLOGY

Eligible participants were people with knee osteoarthritis. The intervention was exercise with BCTs. Primary outcomes included physical function, quality of life (QOL) 6 to 12 months after intervention, and adverse events. Secondary outcomes were knee pain, exercise adherence, mobility, and self-efficacy 3 months or more after intervention. The bias risk was assessed using the Risk of Bias 2 tool. The random-effects model was used for the meta-analysis.

SYNTHESIS

We found 16 individual BCTs, and 37.7% of trials used a single BCT. For meta-analysis, we included 21 RCTs (n = 1623). Most outcomes had a very low certainty of evidence, and the risk of bias was the consistent reason for downgrading evidence levels. The standardized mean difference (SMD) with 95% confidence interval (95% CI) was 0.00 (-0.24, 0.24) in physical function, 0.33 (-0.51, 1.17) in exercise adherence, and 0.04 (-0.39, 0.47) in self-efficacy. The risk ratio (95% CI) of adverse events was 3.6 (0.79, 16.45). QOL was not pooled due to insufficient data (very low certainty of evidence). In contrast, the SMD (95% CI) for knee pain reduction and mobility improvement was -0.33 (-0.53, -0.13) and 0.21 (-0.05, 0.47) with moderate and low certainty of evidence, respectively.

CONCLUSION

The evidence is inconclusive regarding the effectiveness of BCTs with exercises on core outcome sets. Further research should explore the effectiveness of BCTs with valid design.

PROTOCOL REGISTRATION

PROSPERO (CRD42020212904).

Effectiveness of home-based exercise interventions on pain, physical function and quality of life in individuals with knee osteoarthritis: a systematic review and meta-analysis

OBJECTIVE

The objective of the study was to evaluate the effectiveness of home-based exercise interventions on pain, physical function and quality of life in individuals with knee osteoarthritis (KOA).

METHODS

Five databases (PubMed, Embase, Cochrane Library, CINAHL, Web of Science Core Collection) were searched for relevant randomized controlled trials (RCTs) published from database inception to 2 August 2022. The Cochrane Collaboration's standards were followed for study selection, eligibility criteria, data extraction and statistics, using the Cochrane Collaboration Risk of Bias Tool and PEDro for quality assessment. A meta-analysis and subgroup analyses, stratified by control condition and intervention duration, were conducted using RevMan 5.4. The study was reported in compliance with the PRISMA statement.

RESULTS

A total of 12 independent RCTs with 1442 participants were included. The meta-analysis showed that the home-based exercise interventions significantly reduced pain in individuals with KOA (SMD =  - 0.32, 95% CI [- 0.41, - 0.22], p < .01) and improved physical function (SMD =  - 0.25, 95% CI [- 0.47, - 0.02], p = .03) and quality of life (SMD = 0.63, 95% CI [0.41, 0.85], p < .001). Subgroup analysis revealed that home-based exercise interventions were superior to health education and no treatment, in terms of pain and physical function, and similar to clinic-based exercise and pharmacologic treatment.

CONCLUSIONS

The effect of home-based exercise intervention is significantly better than health education and no treatment for reducing knee pain and improving physical function, and was able to achieve the effects of clinic-based exercise treatment and pharmacologic treatment. With regard to quality of life, the unsupervised home strength exercise intervention showed a significant effect compared with the health education control and combined with cognitive behavioural therapies may produce better results. Although home-based intervention provides effective treatment options for individuals with clinical treatment limitations, individual disease complications and the dosimetry of exercise need to be considered in practice. Furthermore, growing evidence supports the effectiveness of Tai Chi in the rehabilitation of KOA.

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

BACKGROUND

Exercise is an effective intervention for knee osteoarthritis (OA), and unsupervised exercise programs should be a common adjunct to most treatments. However, it is unknown if current clinical trials are capturing information regarding adherence.

OBJECTIVE

To summarize the extent and quality of reporting of unsupervised exercise adherence in clinical trials for knee OA.

