1
|
Ni X, Hu L, Zhang X, Wang Z, Yan C, Peyrodie L, Lin M, Wu X, Wang H, Hu S. Physical therapy options for knee osteoarthritis: A review. Medicine (Baltimore) 2024; 103:e38415. [PMID: 39058811 PMCID: PMC11272378 DOI: 10.1097/md.0000000000038415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 05/09/2024] [Indexed: 07/28/2024] Open
Abstract
In recent years, osteoarthritis of the knee, a common degenerative joint disease, often occurs in the elderly population. This disease has a significant impact on the quality of life of patients. For treating knee osteoarthritis, physical therapy is highly regarded as a very effective treatment method. This article delves deeply into commonly used physical therapy methods and analyzes their therapeutic effects, cost-effectiveness, and applicability, aiming to find treatments with broader applicability and better cost-effectiveness. The goal is to help a large number of patients effectively alleviate the discomfort caused by knee osteoarthritis, enhance the clinical therapeutic effects, and introduce home treatment methods to reduce financial burdens. The article also compares various physical therapy methods and finds that moxibustion and electrotherapy are more suitable for home use. Other treatment methods provide a reliable scientific basis for patient treatment.
Collapse
Affiliation(s)
- Xinxin Ni
- Huzhou University, Huzhou, Zhejiang, China
| | - Lianxin Hu
- Huzhou University, Huzhou, Zhejiang, China
| | - Xun Zhang
- Huzhou University, Huzhou, Zhejiang, China
- Institut Supérieur d’Électronique de Paris, Paris, France
| | | | - Cong Yan
- Beijing University of Chinese Medicine, Beijing, China
| | - Laurent Peyrodie
- ICL, Junia, Université Catholique de Lille, LITL, F-59000 Lille, France
| | | | - Xinyue Wu
- Beijing University of Chinese Medicine, Beijing, China
| | | | - Shijia Hu
- Huzhou University, Huzhou, Zhejiang, China
| |
Collapse
|
2
|
Luo Y, Rahmati M, Kazemi A, Liu W, Lee SW, Gyasi RM, López Sánchez GF, Koyanagi A, Smith L, Yon DK. Effects of therapeutic ultrasound in patients with knee osteoarthritis: A systematic review and meta-analysis. Heliyon 2024; 10:e30874. [PMID: 38803857 PMCID: PMC11128881 DOI: 10.1016/j.heliyon.2024.e30874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/02/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024] Open
Abstract
Background Therapeutic ultrasound (US) is a treatment for knee osteoarthritis (KOA), but its efficacy and safety are unclear. The objective of this study is to quantify the effect of US on pain relief and function recovery in KOA, and to analyze the US treatment duration and parameters on treatment outcome. Methods We searched PubMed, MEDLINE, EMBASE, Google Scholar, Cochrane databases and ClinicalTrials.gov databases up to April 7, 2023. RCTs that compared the efficacy of therapeutic US with the control in KOA were included in the study, and the methodological quality of the trials was assessed using the Cochrane Risk of Bias tool. Results Twenty-one RCTs (1315 patients) were included. US had a positive effect on visual analog scale (VAS) (SMD = -0.64, 95 % CI [-0.88, -0.40], I2 = 71 %) and Western Ontario and McMaster Universities (WOMAC) total scale (SMD = -0.45, 95 % CI [-0.69, -0.20]; I2 = 67 %). Pulsed US with an intensity ≤2.5 W/cm2 reduced visual analog scale (VAS), and differed in sessions (24 sessions (SMD = -0.80, 95 % CI [-1.07, -0.53], I2 = 0 %) vs 10 sessions (SMD = -0.71, 95 % CI [-1.09, -0.33], I2 = 68 %)). For pulsed US, a duration of treatment of 4-8 weeks (SMD = -0.69, 95 % CI [-1.13, -0.25], I2 = 73 %) appeared to be superior to ≤4 weeks (SMD = -0.77, 95 % CI [-1.04, -0.49], I2 = 0 %) for reducing visual analog scale (VAS). No US treatment-related adverse events were reported. Conclusion Therapeutic US may be a safe and effective treatment for patients with KOA. The mode, intensity, frequency, and duration of US may affect the effectiveness of pain relief. Pulsed US with an intensity ≤2.5 W/cm2, 24 sessions, and a treatment duration of ≤4 weeks appears to have better pain relief.
Collapse
Affiliation(s)
- Yan Luo
- Clinical Medicine Eight-Year Program, Xiangya Hospital, Central South University, Changsha, China
| | - Masoud Rahmati
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Abdolreza Kazemi
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Wenbing Liu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, WenZhou Medical University, Wenzhou, 325027, China
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University College of Medicine, Suwon, Republic of Korea
| | - Razak M. Gyasi
- African Population and Health Research Center, Nairobi, Kenya
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia
| | - Guillermo F. López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830, Barcelona, Spain
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Oliveira S, Andrade R, Valente C, Espregueira-Mendes J, Silva F, Hinckel BB, Carvalho Ó, Leal A. Mechanical-based therapies may reduce pain and disability in some patients with knee osteoarthritis: A systematic review with meta-analysis. Knee 2022; 37:28-46. [PMID: 35660536 DOI: 10.1016/j.knee.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/09/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Mechanical-based therapies are not yet recommended to manage osteoarthritis (OA). This systematic review and meta-analysis aim to assess the effects of passive mechanical-based therapies (isolated or combined with other therapies) on patients with knee OA compared to placebo, other isolated or combined interventions. METHODS Pubmed, Cochrane, Web of Science and EMBASE were searched up to December 2020. We included randomized and non-randomized trials using therapeutic ultrasound, phonophoresis, extracorporeal shockwave therapy (ESWT) and vibration (single or combined with other therapies) compared to placebo, and/or other physical therapies groups. Biochemical, patient-reported, physical and imaging outcome measures were retrieved. We judged risk of bias using the RoB2 tool for randomized studies, the ROBINS-I tool for non-randomized studies, and the GRADE to interpret certainty of results. RESULTS We included 77 clinical studies. Ultrasound and ESWT statistically improved pain and disability comparing to placebo (combined or not with other therapies), and when added to other therapies versus other therapies alone. Ultrasound was statistically inferior to phonophoresis (combined or not with other therapies) in reducing pain and disability for specific therapeutic gels and/or combined therapies. Vibration plus exercise statistically improved pain relief and function versus exercise alone. All meta-analyses showed very-low certainty of evidence, with 15 of 42 (38%) pooled comparisons being statistically significant (weak to large effect). CONCLUSIONS Despite the inconsistent evidence with very-low certainty, the potential benefits of passive mechanical-based therapies should not be disregard and cautiously recommended that clinicians might use them in some patients with knee OA.
Collapse
Affiliation(s)
- Sofia Oliveira
- Center for MicroElectroMechanical Systems (CMEMS‑UMINHO), University of Minho, Azurém Campus, 4800‑058 Guimarães, Portugal; LABBELS - Associate Laboratory, Braga, Guimarães, Portugal.
| | - Renato Andrade
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports, University of Porto, Porto, Portugal.
| | - Cristina Valente
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal.
| | - João Espregueira-Mendes
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; 3B's Research Group‑Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805‑017 Guimarães, Portugal; School of Medicine, University of Minho, Braga, Portugal.
| | - Filipe Silva
- Center for MicroElectroMechanical Systems (CMEMS‑UMINHO), University of Minho, Azurém Campus, 4800‑058 Guimarães, Portugal; LABBELS - Associate Laboratory, Braga, Guimarães, Portugal.
| | - Betina B Hinckel
- Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, MI, USA.
| | - Óscar Carvalho
- Center for MicroElectroMechanical Systems (CMEMS‑UMINHO), University of Minho, Azurém Campus, 4800‑058 Guimarães, Portugal; LABBELS - Associate Laboratory, Braga, Guimarães, Portugal.
| | - Ana Leal
- Center for MicroElectroMechanical Systems (CMEMS‑UMINHO), University of Minho, Azurém Campus, 4800‑058 Guimarães, Portugal; LABBELS - Associate Laboratory, Braga, Guimarães, Portugal; Dom Henrique Research Centre, Porto, Portugal.
| |
Collapse
|
5
|
It Hurts to Move! Intervention Effects and Assessment Methods for Movement-Evoked Pain in Patients With Musculoskeletal Pain: A Systematic Review with Meta-analysis. J Orthop Sports Phys Ther 2022; 52:345-374. [PMID: 35128943 DOI: 10.2519/jospt.2022.10527] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To estimate the effects of musculoskeletal rehabilitation interventions on movementevoked pain and to explore the assessment methods/protocols used to evaluate movement-evoked pain in adults with musculoskeletal pain. DESIGN Systematic review with meta-analysis. LITERATURE SEARCH Three electronic databases (PubMed, Web of Science, and Scopus) were searched. STUDY SELECTION CRITERIA Randomized controlled trials investigating musculoskeletal rehabilitation interventions for movement-evoked pain in adults with musculoskeletal pain were included. DATA SYNTHESIS Meta-analysis was conducted for outcomes with homogeneous data from at least 2 trials. The mean change in movementevoked pain was the primary outcome measure. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. RESULTS Thirty-eight trials were included, and 60 different interventions were assessed. There was moderate-certainty evidence of a beneficial effect of exercise therapy compared to no treatment (standardized mean difference [SMD], -0.65; 95% confidence interval [CI]: -0.83, -0.47; P<.001) on movement-evoked pain in adults with musculoskeletal pain. There was low-certainty evidence of a beneficial effect of transcutaneous electrical nerve stimulation compared to no treatment (SMD, -0.46; 95% CI: -0.71, -0.21; P = .0004). There was no benefit of transcutaneous electrical nerve stimulation when compared to sham transcutaneous electrical nerve stimulation (SMD, -0.28; 95% CI: -0.60, 0.05; P = .09; moderate-certainty evidence). CONCLUSION There was moderate-certainty evidence that exercise therapy is effective for reducing movement-evoked pain in patients with musculoskeletal pain compared to no treatment. Consider exercise therapy as the first-choice treatment for movement-evoked pain in clinical practice. J Orthop Sports Phys Ther 2022;52(6):345-374. Epub: 05 Feb 2022. doi:10.2519/jospt.2022.10527.