METHODS

Reviewers searched five databases (PubMed, CINAHL, Medline (OVID), EMBASE and Cochrane). Randomized controlled trials where participants with knee OA engaged in an unsupervised exercise program were included. The extent to which exercise adherence was monitored and reported was assessed and findings were subgrouped according to method for tracking adherence. The types of adherence measurement categories were synthesized. A quality assessment was completed using the Physiotherapy Evidence Database (PEDro) scores.

RESULTS

Of 3622 abstracts screened, 176 studies met criteria for inclusion. PEDro scores for study quality ranged from two to ten (mean=6.3). Exercise adherence data was reported in 72 (40.9%) studies. Twenty-six (14.8%) studies only mentioned collection of adherence. Adherence rates ranged from 3.7 to 100% in trials that reported adherence. For 18 studies (10.2%) that tracked acceptable adherence, there was no clear superiority in treatment effect based on adherence rates.

CONCLUSIONS

Clinical trials for knee OA do not consistently collect or report adherence with unsupervised exercise programs. Slightly more than half of the studies reported collecting adherence data while only 40.9% reported findings with substantial heterogeneity in tracking methodology. The clinical relevance of these programs cannot be properly contextualized without this information.

Effect of low-level laser therapy plus exercise therapy on pain, range of motion, muscle strength, and function in knee osteoarthritis - a systematic review and meta-analysis

BACKGROUND

Knee osteoarthritis (KOA) is commonly associated with multiple musculoskeletal impairments.

OBJECTIVE

The purpose of this review was (1) to investigate the effectiveness of LLLT plus ET on pain, ROM, muscle strength, and function in KOA immediately after therapy and (2) whether the effectiveness of LLLT plus ET could be sustained at follow-up (4 - 32 weeks).

METHODS

Six databases were systematically searched upto December 2021 to find relevant articles. Included studies were RCTs written in English, which compared LLLT plus ET with placebo LLLT plus ET in KOA. Three independent reviewers extracted data and assessed the quality of included studies. Standard mean difference (SMD) was used in meta-analysis using random effect model.

RESULT

Of the 6307 articles, 14 RCTs (820 patients) met the inclusion criteria. The results demonstrated that there was a significant difference in pain immediately after therapy (SMD: -0.58, p = 0.001) and at follow-up (SMD: -1.35, p = 0.05) in LLLT plus ET group. There were no significant differences in knee ROM, muscle strength, and knee function outcomes immediately and at follow-up.

CONCLUSION

Our findings indicate that LLLT plus ET could be considered to alleviate pain in the KOA. LLLT reduces pain at 4-8J with a wavelength of 640-905nm per point applied for 10-16 sessions at a frequency of 2 sessions/week. An exercise therapy program at prescribed dosage involving major muscle groups might help. However, LLLT plus ET is no more effective than placebo LLLT plus ET in improving ROM, muscle strength, and function in KOA.

Efficacy of balance training on postural control in patients with rotator cuff disease: a randomized controlled study

We evaluated the efficacy of adding balance training to a physical therapy program on postural control and health-related quality of life in patients with rotator cuff disease. Forty-two participants were randomly allocated to the control and intervention groups. Both groups received physical therapy (education, stretching, supervised strength training, and home exercise program) 3 days/week for 6 weeks. The intervention group was instructed to perform balance exercises at home. The primary outcomes were the stability index, the Fourier transformation (F5 and F6), the weight distribution index, and the fall index, as assessed by the posturography during eight conditions with different combinations of standing (solid surface, pillows, and different head positions) and vision (eyes open/closed). The secondary outcomes included the Western Ontario Rotator Cuff Index to assess the health-related quality of life, the Shoulder Pain and Disability Index, and the Numeric Pain Rating Scale. The adherence to in-person and home-based therapy was high (>83%). The intervention group significantly improved the stability index, F5, and F6 parameters but each in only one condition (P < 0.05). No significant improvement was found in the conditions for the other primary outcomes and in the health-related quality of life. (P > 0.05). We conclude that adding the balance training protocol to the physical therapy program does not improve postural control and health-related quality of life in patients with rotator cuff disease.

The effect of self-reported knee instability on plantar pressure and postural sways in women with knee osteoarthritis

BACKGROUND

Giving way and knee instability are common problems in patients with knee osteoarthritis, disrupting the daily activities and balance of the affected individual. The present study aimed to evaluate the postural control status of women with knee osteoarthritis with and without self-report knee instability (KI).

METHODS

This cross-sectional, single-blind study was conducted on 57 female patients with knee osteoarthritis. The patients were selected based on the inclusion and exclusion criteria and divided into two groups of with KI (n = 26) and without KI (n = 31). Fear of movement was assessed using the Tampa questionnaire, the degree of knee instability was measured based on the Fitzgard scale, the static and dynamic balance of the subjects were evaluated with open and closed eyes using a Biodex balance device, and foot pressure distribution situation was measured using a FDM-S-Zebris device.

RESULTS

Mean comparison showed a significant difference between the subjects with and without KI in static balance only in anterior-posterior direction with open eyes (p = 0.01) and closed eyes (p = 0.0001). In the dynamic balance test, the subjects in both groups had significant differences in terms of all the indicators of anterior-posterior stability (p = 0.001), medial-lateral stability (p = 0.0001), and overall stability (p = 0.0001) with closed eyes. However, no significant difference was observed with open eyes (p > 0.05). Multiple regression also indicated significant positive correlations between pain intensity and disease duration with the degree of KI (p < 0.05).

CONCLUSIONS

According to the results, there were significant differences between the mean pain scores, static and dynamic balance, and the rate of fall between the women with knee osteoarthritis with and without the KI index. Therefore, patients with knee osteoarthritis, which also has an index of KI, are more susceptible to falls, and proper strategies are required to reduce the level of KI in these patients.

Level of pain, muscle strength and posture: effects of PBM on an exercise program in women with knee osteoarthritis - a randomized controlled trial

To evaluate the effectiveness of an exercise program associated to photobiomodulation (PBM) on pain, postural changes, functionally, and muscular strength in women, one of the risk factors, with knee osteoarthritis (OA). A randomized controlled trial, with a blinded assessor and intention-to-treat analysis and placebo control. Sixty-two participants with knee OA (with confirmed radiological diagnosis) were evaluated for this study. However, 34 were considered eligible and were randomized into two groups: EPPG - exercise and PBM placebo group (n = 17) and EPAG - exercise and PBM active group (n = 16), but one participant was excluded of EPAG. The exercise program and PBM (808 nm, 100 mW/point, 4 J/point, 56 J total, 91 J/cm2) were realized twice a week, during 8 weeks. West Ontario and the McMaster University Osteoarthritis Index (WOMAC) and Lequesne questionnaires, 1-repetition maximum test (1-RM) and posture evaluation software (SAPO) were used to analyze the effects of the therapies. In intragroup analysis, a significant improvement in pain WOMAC (p < 0.001), stiffness (p < 0.001), function (p < 0.001), Lequesne (p < 0.001), and 1-RM (all muscle groups) (p < 0.001) were observed. In this study, the exercise program improved pain, function, and muscle strength of all the participants. However, PBM, in the parameters used, did not optimize the effects of the exercise program in women with knee OA.

Efficacy of Piroxicam Mesotherapy in Treatment of Knee Osteoarthritis: A Randomized Clinical Trial

Introduction

Knee osteoarthritis (KOA) is one of the most common degenerative diseases that lead to pain and disability. Oral NSAIDs are effective drugs used to alleviate symptoms in patients with KOA, but they have several important complications, especially in the elderly. In this study, we evaluated the effectiveness of mesotherapy on pain reduction and improvement of functioning in patients with KOA.