Collapse
|
6
|
Wang CP, Lee WC, Hsieh RL. Effects of Repeated Co-Injections of Corticosteroids and Hyaluronic Acid on Knee Osteoarthritis: A Prospective, Double-Blind Randomized Controlled Trial. Am J Med 2022; 135:641-649. [PMID: 34958762 DOI: 10.1016/j.amjmed.2021.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/05/2021] [Accepted: 11/13/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND We compared the effects of repeated co-injections of corticosteroids plus hyaluronic acid (HA) with the effects of HA injections alone in patients with knee osteoarthritis. METHODS A double-blind randomized controlled trial was conducted between October 2016 and July 2017 at a medical center. Patients (n = 57) who fulfilled the clinical and radiographic criteria for knee osteoarthritis established by the American College of Rheumatology with a Kellgren-Lawrence score of 2 or 3 were included. They were assigned to either the HA group (n = 29) or corticosteroids plus HA group (n = 28), and injections were administered under ultrasound guidance once a week for 3 consecutive weeks. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were the primary outcomes. Physical functional performance (10-m fast walking and chair-rising time) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were secondary outcomes. The assessment was performed prior to injections, 1 week, and 1, 3, and 6 months after injections. Data were analyzed through repeated-measures analysis of covariance. RESULTS Both groups experienced decreased pain and improved physical function and physical functional performance over time. We found significant group × time interaction effects favoring the corticosteroids plus HA group in WOMAC-pain (P = .005) and physical function (P = .005), chair-rising time (P = .032), and KOOS-pain (P = .001). CONCLUSIONS Repeated co-injections of corticosteroids plus HA more effectively decreased pain and improved physical function and physical functional performance than injections of HA alone from 1 week through 6 months posttreatment.
Collapse
Affiliation(s)
- Chun-Ping Wang
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Wen-Chung Lee
- College of Public Health, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Ru-Lan Hsieh
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
7
|
Silișteanu AE, Szakács J. Study on the effects of the use of therapeutic ultrasound in the treatment of osteoarticular diseases. BALNEO AND PRM RESEARCH JOURNAL 2022. [DOI: 10.12680/balneo.2022.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. The use of therapeutic ultrasounds is a method that proved its efficiency in articu-lar and periarticular pathology, in the subacute and chronic stages. The biological effects of the ultrasound use are determined by their interaction with the cellular structures whereas the re-sults depend on the used parameters. The purpose of the survey is to evaluate / identify the ef-fects of using ultrasounds in the treatment of musculoskeletal conditions (lumbar discopathy), knee osteoarthritis). Material and method. The survey was conducted on an outpatient basis in a period of 7 months and it is of the longitudinal type. It included 151 patients diagnosed with low back pain and knee osteoarthritis. The evaluated parameters were: pain, functional skills, articu-lar rigidity and the quality of life. Results. The effects of the use of ultrasounds is found in the decrease of pain, the stiffness of the joints and the contracture of the muscles, as shown by the re-sults of several surveys. Our survey proves that the use of ultrasounds decreases pain and in-creases the functional skills, it influences the physical function more obviously in patients with knee osteoarthritis, which is an aspect found in others surveys. Discussion. The use of a complex ultrasound treatment (in the pulsed way to avoid thermal effects) and kinesiotherapy enabled in our research the decrease of the pain and of the rigidity in the joints, the increase of the function-al skills and the quality of life, whereas these obtained results are in accordance with those of others surveys. Conclusions. The use of the therapeutic ultrasounds can have the following ef-fects: the decrease of the pain and of the joint rigidity, the improvement of the physical capacity for daily activities and the improvement of the quality of life. The use of low intensity ultra-sounds can determine biological effects with actions for a short period or for an average one.
Keywords: therapeutic ultrasound, treatment, osteoarticular diseases, quality of life
Collapse
Affiliation(s)
- Andrei-Emanuel Silișteanu
- 1 Master- Health Management- Lucian Blaga University, Faculty of Medicine, Sibiu 2 Faculty of Political, Administrative and Communication Sciences of Cluj-Napoca, Romania
| | - Juliánna Szakács
- 3 George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Faculty of Medicine, Department of Biophysics
| |
Collapse
|
8
|
Dantas LO, Osani MC, Bannuru RR. Therapeutic ultrasound for knee osteoarthritis: A systematic review and meta-analysis with grade quality assessment. Braz J Phys Ther 2021; 25:688-697. [PMID: 34535411 PMCID: PMC8721076 DOI: 10.1016/j.bjpt.2021.07.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/01/2021] [Accepted: 07/30/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Therapeutic ultrasound (US) is a widely used intervention in physical therapy to manage pain and to aid in the healing of soft tissue. OBJECTIVE This systematic review aimed to determine the effects of therapeutic US on knee osteoarthritis (KOA) symptoms. METHODS PubMed, MEDLINE, EMBASE, Google Scholar, and the Cochrane databases were searched from inception to April 2019. Randomized controlled trials (RCTs) involving adults with symptomatic KOA that compared therapeutic US with a sham or other control were included. The methodological quality of the trials was assessed at the study level using the Cochrane Risk of Bias tool. The quality of evidence at the outcome level- and overall- was assessed using GRADE methodology. Meta-analyses were conducted using random effects models, and heterogeneity was assessed using the I2 statistic. RESULTS Four studies (N = 234 participants) were eligible for inclusion in our primary analyses assessing therapeutic US versus sham. The methodological quality of the included RCTs ranged from moderate to very low. Treatment with therapeutic US resulted in small, statistically significant benefits for pain (approximate 9.6% improvement on a 0-100 visual analog scale [95% confidence interval: 2, 17.4%]) and self-reported measures of function (approximate 12.8% improvement on a 0-100 visual analog scale [0.4, 25.2%]). The overall quality of the evidence was very low. No adverse events were reported in any of the included studies. CONCLUSIONS The use of therapeutic US may provide additional benefits to physical therapy regimens in terms of symptom relief in individuals with KOA. However, it is not possible to make any meaningful recommendations for clinical practice due to the small number of applicable RCTs and the low methodological quality of the RCTs deemed eligible for this study.
Collapse
Affiliation(s)
- Lucas Ogura Dantas
- Division of Rheumatology, Tufts Medical Center, Boston, MA, USA; Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Mikala C Osani
- Center for Treatment Comparison and Integrative Analysis, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - Raveendhara R Bannuru
- Center for Treatment Comparison and Integrative Analysis, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA; Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA.
| |
Collapse
|
9
|
Investigation of the effects of therapeutic ultrasound or photobiomodulation and the role of spinal glial cells in osteoarthritis-induced nociception in mice. Lasers Med Sci 2021; 37:1687-1698. [PMID: 34542770 DOI: 10.1007/s10103-021-03418-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/13/2021] [Indexed: 01/04/2023]
Abstract
Pain is the most common symptom of osteoarthritis, and spinal glia is known to contribute to this symptom. Therapeutic ultrasound and laser therapy have been used to effectively treat osteoarthritis, with few adverse effects. Thus, this study aimed to investigate the effects of ultrasound and photobiomodulation on the symptoms and evaluate the participation of spinal glia in osteoarthritis-induced nociception in mice. Male Swiss mice were subjected to osteoarthritis induction with a 0.1-mg intra-articular injection of monosodium iodoacetate. Additionally, the mice received chronic ultrasound or photobiomodulation treatment for 21 days or a single treatment at day 14. Nociception was evaluated using von Frey filaments, and osteoarthritis symptoms were assessed by analysis of gait, joint temperature, and knee joint diameter. The role of spinal microglia and astrocytes on nociception was evaluated via an intrathecal injection of minocycline or fluorocitrate, and the spinal release of IL-1β and TNF-α was assessed by ELISA after chronic treatment with ultrasound or photobiomodulation. Our data showed that both single and chronic treatment with ultrasound or photobiomodulation attenuated the osteoarthritis-induced nociception. No differences in gait, knee joint temperature, or knee joint diameter were found. The intrathecal injection of minocycline and fluorocitrate decreased the osteoarthritis-induced nociception. There was an increase in the spinal levels of TNF-α, which was reverted by chronic ultrasound and laser treatments. These results suggest that osteoarthritis induces nociception and glial activation via spinal release of TNF-α and that the chronic treatment with ultrasound or photobiomodulation decreased nociception and TNF-α release.