Methods

Sixty-two patients with KOA, grade 2-3 of the Kellgren–Lawrence scale, were randomized into two groups: the mesotherapy group, in which two injections were applied with piroxicam at a 10-day interval, and the oral group, in which piroxicam was prescribed for 10 days. The patients were evaluated before the treatment and 2, 4, and 8 weeks after it using the Visual Analogue Scale (VAS), Oxford Knee Scare (OKS), and Western Ontario McMaster University Osteoarthritis Index (WOMAC, Persian version).

Results

There was no significant difference in demographic characteristics and baseline pain and function scores between the two groups. After 2, 4, and 8 weeks of follow-up, VAS, WOMAC, and OKS scores significantly improved in both groups (in the mesotherapy group: p value <0.001 in all three scores and in the oral group: p value <0.001 in the VAS scale and p value <0.05 in WOMAC and OKS scores). There was no significant difference between the two groups at any time in the VAS score, but improvement in WOMAC and OKS scales in the mesotherapy group was significantly better (p value <0.05 in both scales [p value <0.03 in OKS and p value <0.02 in WOMAC scales]). Side effects in both groups were not serious: limited heart burn in 32.2% of the total subjects in the oral group and pain at the injection site in 3.2% and bruises in 38.7% of the total subjects in the mesotherapy group.

Conclusion

Mesotherapy is an effective and safe treatment modality in patients with mild-to-moderate KOA in the short term. This trial is registered with IRCT2017052434113N1.

Thread-Embedding Therapy for Knee Osteoarthritis

The aim of this study was to investigate the efficacy of thread-embedding therapy for the treatment of knee osteoarthritis. There were 20 patients treated with thread-embedding therapy at various acupoints on the muscles around the knee. Gender, age, location, morbidity period, numeric rating scale (NRS), Western Ontario and McMaster Universities (WOMAC) index, improvement result, side effects, and patient’s satisfaction were investigated. After the treatment, the NRS score (z = -4.07, <i>p</i> < 0.001) and WOMAC (<i>p</i> < 0.001) indices decreased in most patients. The NRS score decreased by more than 2 points in 95% of the patients. The WOMAC index decreased by 6-12 points. There were no serious side effects, although bruising, pain, and edema were observed. Overall, 85% of the patients felt satisfied with the thread-embedding therapy. These findings suggested that threadembedding therapy was effective and may be used widely for knee osteoarthritis.

Influência da reabilitação física sobre aspectos funcionais em indivíduos submetidos à artroplastia total de quadril: uma revisão sistemática

Resumo Objetivo: Avaliar, por meio de revisão sistemática, a influência do tratamento fisioterapêutico sobre a funcionalidade, amplitude de movimento articular e força muscular em pacientes submetidos à artroplastia total de quadril devido à osteoartrite. Métodos: A busca sistemática de ensaios clínicos randomizados e não randomizados foi conduzida utilizando os bancos de dados eletrônicos PubMed, Web of Science, PEDro, Cochrane, Clinical Trials e SciELO, com base nas estratégias de pesquisa recomendadas pelos itens de relatórios preferenciais para análises sistemáticas e metanálises (PRISMA). Resultados: Em geral, protocolos supervisionados por fisioterapeutas associados à realização de exercícios ativos da musculatura periarticular do quadril e de extensores de joelho têm propiciado importante prognóstico físico e funcional. Exercícios resistidos (dinâmicos e isométricos) de alta intensidade são mais eficazes para a funcionalidade. Para a força muscular e Amplitude de movimento (ADM), exercícios dinâmicos com 3 a 5 séries de 8 a 12 repetições com baixa e alta intensidade promoveram ganhos mais expressivos em relação a outras modalidades terapêuticas. Conclusões: As técnicas e os protocolos utilizados pela fisioterapia para o tratamento da ATQ são variados e possuem importante eficácia clínica comprovada na literatura.

Effectiveness of behaviour change techniques in physiotherapy interventions to promote physical activity adherence in lower limb osteoarthritis patients: A systematic review

Background

Lower limb osteoarthritis (OA) causes high levels of individual pain and disability and is an increasing socio-economic burden to global healthcare systems. Physical Activity interventions are commonly provided by physiotherapists to help patients with lower limb OA manage their clinical symptoms.

Objective

To identify and evaluate the effectiveness of behavioural change techniques (BCTs) within physiotherapy interventions to increase physical activity (PA) adherence in patients with lower limb OA.

Design

A systematic review was conducted, following Cochrane guidelines according to a published and registered protocol (CRD42016039932). Two independent researchers conducted searches, determined eligibility, assessed risk of bias (Cochrane tool), intervention fidelity (NIHBCC checklist), and coded randomised controlled trials (RCTs) for BCTs (V1 taxonomy). BCT effectiveness ratios were calculated and RCT risk of bias and intervention fidelity were summarised narratively.

Data sources

A highly sensitive search strategy was conducted on Medline, Embase, PsycINFO, CENTRAL, CINAHL and PEDro and grey literature databases from inception to January 2^nd, 2018. Reference lists of included RCTs and relevant articles were reviewed, and a citation search was conducted using Web of Science.

Eligibility criteria for selecting studies

RCTs that evaluated the effectiveness of a physiotherapy intervention that incorporated ≥1 BCT that promoted home or community-based PA adherence in patients with lower limb osteoarthritis.

Results

Twenty-four RCTs (n = 2366 participants) of variable risk of bias (RoB) (5 low; 7 moderate; 12 high) and poor intervention reporting from 10 countries were included. Heterogeneity of intervention BCTs and PA adherence outcome measures precluded meta-analysis. Thirty-one distinct BCTs were identified in 31 interventions across RCTs. In general, BCTs demonstrated higher effectiveness ratios for short-term and long-term PA adherence compared with medium-term outcomes. The BCTs ‘behavioural contract’, ‘non-specific reward’, ‘patient-led goal setting’ (behaviour), ‘self-monitoring of behaviour’, and ‘social support (unspecified) demonstrated the highest effectiveness ratios across time points to promote PA adherence.

Conclusions

BCTs demonstrate higher short and long-term than medium-term effectiveness ratios. Further research involving low RoB RCTs incorporating transparently reported interventions with pre-specified BCTs aimed at optimising lower limb OA patient PA adherence is required.

Photobiomodulation via a cluster device associated with a physical exercise program in the level of pain and muscle strength in middle-aged and older women with knee osteoarthritis: a randomized placebo-controlled trial

Osteoarthritis (OA) is a chronic joint disease that leads to pain and functional incapacity. The aim of the study is to investigate the effects of the incorporation of photobiomodulation (PBM) (via cluster) into a physical exercise program on the level of pain, lower limb muscle strength, and physical capacity, in patients with knee OA. Sixty-two female volunteers with a diagnosis of knee OA were distributed in 4 groups: exercise associated with placebo PBM group, exercise associated with active PBM group, active PBM group, and placebo PBM group. Sixteen sessions of lower limb strength exercises and PBM via cluster (808 nm, 100 mW, 7 points each side, 56 J total) were performed. The level of pain, physical capacity, and lower limb muscle strength were evaluated with the use of the numeric pain rating scale (NPRS), 6-min walking test (6-MWT) and timed up and go (TUG), and maximal voluntary isometric torque (MVIT) before and after the interventions. Both groups presented a significant decrease in the level of pain when compared with the placebo-treated women. Furthermore, the 6-MWT showed that the trained groups (with or without PBM) demonstrated higher values in the distance walked comparing pre and post-treatment values. The same behavior was found for the MVIT load before and after intervention. TUG was higher for all the treated with exercise groups comparing the pre and post-treatment values. Physical exercise and PBM showed analgesic effects. However, PBM did not have any extra effect along with the effects of exercise in improving the distance walked, the TUG, and the muscle strength.Trial registration: RBR-7t6nzr.