Collapse
|
10
|
Aiyer R, Noori SA, Chang KV, Jung B, Rasheed A, Bansal N, Ottestad E, Gulati A. Therapeutic Ultrasound for Chronic Pain Management in Joints: A Systematic Review. PAIN MEDICINE 2021; 21:1437-1448. [PMID: 31095336 DOI: 10.1093/pm/pnz102] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Treatments for joint pain and dysfunction focus on restoration of joint motion, improvement in pain and a return to the previous level of the patient's daily activity. Therapeutic ultrasound is a noninvasive modality widely utilized in the management of musculoskeletal disorders. The objective of this systematic review was to evaluate the effectiveness of therapeutic ultrasound in the management of patients with knee, shoulder and hip pain. METHODS Using PRISMA guidelines, a search of the PubMed, CENTRAL (The Cochrane Library), Web of Science and Scopus databases was performed to retrieve randomized controlled trials (RCTs) that evaluated therapeutic ultrasound (continuous and pulsed) in patients with chronic knee, shoulder and hip pain. RESULTS The search strategy identified 8 trials for knee, 7 trials for shoulder and 0 trials for hip that met the criteria for inclusion. All 8 trials showed improvement in knee pain, and of these studies 3 showed statistical significance improvement for therapeutic ultrasound versus the comparator. For shoulder pain, all 7 trials showed reduction in pain, but should be noted that 4 of studies demonstrated that therapeutic ultrasound is inferior to the comparator modality. CONCLUSION Therapeutic ultrasound is frequently used in the treatment of knee, shoulder and hip pain and is often combined with other physiotherapeutic modalities. The literature on knee arthritis is most robust, with some evidence supporting therapeutic ultrasound, though the delivery method of ultrasound (pulsed vs continuous) is controversial. As a monotherapy, ultrasound treatment may not have a significant impact on functional improvement but can be a reasonable adjunct to consider with other common modalities. In all three pain syndromes, especially for hip pain, further trials are needed to define the true effect of low-intensity ultrasound therapy knee, shoulder and hip pain. No conclusive recommendations may be made for optimal settings or session duration.
Collapse
Affiliation(s)
- Rohit Aiyer
- Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Selaiman A Noori
- Department of Pain Management, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei City, Taiwan
| | - Boyoun Jung
- Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Abdullah Rasheed
- Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Nitin Bansal
- Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Einar Ottestad
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Amitabh Gulati
- Department of Anesthesia and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
11
|
Hawez SW, Hajee SI. Comparing the Effects of Ultrasound and Microwave Physiotherapy Treatments on Knee Osteoarthritis by Measuring Osteocalcin Level and Erythrocyte Sedimentation Rate in Blood. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2020. [DOI: 10.29333/ejgm/7810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
12
|
Alfredo PP, Junior WS, Casarotto RA. Efficacy of continuous and pulsed therapeutic ultrasound combined with exercises for knee osteoarthritis: a randomized controlled trial. Clin Rehabil 2020; 34:480-490. [PMID: 32063035 DOI: 10.1177/0269215520903786] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To compare the effects of continuous and pulsed therapeutic ultrasound combined with strengthening exercises. DESIGN This is a double-blind randomized controlled trial. SETTING Pontifical Catholic University. SUBJECTS One hundred participants with Grade 2-4 knee osteoarthritis and both genders were involved. INTERVENTION Participants were randomized into five groups: Group I (n = 20; in the first month, continuous ultrasound was applied), Group II (n = 20; in the first month, pulsed ultrasound was applied), Group III (n = 20; in the first and second months, continuous ultrasound was applied), Group IV (n = 20; in the first and second months, pulsed ultrasound was applied) and Group V (n = 20; patients received only exercise sessions for eight weeks). All patients in the groups that received ultrasound application performed exercises in the second month of treatment. The sessions occurred three times a week. MAIN MEASURES Pain was assessed using the visual analogical scale, functionality was assessed using the Lequesne questionnaire, range of motion was assessed using a universal goniometer, muscular strength was assessed using a dynamometer, mobility was assessed using the Timed Up and Go test and 8-meter walk test and the activity level was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. RESULTS Statistically significant differences (P < 0.05) were presented by Group III in the variables pain during activities of daily living (ADLs) 5.89 (2.18), mobility assessed by 8-meter test 2.68 (2.56), in pain 10.65 (4.40), function 25.50 (10.87) and total 38.65 (15.29) of WOMAC and functionality 9.10 (5.15). CONCLUSION Prolonged applications of continuous ultrasound combined with exercises are effective in providing pain, mobility, functionality and activity in subjects with knee osteoarthritis.
Collapse
Affiliation(s)
- Patrícia Pereira Alfredo
- Department of Speech Therapy, Physical Therapy and Occupational Therapy, School of Medicine, São Paulo University, São Paulo, Brazil
| | | | - Raquel Aparecida Casarotto
- Department of Speech Therapy, Physical Therapy and Occupational Therapy, School of Medicine, São Paulo University, São Paulo, Brazil
| |
Collapse
|
13
|
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
| |
Collapse
|
14
|
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: 37] [Impact Index Per Article: 7.4] [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.
Collapse
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
| |
Collapse
|
15
|
Sangtong K, Chupinijrobkob C, Putthakumnerd W, Kuptniratsaikul V. Does adding transcutaneous electrical nerve stimulation to therapeutic ultrasound affect pain or function in people with osteoarthritis of the knee? A randomized controlled trial. Clin Rehabil 2019; 33:1197-1205. [DOI: 10.1177/0269215519838017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kwanchanog Sangtong
- Department of Rehabilitation Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chonlada Chupinijrobkob
- Division of Physical Therapy, Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wantana Putthakumnerd
- Department of Surgical Nursing, Faculty of Nursing, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vilai Kuptniratsaikul
- Department of Rehabilitation Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
16
|
Özgönenel L, Okur SÇ, Dogan YP, Çaglar NS. Effectiveness of Therapeutic Ultrasound on Clinical Parameters and Ultrasonographic Cartilage Thickness in Knee Osteoarthritis: A Double-Blind Trial. J Med Ultrasound 2019; 26:194-199. [PMID: 30662150 PMCID: PMC6314098 DOI: 10.4103/jmu.jmu_21_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/12/2018] [Indexed: 11/29/2022] Open
Abstract
Objective: A double-blind placebo-controlled randomized study was conducted to assess the effectiveness of therapeutic ultrasound (US) in knee OA. Patients and Methods: Thirty-three patients (mean age 54.7 ± 14.7) were randomized to receive either continuous US (n = 15) or sham US (n = 18) as a placebo. Continuous ultrasonic waves with 1 MHZ frequency and 1 watt/cm2 power were applied for 5 min for 10 sessions. The primary outcome was pain on movement assessed by visual analog scale (VAS). The secondary outcomes were WOMAC scores and measurements of distal femoral cartilage thickness by imaging US. Results: Both groups showed reduced knee pain on movement following intervention. The VAS measurements improved significantly both in the treatment and the placebo group patients (P < 0.05 and P < 0.05). WOMAC scores improved statistically significant in all domains (pain, stiffness, physical function, and total score) in the treatment group (P < 0.05). All domains of WOMAC score showed statistically significant change when compared with the placebo group (P < 0.05). There was no change in the cartilage thickness measurements of medial femoral condyle, lateral femoral condyle, and intercondylar area in both groups after intervention. Conclusion: Results suggest that US is effective treatment modality in pain relief and improvement of function in patients with knee OA; however, US had no effect on cartilage repair.