Supervised Physical Activity and Improved Functional Capacity among Adults Living with HIV: A Systematic Review

Physical activity (PA) combats the effects of multimorbidity and antiretroviral therapy in people living with HIV (PLWH), but PLWH often don't meet recommended PA guidelines. The purpose of our review was to investigate whether supervised PA improved functional capacity in PLWH. Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Five databases were searched for randomized controlled trials in English, with participants ages 18 years and older, and a supervised PA intervention. A database search yielded 8,267 articles, with 15 eligible for review inclusion. We found a low risk of bias within and across studies. Combined aerobic/progressive resistance training (PRT) improved strength, cardiovascular, and flexibility outcomes; aerobic interventions alone showed no significant improvements; PRT improved strength outcomes; yoga or yoga/meditation showed no outcome differences; and t'ai chi showed cardiovascular and flexibility improvements. We found that supervised PA increased functional capacity in PLWH and that self-report was not a reliable assessment.

A randomized, double-blind, placebo-controlled Phase III trial of duloxetine in Japanese patients with knee pain due to osteoarthritis

Purpose

To examine the efficacy and safety of duloxetine in Japanese patients with knee pain due to osteoarthritis.

Patients and methods

Patients were randomized to receive duloxetine 60 mg/day or placebo for 14 weeks in a double-blind manner (ClinicalTrials.gov Identifier: NCT02248480). The primary efficacy endpoint was mean change in Brief Pain Inventory pain severity (BPI-Severity) average pain. Secondary endpoints included improvement in other BPI-Severity scales, Patient Global Impression of Improvement, Clinical Global Impressions of Severity, health-related quality of life (HRQoL) scales, range of motion of the knee joint, safety and tolerability, and structural changes on X-ray images.

Results

Of the 354 randomized patients, 161 in the duloxetine group and 162 in the placebo group completed the study. BPI-Severity average pain improved significantly with duloxetine vs. placebo (−2.57 vs. −1.80; adjusted mean difference: −0.77; 95% CI: −1.11 to −0.43; P<0.0001). Secondary efficacy endpoints and most HRQoL scales showed greater improvements in the duloxetine group than the placebo group. Adverse events observed in ≥5% of patients that were more frequent in the duloxetine than placebo group were somnolence, constipation, dry mouth, nausea, malaise, and decreased appetite. There were no marked changes in range of motion of the knee joint (efficacy), X-ray images, or Kellgren–Lawrence grade (safety) in either group.

Conclusion

Duloxetine reduced pain and improved function in patients with knee osteoarthritis, without causing X-ray abnormalities or altered knee joint mobility. Reduced pain was associated with improved HRQoL. Adverse events were consistent with duloxetine’s known safety profile.

Efficacy of a biomechanically-based yoga exercise program in knee osteoarthritis: A randomized controlled trial

OBJECTIVE

Certain exercises could overload the osteoarthritic knee. We developed an exercise program from yoga postures with a minimal knee adduction moment for knee osteoarthritis. The purpose was to compare the effectiveness of this biomechanically-based yoga exercise (YE), with traditional exercise (TE), and a no-exercise attention-equivalent control (NE) for improving pain, self-reported physical function and mobility performance in women with knee osteoarthritis.

DESIGN

Single-blind, three-arm randomized controlled trial.

SETTING

Community in Southwestern Ontario, Canada.

PARTICIPANTS

A convenience sample of 31 women with symptomatic knee osteoarthritis was recruited through rheumatology, orthopaedic and physiotherapy clinics, newspapers and word-of-mouth.

INTERVENTIONS

Participants were stratified by disease severity and randomly allocated to one of three 12-week, supervised interventions. YE included biomechanically-based yoga exercises; TE included traditional leg strengthening on machines; and NE included meditation with no exercise. Participants were asked to attend three 1-hour group classes/sessions each week.

MEASUREMENTS

Primary outcomes were pain, self-reported physical function and mobility performance. Secondary outcomes were knee strength, depression, and health-related quality of life. All were assessed by a blinded assessor at baseline and immediately following the intervention.

RESULTS

The YE group demonstrated greater improvements in KOOS pain (mean difference of 22.9 [95% CI, 6.9 to 38.8; p = 0.003]), intermittent pain (mean difference of -19.6 [95% CI, -34.8 to -4.4; p = 0.009]) and self-reported physical function (mean difference of 17.2 [95% CI, 5.2 to 29.2; p = 0.003]) compared to NE. Improvements in these outcomes were similar between YE and TE. However, TE demonstrated a greater improvement in knee flexor strength compared to YE (mean difference of 0.1 [95% CI, 0.1 to 0.2]. Improvements from baseline to follow-up were present in quality of life score for YE and knee flexor strength for TE, while both also demonstrated improvements in mobility. No improvement in any outcome was present in NE.

CONCLUSIONS

The biomechanically-based yoga exercise program produced clinically meaningful improvements in pain, self-reported physical function and mobility in women with clinical knee OA compared to no exercise. While not statistically significant, improvements in these outcomes were larger than those elicited from the traditional exercise-based program. Though this may suggest that the yoga program may be more efficacious for knee OA, future research studying a larger sample is required.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT02370667).

Osteoarthritis year in review 2017: rehabilitation and outcomes

OBJECTIVE

The purpose of this systematic review was to describe studies examining rehabilitation for people with osteoarthritis (OA) and to summarize findings from selected key systematic reviews (SRs) and randomized controlled trials (RCTs).

DESIGN

A systematic search was performed using Pubmed, Embase and Cochrane databases from April 1^st 2016 to May 15^th 2017 using the terms 'osteoarthritis', 'randomized controlled trial', and 'systematic review'. Inclusion criteria were: clinically or radiologically diagnosed patients with OA, rehabilitation treatment, RCT or SRs. A selection of the included studies is discussed based on study quality and perceived importance to the field; including those that are innovative, inform the direction of the field or generate controversy. Methodological quality of the included studies was assessed using the PEDro-scale for RCTs and the Amstar guideline for SRs.

RESULTS

From 1211 articles, 80 articles met the eligibility criteria including 21 SRs and 61 RCTs. The median of the methodological quality of the SRs and RCTs was 7 (2-9) and 6 (3-10), respectively. The studies were grouped into several themes, covering the most important rehabilitation fields.

CONCLUSIONS

Striking is the small number of studies investigating another joint (18%) than the knee (82%). Exercise is the most common treatment evaluated and should be accompanied with education to effectuate a behavioural change in physical activity of people with OA. No new insights in the field of braces (or orthoses) and in the field of acupuncture were found.

Evidence-Based Cutoff Threshold Values from Receiver Operating Characteristic Curve Analysis for Knee Osteoarthritis in the 50-Year-Old Korean Population: Analysis of Big Data from the National Health Insurance Sharing Service

We aimed to investigate the characteristics of patients with osteoarthritis (OA), using the data of all Koreans registered in the National Health Insurance Sharing Service Database (NHISS DB), and to provide ideal alternative cutoff thresholds for alleviating OA symptoms. Patients with OA (codes M17 and M17.1–M17.9 in the Korean Standard Classification of Disease and Causes of Death) were analyzed using SAS software. Optimal cutoff thresholds were determined using receiver operating characteristic curve analysis. The 50-year age group was the most OA pathogenic group (among 40~70 years, n = 2088). All exercise types affected the change of body mass index (p < 0.05) and the sex difference in blood pressure (BP) (p < 0.01). All types of exercise positively affected the loss of waist circumference and the balance test (standing time on one leg in seconds) (p < 0.01). The cutoff threshold for the time in seconds from standing up from a chair to walking 3 m and returning to the same chair was 8.25 (80% sensitivity and 100% specificity). By using the exercise modalities, categorized multiple variables, and the cutoff threshold, an optimal alternative exercise program can be designed for alleviating OA symptoms in the 50-year age group.