Collapse
Affiliation(s)
- Levent Özgönenel
- Department of Physical Medicine and Rehabilitation, School of Medicine, Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey
| | - Sibel Çaglar Okur
- Department of Physical Medicine and Rehabilitation, Istanbul Research and Education Hospital, Istanbul, Turkey
| | - Yasemin Pekin Dogan
- Department of Physical Medicine and Rehabilitation, Istanbul Research and Education Hospital, Istanbul, Turkey
| | - Nil Sayiner Çaglar
- Department of Physical Medicine and Rehabilitation, Istanbul Research and Education Hospital, Istanbul, Turkey
| |
Collapse
|
17
|
Sullivan JK, Irrgang JJ, Losina E, Safran-Norton C, Collins J, Shrestha S, Selzer F, Bennell K, Bisson L, Chen AT, Dawson CK, Gil AB, Jones MH, Kluczynski MA, Lafferty K, Lange J, Lape EC, Leddy J, Mares AV, Spindler K, Turczyk J, Katz JN. The TeMPO trial (treatment of meniscal tears in osteoarthritis): rationale and design features for a four arm randomized controlled clinical trial. BMC Musculoskelet Disord 2018; 19:429. [PMID: 30501629 PMCID: PMC6271417 DOI: 10.1186/s12891-018-2327-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/29/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Meniscal tears often accompany knee osteoarthritis, a disabling condition affecting 14 million individuals in the United States. While several randomized controlled trials have compared physical therapy to surgery for individuals with knee pain, meniscal tear, and osteoarthritic changes (determined via radiographs or magnetic resonance imaging), no trial has evaluated the efficacy of physical therapy alone in these subjects. METHODS The Treatment of Meniscal Tear in Osteoarthritis (TeMPO) Trial is a four-arm multi-center randomized controlled clinical trial designed to establish the comparative efficacy of two in-clinic physical therapy interventions (one focused on strengthening and one containing placebo) and two protocolized home exercise programs. DISCUSSION The goal of this paper is to present the rationale behind TeMPO and describe the study design and implementation strategies, focusing on methodologic and clinical challenges. TRIAL REGISTRATION The TeMPO Trial was first registered at clinicaltrials.gov with registration No. NCT03059004 . on February 14, 2017.
Collapse
Affiliation(s)
- James K. Sullivan
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
| | - James J. Irrgang
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA USA
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
- Harvard Medical School, Boston, MA USA
- Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Clare Safran-Norton
- Department of Rehabilitation Services – Physical and Occupational Therapy, Brigham and Women’s Hospital, Boston, MA USA
| | - Jamie Collins
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
- Harvard Medical School, Boston, MA USA
| | - Swastina Shrestha
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
| | - Faith Selzer
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
- Harvard Medical School, Boston, MA USA
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, School of Health Sciences, University of Melbourne, Parkville, Australia
| | - Leslie Bisson
- UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - Angela T. Chen
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
| | - Courtney K. Dawson
- Harvard Medical School, Boston, MA USA
- Department of Orthopaedics, Brigham and Women’s Hospital, Boston, MA USA
| | - Alexandra B. Gil
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA USA
| | - Morgan H. Jones
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH USA
| | - Melissa A. Kluczynski
- UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - Kathleen Lafferty
- UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - Jeffrey Lange
- Harvard Medical School, Boston, MA USA
- Department of Orthopaedics, Brigham and Women’s Hospital, Boston, MA USA
| | - Emma C. Lape
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
| | - John Leddy
- UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - Aaron V. Mares
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Kurt Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH USA
| | - Jennifer Turczyk
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH USA
| | - Jeffrey N. Katz
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 60 Fenwood Road, BTM 5016, Boston, MA 02115 USA
- Harvard Medical School, Boston, MA USA
- Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA USA
- Departments of Epidemiology and Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA USA
| |
Collapse
|
18
|
Draper DO, Klyve D, Ortiz R, Best TM. Effect of low-intensity long-duration ultrasound on the symptomatic relief of knee osteoarthritis: a randomized, placebo-controlled double-blind study. J Orthop Surg Res 2018; 13:257. [PMID: 30326947 PMCID: PMC6192104 DOI: 10.1186/s13018-018-0965-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 10/04/2018] [Indexed: 01/18/2023] Open
Abstract
Background Wearable long-duration low-intensity ultrasound is an emerging non-invasive and non-narcotic therapy for the daily treatment of musculoskeletal pain. The aim of this randomized, double-blind, placebo-controlled study was to examine whether long-duration low-intensity ultrasound was effective in treating pain and improving function in patients with knee osteoarthritis. Methods Ninety patients with moderate to severe knee pain and radiographically confirmed knee osteoarthritis (Kellgren-Lawrence grade I/II) were randomized for treatment with active (n = 55) or placebo (n = 35) devices applied daily to the treated knee. Investigators and subjects were blinded to treatment groups. Ultrasound (3 MHz, 0.132 W/cm2, 1.3 W) was applied with a wearable device for 4 h daily for 6 weeks, delivering 18,720 J per treatment. The primary outcome was change in pain intensity (numeric rating scale) assessed prior to intervention (baseline) and after 6 weeks. Secondary outcomes of functional change were measured at baseline and after 6 weeks using the Western Ontario McMaster Osteoarthritis Questionnaire (n = 84), along with range of motion (flexion, extension) and isometric muscle strength (flexion, extension and rotation) tests on the injured knee in a small pilot subset (n = 17). Results The study had a 93% retention rate, and there were no significant differences between the groups regarding demographic variables or baseline outcome measures. Patients treated with active therapy observed a significant mean NRS pain reduction over the 6-week study of 1.96 points for active (p < 0.0001), compared with a 0.85 points reduction for placebo (p = 0.13). The functional score was also significantly improved by 505 points for the active group over the 311-point improvement for placebo group compared to baseline (p = 0.02). In the pilot subset evaluated, rotational strength increased from baseline to 6 weeks (3.2 N, p = 0.03); however, no other measures were significant. Conclusions Long-duration low-intensity ultrasound significantly reduced pain and improved joint function in patients with moderate to severe osteoarthritis knee pain. The clinical findings suggest that ultrasound may be used as a conservative non-pharmaceutical and non-invasive treatment option for patients with knee osteoarthritis. Additional research is warranted on non-weight bearing joints of the musculoskeletal system as well as extended treatment time frames and follow-up. Trial registration NCT02083861, registered 11 March 2014, https://clinicaltrials.gov/ct2/show/results/NCT02083861
Collapse
Affiliation(s)
- David O Draper
- Department of Exercise Sciences, Brigham Young University, 106 SFH, Provo, UT, USA.
| | - Dominic Klyve
- Department of Mathematics, Central Washington University, Ellensburg, USA
| | - Ralph Ortiz
- Medical Pain Consultants, Dryden, Dryden, USA
| | - Thomas M Best
- UHealth Sports Performance and Wellness Institute, University of Miami, Florida, USA
| |
Collapse
|
19
|
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
|
20
|
Rodríguez-Grande EI, Osma-Rueda JL, Serrano-Villar Y, Ramírez C. Effects of pulsed therapeutic ultrasound on the treatment of people with knee osteoarthritis. J Phys Ther Sci 2017; 29:1637-1643. [PMID: 28932004 PMCID: PMC5599837 DOI: 10.1589/jpts.29.1637] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 06/15/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim was to evaluate the effect of therapeutic ultrasound on the pain, joint mobility, muscle strength, physical function, and quality of life of people with knee OA. [Subjects and Methods] One-site, one-arm, before-after study that included people with Grade II or III tibiofemoral osteoarthritis. Ten therapeutic ultrasound sessions (duty cycle=20%, ERA=10 cm2, BNR=6:1, SATP=2.2 W/cm2, SATA=0.44 W/cm2, frequency=1 MHz, time=4 minutes) were applied. Assessments of primary outcome variables: pain intensity and function, and secondary variables: joint mobility, muscle strength and quality of life, were performed at onset and end of therapy; an additional intermediate evaluation was included for the primary variables. [Results] Means of repeated measurements of pain intensity (pain at rest, pain on palpation and pain after functional activities) and function showed significant differences. There was a significant reduction in pain intensity at the end of functional activities as well as a significant increase in function and in quadriceps muscle strength. [Conclusion] Therapeutic ultrasound applied in accordance with the parameters used, could be recommended during the treatment of individuals with knee osteoarthritis, because it significantly decreased the intensity of pain after the 5th session, and this reduction was maintained until the end of the intervention.
Collapse
Affiliation(s)
- Eliana-Isabel Rodríguez-Grande
- Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, GI Ciencias de la Rehabilitación: Bogota, Cundinamarca, Colombia
| | - Jose-Luis Osma-Rueda
- Department of Surgery and Orthopedics, School of Medicine, Universidad Industrial de Santander, Colombia
| | | | - Carolina Ramírez
- School of Physiotherapy, Universidad Industrial de Santander, Colombia
| |
Collapse
|
21
|
Ferronato L, Cunha HM, Machado PM, Souza GDSD, Limana MD, Avelar NCPD. Phisical modalities on the functional performance in knee osteoarthritis: a sytematic review. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.003.ar02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Abstract Introduction: Despite recent advances in the treatment of osteoarthritis (OA), few studies have evaluated the longitudinal effect of physical modalities in functional capacity in patients with knee OA. Thereby, since the physical components and pain can affect the functional performance of daily activities, the effect of these treatment’s form is still to be established. Objective: Evaluate the effectiveness of therapeutic ultrasound, electrical stimulation and phototherapy in the functional performance, in patients with knee osteoarthritis. Methods: Articles present in the PubMed, Lilacs, SciELO and PEDro’s databases were evaluated. The used keywords were “pulsed ultrasound therapy”, “ultrasound therapy”, “electric stimulation” and “low level laser therapy” in combination with “knee osteoarthritis”. Were included in this presented review, randomized clinical studies using ultrasound, electrical and laser stimulation in subjects with knee osteoarthritis. To evaluate the methodological quality of the selected studies, was used the PEDro’s scale. The dependent variables of the study were: pain, physical function, joint stiffness, life quality and functional performance. Results: 268 studies were found, of these, 41 studies met eligibility criteria and were classified for analysis in full. The used methodology in the studies varied widely, however, in most cases there was improvement in functional performance of individuals with knee OA, with the use of physical modalities, for the pulsed ultrasound, continuous ultrasound, electrical stimulation and laser resourses. Conclusion: The physical modalities used in the studies demonstrated improvement in functional performance of individuals with knee OA.
Collapse
|
22
|
Yeğin T, Altan L, Kasapoğlu Aksoy M. The Effect of Therapeutic Ultrasound on Pain and Physical Function in Patients with Knee Osteoarthritis. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:187-194. [PMID: 27727020 DOI: 10.1016/j.ultrasmedbio.2016.08.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 08/11/2016] [Accepted: 08/29/2016] [Indexed: 06/06/2023]
Abstract
Osteoartritis (OA) is one of the most frequent causes of pain, loss of function and disability in adults. The prevalence of OA is expected to increase substantially in the future. Knee OA is the most common subset of OA. Therapeutic ultrasound (US) is one of several physical therapy modalities suggested for the management of pain and loss of function due to OA. The purpose of our study was to investigate the efficacy of US therapy in reducing pain and functional loss and improving the quality of life in patients with knee OA in comparison to sham US therapy. The study involved 62 patients. The patients were randomly divided into two groups. The patients in group 1 (n = 30) were administered 1 W/cm2, 1 MHz continuous US, and the patients in group 2 (n = 32) were administered sham US. The US treatment was applied for 8 min to each knee, 16 min in total, 5 d a wk, for a total of 10 sessions during 2 wk. The patients were evaluated immediately after treatment and 1 mo after therapy according to the visual analog scale (VAS), night pain, range of motion, morning stiffness, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne and Short Form-36 (SF-36) scales and 6 min walking distance. Improvement in pain and joint functions was observed in both groups according to the evaluation immediately after treatment and at 1 mo after the therapy. According to the evaluation results immediately after treatment, there was significant improvement in all pain scales (VAS, WOMAC, Lequesne, SF-36), morning stiffness and 6 min walking distance in patients receiving real US treatment (p < 0.05), but only in some pain scales (VAS, WOMAC) and functions in the group receiving sham US (p < 0.05). Significantly better improvement was observed in some pain scales (SF-36), functions (WOMAC, SF-36) and 6 min walking distance in the real US group. At 1 mo after therapy, no significant difference was observed between groups except for improvement in night pain in the real US group. In conclusion, US therapy has been found to be effective in reducing pain and improving physical function in the short term, but this positive effect was not persistent in the long term. However, we believe that the results of our study may contribute to ongoing research for the treatment of patients with knee OA, and further systematic investigation on larger patient populations may delineate the role of US in knee OA treatment.
Collapse
Affiliation(s)
- Tuğba Yeğin
- Department of Physical Medicine and Rehabilitation, BursaYüksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Lale Altan
- Department of Physical Medicine and Rehabilitation, BursaYüksek Ihtisas Training and Research Hospital, Bursa, Turkey; Department of Physical Medicine and Rehabilitation, Uludağ University Medicine Faculty, Bursa, Turkey
| | - Meliha Kasapoğlu Aksoy
- Department of Physical Medicine and Rehabilitation, BursaYüksek Ihtisas Training and Research Hospital, Bursa, Turkey.
| |
Collapse
|
23
|
Best TM, Wilk KE, Moorman CT, Draper DO. Low Intensity Ultrasound for Promoting Soft Tissue Healing: A Systematic Review of the Literature and Medical Technology. ACTA ACUST UNITED AC 2016; 2. [PMID: 30198009 DOI: 10.18103/imr.v2i11.271] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Therapeutic ultrasound has been studied and used for the past seven decades to treat musculoskeletal injuries. Recently, a significant body of animal and human research has focused on the biomechanical effects of daily-applied, low intensity therapeutic ultrasound (LITUS) on soft tissue recovery. We performed a systematic review of the last two decades of LITUS literature to examine the effects on tendon, skeletal muscle, ligament, and tendon-bone junction injuries. LITUS facilitated tendon healing, with increased tensile strength and improved collagen alignment. For skeletal muscle and ligament injuries, LITUS increased cell proliferation during myoregeneration and improved tissue biomechanics (ultimate load, stiffness, energy absorption). LITUS aided tendon-bone junction healing through improved tissue function. Scientific evidence supports the use of LITUS to treat soft tissue injuries, and improve outcomes for musculoskeletal injuries and post-operative recovery. Lastly, we discuss the use of LITUS devices facilitating daily applied therapy in the home setting.
Collapse
|
24
|
Daglish J, Mama KR. Pain: Its Diagnosis and Management in the Rehabilitation of Horses. Vet Clin North Am Equine Pract 2016; 32:13-29. [PMID: 27012506 DOI: 10.1016/j.cveq.2015.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This article provides a brief overview of pain physiology and its relevance to equine patients. Objective and subjective techniques for assessing pain in the horse are described in depth. Pharmacologic and interventional pain modulation treatments are discussed with a focus on the rehabilitating horse.
Collapse
Affiliation(s)
- Jodie Daglish
- Equine Sports Medicine and Rehabilitation, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Road, Fort Collins, CO 80523, USA
| | - Khursheed R Mama
- Veterinary, Anesthesiology, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA.
| |
Collapse
|
25
|
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.
Collapse
|
26
|
Effect of Continuous-Wave Low-Intensity Ultrasound in Inflammatory Resolution of Arthritis-Associated Synovitis. Phys Ther 2016; 96:808-17. [PMID: 26586863 DOI: 10.2522/ptj.20140559] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 11/10/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Low-intensity ultrasound (LIUS) can reduce pain and improve function in arthritic joints. Neutrophils are first-line actors in host defense that recruit macrophages. Dead neutrophils are removed during resolution of inflammation. Delayed neutrophil clearance can lead to extended inflammation or even chronic autoimmune disease. Although neutrophil extracellular traps (NETs) in arthritic tissue are involved in the pathogenesis of arthritis, their functional role has not been clarified. OBJECTIVES This study aimed to investigate the effect of LIUS on synovial inflammation and its resolution via neutrophil clearance. METHODS Synovitis was induced by intra-articular injection of complete Freund's adjuvant (CFA) into the left knee joint of 58 adult male Sprague-Dawley rats. Low-intensity ultrasound (1 MHz, 200 mW/cm(2)) was applied for 10 minutes daily. Neutrophil clearance was assessed with the expression of myeloperoxidase (MPO). In addition, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining and NET formation in the synovium were observed. In neutrophil and macrophage cultures from peripheral blood, the effect of NET clearance by LIUS was investigated. RESULTS In CFA-induced synovitis, MPO-positive neutrophils peaked after 2 to 3 days, filling the inflammatory core. Monocytes and macrophages in the periphery later infiltrated the core and were reduced thereafter. Low-intensity ultrasound reduced synovial hyperplasia and induced earlier MPO clearance. Neutrophils in the core of the inflamed synovium exhibited NET formation, which LIUS increased. Low-intensity also induced NETs in peripheral polymorphonuclear cells in an intensity-dependent manner and potentiated phorbol myristate acetate (PMA)-induced NETosis. The PMA-induced NETs were cleared by macrophages; clearance was enhanced by LIUS. LIMITATIONS The effect of LIUS on CFA-induced inflammation was observed only during the acute phase. Although the effect of LIUS on NETosis in the in vitro neutrophil culture system was clear, the in vivo NETosis cannot be quantified. CONCLUSIONS Neutrophil extracellular traps act in inflammatory synovitis, and LIUS enhanced the NETs and resulted in neutrophil clearance by enhancing the phagocytosis of macrophages, which might be a factor underlying the therapeutic effect of LIUS in arthritic synovium.
Collapse
|
27
|
Sánchez AG, Andrade EL, Marsal JV, Tauste LA, Mingot CG, Monge JL, Puértolas MC, Calero NS, Argemí AS, Badia BG, Moncusí SP, Benito HG, Peñabad LN, Pujol ML, Nieves I Collado M, Ruiz LB. A study to evaluate the effect of ultrasound treatment on nodules in multiple sclerosis patients. Int J Neurosci 2016; 127:404-411. [PMID: 27144498 DOI: 10.1080/00207454.2016.1186025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Purpose/aim: Ultrasound has demonstrated anti-inflammatory and pain-relief benefits in several conditions such as cellulite or trauma events. We assessed the efficacy of ultrasound therapy on nodules associated with first-line treatments in multiple sclerosis patients. MATERIALS AND METHODS Twenty-two multiple sclerosis patients were enrolled during 2013 and randomized to two groups: in the control group patients were treated only with a conventional gel prescribed for cellulite and nodules, while in the experimental group the gel was combined with ultrasound therapy. Patients were treated during 10 weeks and followed up for 10 additional weeks. Three nodules were assessed for each patient, measuring size, pain and redness at 0, 10 and 20 weeks. RESULTS We found a significant decrease in both groups in size, pain and redness across the three visits (p < 0.0001 for size, p = 0.01 and p < 0.0001 for pain, and p = 0.0002 and p < 0.0001 for redness, respectively for the difference at visit 2 and 3 with respect to visit 1). More interestingly, we observed a greater reduction in pain and redness in the ultrasound-treated group, but the difference was only statistically significant at 10 weeks (p = 0.01 for both pain and redness). On the third visit, no differences between control and experimental groups were detected, both achieving the same levels in measured variables. CONCLUSIONS Both treatments are useful to improve skin reaction after first-line treatments, but ultrasound in combination with gel achieves a faster reduction in pain and redness, suggesting that ultrasound treatment might be a good analgesic for nodule management in multiple sclerosis patients.
Collapse
Affiliation(s)
- Anna Gil Sánchez
- a a Neurology Department-Multiple Sclerosis Unit, Hospital Universitario Arnau de Vilanova and Institut de Recerca Biomèdica Lleida , Lleida , Spain
| | - Eugenia Lacasa Andrade
- b b Multiple Sclerosis Unit, Hospital de Día Miquel Martí i Pol, Fundación Esclerosis Múltiple (FEM) , Lleida , Spain
| | - Joan Valls Marsal
- c c Biostatistics Unit, Institut de Recerca Biomèdica Lleida , Lleida , Spain
| | - Lourdes Assens Tauste
- b b Multiple Sclerosis Unit, Hospital de Día Miquel Martí i Pol, Fundación Esclerosis Múltiple (FEM) , Lleida , Spain
| | - Cristina González Mingot
- a a Neurology Department-Multiple Sclerosis Unit, Hospital Universitario Arnau de Vilanova and Institut de Recerca Biomèdica Lleida , Lleida , Spain
| | - Jorge Lecina Monge
- a a Neurology Department-Multiple Sclerosis Unit, Hospital Universitario Arnau de Vilanova and Institut de Recerca Biomèdica Lleida , Lleida , Spain
| | - Margarita Casalilla Puértolas
- b b Multiple Sclerosis Unit, Hospital de Día Miquel Martí i Pol, Fundación Esclerosis Múltiple (FEM) , Lleida , Spain
| | - Nuria Sáez Calero
- b b Multiple Sclerosis Unit, Hospital de Día Miquel Martí i Pol, Fundación Esclerosis Múltiple (FEM) , Lleida , Spain
| | - Albert Sacristán Argemí
- b b Multiple Sclerosis Unit, Hospital de Día Miquel Martí i Pol, Fundación Esclerosis Múltiple (FEM) , Lleida , Spain
| | - Blanca Guiu Badia
- a a Neurology Department-Multiple Sclerosis Unit, Hospital Universitario Arnau de Vilanova and Institut de Recerca Biomèdica Lleida , Lleida , Spain
| | - Silvia Peralta Moncusí
- b b Multiple Sclerosis Unit, Hospital de Día Miquel Martí i Pol, Fundación Esclerosis Múltiple (FEM) , Lleida , Spain
| | - Hugo Gonzalo Benito
- a a Neurology Department-Multiple Sclerosis Unit, Hospital Universitario Arnau de Vilanova and Institut de Recerca Biomèdica Lleida , Lleida , Spain
| | - Lara Nogueras Peñabad
- a a Neurology Department-Multiple Sclerosis Unit, Hospital Universitario Arnau de Vilanova and Institut de Recerca Biomèdica Lleida , Lleida , Spain
| | - Marta Lordan Pujol
- b b Multiple Sclerosis Unit, Hospital de Día Miquel Martí i Pol, Fundación Esclerosis Múltiple (FEM) , Lleida , Spain
| | - Mónica Nieves I Collado
- b b Multiple Sclerosis Unit, Hospital de Día Miquel Martí i Pol, Fundación Esclerosis Múltiple (FEM) , Lleida , Spain
| | - Luis Brieva Ruiz
- a a Neurology Department-Multiple Sclerosis Unit, Hospital Universitario Arnau de Vilanova and Institut de Recerca Biomèdica Lleida , Lleida , Spain
| |
Collapse
|
28
|
Alghadir A, Anwer S. Effect of retro and forward walking on quadriceps muscle strength, pain, function, and mobility in patients with knee osteoarthritis: a protocol for a randomized controlled trial. BMC Musculoskelet Disord 2016; 17:161. [PMID: 27072798 PMCID: PMC4830006 DOI: 10.1186/s12891-016-1021-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/09/2016] [Indexed: 11/22/2022] Open
Abstract
Background Walking, a closed kinetic chain (CKC) activity, is widely used in knee rehabilitation as it allows early weight bearing and movement. It has been suggested that retro-walking may provide additional benefits beyond those experienced by forward-walking. The present study will investigate the effect of retro- and forward-walking on quadriceps muscle strength, pain, function, balance and mobility in knee Osteoarthritis (OA) subjects. Methods/Design Sixty-nine participants with knee OA will be recruited from the outpatient department in this randomized controlled trial. The participants will be randomly assigned to one of three groups; retro walking, forward walking or control group. The training program will be 3 days/week for 6 weeks. In addition, all the participants will receive a standard physiotherapy training program. An independent assessor blinded to group assignment will measure quadriceps muscle strength, knee pain intensity, functional disability, and mobility at baseline and 6 weeks after training. Discussion The results of this study will enhance our understanding on the therapeutic effects of walking (retro- or forward-walking) in knee OA. The findings from this study will help determine whether retro- or forward-walking or both are effective in the rehabilitation of subjects with knee OA. Trial registration Controlled Trials ISRCTN12850845, Registered 26 January 2015.
Collapse
Affiliation(s)
- Ahmad Alghadir
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O.Box-10219, Riyadh, Saudi Arabia
| | - Shahnawaz Anwer
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O.Box-10219, Riyadh, Saudi Arabia. .,Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pune, India.
| |
Collapse
|
29
|
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.
Collapse
Affiliation(s)
| | - Demet Uçar
- Istanbul Medeniyet University Göztepe Education and Research Hospital, Turkey
| | - Kadriye Öneş
- Istanbul Physical Therapy Rehabilitation, Education and Research Hospital, Turkey
| |
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
MacIntyre NJ, Negm A, Loyola-Sánchez A, Bhandari M. Efficacy of therapeutic ultrasound vs sham ultrasound on pain and physical function in people with knee osteoarthritis: A meta-analysis of randomized controlled trials. World J Meta-Anal 2014; 2:78-90. [DOI: 10.13105/wjma.v2.i3.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 05/01/2014] [Accepted: 05/29/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To determine the efficacy of therapeutic ultrasound vs sham for improving pain and physical function immediately post-intervention in people with knee osteoarthritis (OA).
METHODS: We hand searched meta-analyses on the topic published in 2010 and updated the search in three electronic databases (MEDLINE, EMBASE, CINAHL) January 1, 2009 to September 5, 2013 to identify relevant studies. The inclusion criteria were human randomized controlled trials published in the English language in which active therapeutic ultrasound was compared to sham ultrasound, data for people with knee OA were reported separately, participants were blinded to treatment allocation and outcomes assessed before and after treatment included pain, self-reported physical function and performance-based physical function. Two reviewers independently screened titles and abstracts retrieved in the search to identify trials suitable for full text review. Data extraction and risk of bias assessment of the identified trials were completed independently by two reviewers. Pooled analyses were conducted using inverse-variance random effects models.
RESULTS: We screened 1013 titles and abstracts. Meta-analysis of pain outcomes from 5 small trials (281 participants/OA knees) showed that, compared to sham ultrasound, therapeutic ultrasound improves pain [standardized mean difference (SMD) (95%CI) = -0.39 (-0.70, -0.08); P = 0.01] but not physical function [self-reported in 3 trials (130 participants/OA knees): SMD (95%CI) = -0.21 (-0.55, 0.14), P = 0.24; walking performance in 4 trials (130 participants/OA knees): SMD (95%CI) = -0.11 (-0.59, 0.37), P = 0.65). For the walking performance outcome, the dispersion of the estimated effects exceeded that expected due to sampling error (χ2 = 8.37, P = 0.04, I² = 64%). Subgroup analyses of three trials that administered high dose ultrasound improved the consistency (I2 = 28%) but the treatment effect remained insignificant.
CONCLUSION: Meta-analyzed double-blind placebo-controlled randomized trials provide low-strength evidence that therapeutic ultrasound decreases knee OA pain and very low-strength evidence that it does not improve physical function.
Collapse
|
32
|
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.
Collapse
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.
| |
Collapse
|
33
|
Morishita K, Karasuno H, Yokoi Y, Morozumi K, Ogihara H, Ito T, Hanaoka M, Fujiwara T, Fujimoto T, Abe K. Effects of therapeutic ultrasound on range of motion and stretch pain. J Phys Ther Sci 2014; 26:711-5. [PMID: 24926137 PMCID: PMC4047237 DOI: 10.1589/jpts.26.711] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 12/05/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to clarify the effects of therapeutic ultrasound on range of motion and stretch pain and the relationships between the effects. [Subjects] The subjects were 15 healthy males. [Methods] Subjects performed all three interventions: (1) ultrasound (US group), (2) without powered ultrasound (placebo group), and (3) rest (control group). Ultrasound was applied at 3 MHz with an intensity of 1.0 W/cm(2) and a 100% duty cycle for 10 minutes. The evaluation indices were active and passive range of motion (ROM), stretch pain (visual analog scale; VAS), and skin surface temperature (SST). The experimental protocol lasted a total of 40 minutes; this was comprised of 10 minutes before the intervention, 10 minutes during the intervention (US, placebo, and control), and 20 minutes after the intervention. [Results] ROM and SST were significantly higher in the US group than in the placebo and control groups for the 20 minutes after ultrasound, though there was no change in stretch pain. [Conclusion] The effects of ultrasound on ROM and SST were maintained for 20 minutes after the intervention. The SST increased with ultrasound and decreased afterwards. Additionally, the SST tended to return to baseline levels within 20 minutes after ultrasound exposure. Therefore, these effects were caused by a combination of thermal and mechanical effects of the ultrasound.
Collapse
Affiliation(s)
- Katsuyuki Morishita
- Koriyama Institute of Health Sciences, Japan ; Interdisciplinary Graduate School of Science and Technology, Shinshu University, Japan
| | | | - Yuka Yokoi
- Koriyama Institute of Health Sciences, Japan ; Interdisciplinary Graduate School of Science and Technology, Shinshu University, Japan
| | | | - Hisayoshi Ogihara
- Koriyama Institute of Health Sciences, Japan ; Interdisciplinary Graduate School of Science and Technology, Shinshu University, Japan
| | - Toshikazu Ito
- Hokkaido Chitose Institute of Rehabilitation Technology, Japan
| | | | - Takayuki Fujiwara
- Koriyama Institute of Health Sciences, Japan ; Interdisciplinary Graduate School of Science and Technology, Shinshu University, Japan
| | - Tetsuya Fujimoto
- Interdisciplinary Graduate School of Science and Technology, Shinshu University, Japan
| | - Koji Abe
- Interdisciplinary Graduate School of Science and Technology, Shinshu University, Japan
| |
Collapse
|
34
|
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]
|
35
|
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.
Collapse
Affiliation(s)
- Ahmet Boyaci
- Department of Physical Medicine and Rehabilitation, Harran University Medical School, Yenisehir Kampusu, 63100, Sanliurfa, Turkey,
| | | | | | | | | |
Collapse
|
36
|
Ramírez-Vélez R, García Sánchez A, Martínez Betancourt C, Parra Galeano C, Ortega J, López Alban C, Agredo Zúñiga R. Effects of two methods of heat therapy on the acute vascular response and hemodynamics in healthy subjects. RADIOLOGIA 2012. [DOI: 10.1016/j.rxeng.2011.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
37
|
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
|
38
|
Carlos KP, Belli BDS, Alfredo PP. Efeito do ultrassom pulsado e do ultrassom contínuo associado a exercícios em pacientes com osteoartrite de joelho: estudo piloto. FISIOTERAPIA E PESQUISA 2012. [DOI: 10.1590/s1809-29502012000300014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A osteoartrite (OA) é uma doença crônica associada à morbidade significante. O objetivo deste estudo foi comparar o exercício isolado ao ultrassom pulsado (USP) e contínuo (USC) associados a exercício na redução da dor, melhora da amplitude de movimento (ADM), força muscular (FM), qualidade de vida (QV) e funcionalidade de pacientes com OA de joelhos. Trinta indivíduos, 50 a 75 anos, OA grau 2-4, foram randomizados: Grupo USC (USC + exercícios), Grupo USP (USP + exercícios) e Grupo EXE (exercícios). Os grupos foram avaliados antes e após o tratamento. A intervenção foi realizada três vezes por semana durante oito semanas: nas quatro primeiras foi aplicado USC ou USP e, nas demais foram realizados os exercícios. O Grupo EXE realizou exercícios durante oito semanas. Para análises intragrupos, utilizou-se o teste de Wilcoxon e, intergrupos, o teste de Kruskall-Walis. Na comparação intragrupos, o Grupo USC apresentou melhora significativa (p<0,05) nas variáveis da Western Ontario and McMaster Universities Osteoarthritis (WOMAC) dor, função e escore total; o Grupo USP na dor repouso, ADM, FM e nas variáveis da WOMAC dor, função e escore total; já, o Grupo EXE na mobilidade e ADM. Na comparação intergrupos, o Grupo USC apresentou melhora significativa (p<0,05) quando comparado aos demais grupos na dor repouso, ADM, escores função e total da WOMAC e o Grupo EXE na dor da WOMAC. A associação do USC a exercícios foi mais efetiva na melhora da dor, ADM, função e QV em pacientes com OA de joelho.
Collapse
|
39
|
Yang PF, Li D, Zhang SM, Wu Q, Tang J, Huang LK, Liu W, Xu XD, Chen SR. Efficacy of ultrasound in the treatment of osteoarthritis of the knee. Orthop Surg 2012; 3:181-7. [PMID: 22009649 DOI: 10.1111/j.1757-7861.2011.00144.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the effect of ultrasound in the treatment of osteoarthritis of the knee. METHODS Eighty-seven out- and in-patients with osteoarthritis of the knee (15 men and 72 women) underwent ultrasonic therapy from February to October 2010. The patients were randomly assigned to an ultrasound group (Group A) and a placebo group (Group B). Group A was offered ultrasonic therapy while Group B underwent mock treatment. The visual analogue scale (VAS) and Lequesne scores of the two groups before and after treatment were compared. The data were analyzed by normal distribution, Student's t-test and the rank sum test. The means during and after treatment of the VAS and Lequesne efficacy index of the treatment group were calculated and plotted on a bar graph. RESULTS Single sample analysis of Groups A and B showed VAS efficacy index: mean = 0.3640, P= 0.000; Lequesne efficacy index, median = 0.3080, P= 0.000, and mean = 0.1000, P= 0.000; Lequesne efficacy index, mean = 0.0364, P= 0.024, respectively. Independent samples t test and rank sum test showed significant differences between the two groups, namely P= 0.000 for both the VAS and Lequesne curative effect indexes. The means of the VAS efficacy index of the treatment group increased during and after treatment. The means of the Lequesne efficacy index of the treatment group showed no apparent decrease by 28 days after treatment. CONCLUSION Ultrasound treatment significantly alleviates joint symptoms, relieving joint swelling, increasing joint mobility and reducing inflammation, in osteoarthritis patients.
Collapse
Affiliation(s)
- Peng-fei Yang
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University National Engineering Research Center of Ultrasound Medicine People's Hospital of Shapingba District, Chongqing, China
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
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.
Collapse
Affiliation(s)
- Yasemin Ulus
- Department of Physical Medicine and Rehabilitation, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
The effect of therapeutic ultrasound to apoptosis of chondrocyte and caspase-3 and caspase-8 expression in rabbit surgery-induced model of knee osteoarthritis. Rheumatol Int 2011; 32:3771-7. [PMID: 22167163 DOI: 10.1007/s00296-011-2196-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 10/22/2011] [Indexed: 02/05/2023]
Abstract
Recent studies have shown a positive correlation between the degree of severity of OA and the number of apoptotic chondrocytes. The purpose of our study was to determine the effect of therapeutic ultrasound on apoptosis in articular cartilage of rabbits with knee osteoarthritis (KOA). Thirty 3-month New Zealand White rabbits were randomizingly divided into three groups, 10 in each group. Two groups underwent anterior cruciate ligament transaction in the right knee and another group left intact. Six weeks later, one group of the operated rabbits (OA-US) underwent ultrasound therapy (300 mW/cm(2), 1 MHz, 20% duty cycle, 10 min each day) for 2 weeks, while the other two groups (OA-Control and Normal Control) left untreated. Eight weeks after transection, all animals were killed. Microscopic morphologic grading was made for histological assessment. The caspases expressions and chondrocytes apoptosis were tested using the immunohistochemistry and TUNEL assessment, respectively. The mean grading of OA-US group was significantly higher than Normal Control group (P = 0.002), but significantly lower than OA-Control group (P = 0.002). Percentage of apoptosis and the optic density of cells expressing caspase-3 and caspase-8 in the three groups showed no statistical significances. Therapeutic ultrasound (300 mW/cm(2), 1 MHz, and 20% duty cycle) could relieve the degree of severity of induced KOA, while it had no effect on apoptosis and the expression of caspase-3 and caspase-8. These findings may provide a certain support for therapeutic ultrasound as an effective access to managing KOA.
Collapse
|
42
|
[Effects of two methods of heat therapy on the acute vascular response and hemodynamics in healthy subjects]. RADIOLOGIA 2011; 54:513-9. [PMID: 22118780 DOI: 10.1016/j.rx.2011.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 03/25/2011] [Accepted: 03/25/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Recently, non-pharmacological resources to relieve pain like hot packs and ultrasound (US) have become common in clinical practice. However, little experimental evidence is available about the possible mechanisms through which these methods bring about pain relief. We aimed to determine the effects of hot packs and US on the acute vascular response and on hemodynamic parameters in healthy subjects. MATERIALS AND METHODS We conducted an experimental study in 20 healthy subjects (10 men and 10 women; mean age, 22.54±1.70 years). The two interventions were randomly applied: a) hot packs (n=10): 15min at 60°C and b) US (n=10): 15min at 1Mhz. Before and after each intervention, the following vascular parameters were measured in the brachial artery using Doppler ultrasonography with a 7MHz probe: arterial compliance, elastic modulus, beta stiffness index, systolic and diastolic arterial diameters, systolic flow velocity and diastolic flow velocity, systolic/diastolic ratio, resistance index, and pulsatility index. The following hemodynamic parameters were monitored: heart rate and blood pressure (systolic, diastolic, and mean). RESULTS After the application of hot packs, we observed changes in diastolic flow velocity and in the pulsatility index (P<05). After the application of US, we observed changes in diastolic flow velocity, systolic/diastolic ratio, resistance index, and arterial compliance (P<05). No changes in hemodynamic parameters were observed after either intervention. CONCLUSIONS Applying hot packs or US modifies the physiology of the vascular system but does not affect hemodynamic parameters in healthy subjects.
Collapse
|
43
|
Giombini A, Di Cesare A, Di Cesare M, Ripani M, Maffulli N. Localized hyperthermia induced by microwave diathermy in osteoarthritis of the knee: a randomized placebo-controlled double-blind clinical trial. Knee Surg Sports Traumatol Arthrosc 2011; 19:980-7. [PMID: 21161171 DOI: 10.1007/s00167-010-1350-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Accepted: 11/25/2010] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the effects of hyperthermia on knee osteoarthritis (OA) in a randomized placebo-controlled double-blind clinical trial. METHODS Sixty-three patients with clinical evidence and radiographic confirmation of knee OA (Kellgren and Lawrence grades II and III) were randomized to either three 30-min sessions of hyperthermia per week for 4 weeks were administered using a 433.92 MHZ microwave generator or receive placebo treatment (machine not turned on) for same number of sessions. The Western Ontario McMaster Universities (WOMAC) questionnaire and the Timed Up and Go test (TUGT), a performance-based measure of function, were obtained at baseline (week 0), at the end of treatment (week 4), and at final follow-up (week 16). RESULTS The treatment group showed a significant decrease in the overall WOMAC score and each of its components, and in the TGUG test between the beginning (week 0) and the end of treatment (week 4), as well as at final follow-up (week 16). In the placebo group, a significant fall was only visible in the pain subscore at week 4. However, the mean improvement was only 1 point and was lost at final follow-up (P=0.332). There was a significant difference in pain -7.4 pre-post (P<0.01), -8.1 pre-follow-up (P<0.01); stiffness -4.6 pre-post (P<0.01), -5.1 pre-follow-up (P<0.01); activities daily living (ADL) -30.9 pre-post (P<0.01), -33.2 pre-follow-up (P<0.01); and WOMAC total score -43 pre-post (P<0.01), -46.4 pre-follow-up (P<0.01); and in TGUG test -2.4 pre-post (P<0.01), -2.9 pre-follow-up (P<0.01) between the treatment and placebo group over the whole length of the trial. CONCLUSIONS A 433.92 MHz microwave hyperthermia regimen showed beneficial effects in patients with moderate knee OA to reduce pain and to improve their physical function. LEVEL OF EVIDENCE I.
Collapse
Affiliation(s)
- Arrigo Giombini
- Department of Health, University of Rome Foro Italico, Rome, Italy
| | | | | | | | | |
Collapse
|
44
|
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: 50] [Impact Index Per Article: 3.6] [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.
Collapse
Affiliation(s)
- F Tascioglu
- Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Meselik Campus, Osmangazi University, 26480 Eskisehir, Turkey.
| | | | | | | |
Collapse
|
45
|
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.
Collapse
|
46
|
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]
|
47
|
Gurkan I, Ranganathan A, Yang X, Horton WE, Todman M, Huckle J, Pleshko N, Spencer RG. Modification of osteoarthritis in the guinea pig with pulsed low-intensity ultrasound treatment. Osteoarthritis Cartilage 2010; 18:724-33. [PMID: 20175971 PMCID: PMC2873836 DOI: 10.1016/j.joca.2010.01.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 12/21/2009] [Accepted: 01/18/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The Hartley guinea pig develops articular cartilage degeneration similar to that seen in idiopathic human osteoarthritis (OA). We investigated whether the application of pulsed low-intensity ultrasound (PLIUS) to the Hartley guinea pig joint would prevent or attenuate the progression of this degenerative process. METHODS Treatment of male Hartley guinea pigs was initiated at the onset of degeneration (8 weeks of age) to assess the ability of PLIUS to prevent OA, or at a later age (12 months) to assess the degree to which PLIUS acted to attenuate the progression of established disease. PLIUS (30 mW/cm(2)) was applied to stifle joints for 20 min/day over periods ranging from 3 to 10 months, with contralateral limbs serving as controls. Joint cartilage histology was graded according to a modified Mankin scale to evaluate treatment effect. Immunohistochemical staining for interleukin-1 receptor antagonist (IL-1ra), matrix metalloproteinase (MMP)-3, MMP-13, and transforming growth factor (TGF)-beta1 was performed on the cartilage to evaluate patterns of expression of these proteins. RESULTS PLIUS did not fully prevent cartilage degeneration in the prevention groups, but diminished the severity of the disease, with the treated joints showing markedly decreased surface irregularities and a much smaller degree of loss of matrix staining as compared to controls. PLIUS also attenuated disease progression in the groups with established disease, although to a somewhat lesser extent as compared to the prevention groups. Immunohistochemical staining demonstrated a markedly decreased degree of TGF-beta1 production in the PLIUS-treated joints. This indicates less active endogenous repair, consistent with the marked reduction in cartilage degradation. CONCLUSIONS PLIUS exhibits the ability to attenuate the progression of cartilage degeneration in an animal model of idiopathic human OA. The effect was greater in the treatment of early, rather than established, degeneration.
Collapse
Affiliation(s)
- Ilksen Gurkan
- National Institute on Aging, National Institutes of Health, Baltimore, MD
| | | | - Xu Yang
- Hospital for Special Surgery, New York, NY
| | - Walter E. Horton
- Northeastern Ohio Universities College of Medicine, Rootstown, Ohio
| | - Martin Todman
- Smith and Nephew Group Research Centre, York Science Park, Heslington, York, UK
| | - James Huckle
- Smith and Nephew Group Research Centre, York Science Park, Heslington, York, UK
| | | | - Richard G. Spencer
- National Institute on Aging, National Institutes of Health, Baltimore, MD
| |
Collapse
|
48
|
Challenges and recommendations for placebo controls in randomized trials in physical and rehabilitation medicine: a report of the international placebo symposium working group. Am J Phys Med Rehabil 2010; 89:160-72. [PMID: 20090428 DOI: 10.1097/phm.0b013e3181bc0bbd] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Compared with other specialties, the field of physical and rehabilitation medicine has not received the deserved recognition from clinicians and researchers in the scientific community. One of the reasons is the lack of sound evidence to support the traditional physical and rehabilitation medicine treatments. The best way to change this disadvantage is through a well conducted clinical research, such as standard placebo- or sham-controlled randomized clinical trials. Therefore, having placebo groups in clinical trials is essential to improve the level of evidence-based practice in physical and rehabilitation medicine that ultimately translates to better clinical care. To address the challenges for the use of placebo in physical and rehabilitation medicine and randomized clinical trials and to create useful recommendations, we convened a working group during the inaugural International Symposium in Placebo (February 2009, in Sao Paulo, Brazil) in which the following topics were discussed: (1) current status of randomized clinical trials in physical and rehabilitation medicine, (2) challenges for the use of placebo in physical and rehabilitation medicine, (3) bioethics, (4) use of placebo in acupuncture trials and for the treatment of low-back pain, (5) mechanisms of placebo, and (6) insights from other specialties. The current article represents the consensus report from the working group.
Collapse
|
49
|
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.
Collapse
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
| | | | | | | |
Collapse
|
50
|
|