Gait analysis of patients with knee osteoarthritis before and after Chinese massage treatment

Effect of manual manipulation on mechanical gait parameters

CONTEXT

A variety of manual manipulation techniques are utilized in clinical practice to alleviate pain and improve musculoskeletal function. Many manual practitioners analyze gait patterns and asymmetries in their assessment of the patient, and an increasing number of gait motion capture studies are taking place with recent improvements in motion capture technology. This study is the first systematic review of whether these manual modalities have been shown to produce an objectively measurable change in gait mechanics.

OBJECTIVES

This study was designed to perform a systematic review of the literature to assess the impact of manual medicine modalities on biomechanical parameters of gait.

METHODS

A master search term composed of keywords and Medical Subject Headings (MeSH) search terms from an initial scan of relevant articles was utilized to search six databases. We screened the titles and abstracts of the resulting papers for relevance and then assessed their quality with the Cochrane Risk of Bias Tool. Clinical trials that featured both a manual manipulation intervention and multiple mechanical gait parameters were included. Case reports and other studies that only measured gait speed or other subjective measures of mobility were excluded.

RESULTS

We included 20 studies in our final analysis. They utilize manipulation techniques primarily from osteopathic, chiropractic, massage, and physiotherapy backgrounds. The conditions studied primarily included problems with the back, knee, and ankle, as well as healthy patients and Parkinson's patients. Control groups were highly variable, if not absent. Most studies measured their gait parameters utilizing either multicamera motion capture systems or force platforms.

CONCLUSIONS

Twelve of 20 papers included in the final analysis demonstrated a significant effect of manipulation on gait variables, many of which included either step length, walking speed, or sagittal range of motion (ROM) in joints of the lower extremity. However, the results and study design are too heterogeneous to draw robust conclusions from these studies as a whole. While there are initial indications that certain modalities may yield a change in certain gait parameters, the quality of evidence is low and there is insufficient evidence to conclude that manual therapies induce changes in biomechanical gait parameters. Studies are heterogeneous with respect to the populations studied and the interventions performed. Comparators were variable or absent across the studies, as were the outcome variables measured. More could be learned in the future with consistent methodology around blinding and sham treatment, and if the gait parameters measured were standardized and of a more robust clinical significance.

The Effectiveness of Tuina in Relieving Pain, Negative Emotions, and Disability in Knee Osteoarthritis: A Randomized Controlled Trial

OBJECTIVE

To evaluate the effectiveness of Tuina in relieving the pain, negative emotions, and disability of patients with knee osteoarthritis (KOA).

DESIGN

Single-center, parallel, randomized controlled trial.

SETTING

Shanghai Guanghua Integrated Chinese and Western Medicine Hospital, Shanghai, China.

SUBJECTS

Adult patients with KOA who were able to speak Chinese and self-report symptoms were eligible.

METHODS

A total of 104 patients were randomly allocated to receive the 6-week treatment of Tuina (Tuina group) or celecoxib (celecoxib group). Data on pain, negative emotions, and disability were collected at baseline, at week 2, 4, and 6, and follow-up (1 month after the last treatment). The primary outcomes were the pressure pain thresholds. The secondary outcomes were: (1) numerical rating scale at rest and with movement; (2) Hamilton Anxiety Scale; (3) Hamilton Depression Scale; (4) Western Ontario and McMaster Universities Osteoarthritis Index; and (5) clinical effective rate. The adverse events of the trial were evaluated.

RESULTS

In total, 99 patients completed the follow-up. Generalized linear mixed models were constructed to analyse the between-group differences. Statistically significant differences were found in the interaction effects (P < .05). In evaluating the group effect, statistical differences were found at week 6 and follow-up (P < .05). Further, all variables showed a time effect (P < .05). A statistical difference in the clinical effective rate was found between the Tuina and celecoxib groups (P < .05).

CONCLUSIONS

Tuina produced superior effects for pain, negative emotions, and disability over time, as compared to celecoxib in patients with KOA.

A randomized, parallel control and multicenter clinical trial of evidence-based traditional Chinese medicine massage treatment VS External Diclofenac Diethylamine Emulgel for the treatment of knee osteoarthritis

BACKGROUND

Both massage and topically administered NSAIDs are safe and effective treatments for knee osteoarthritis (KOA); however, different massage technique sects in China caused assessment difficulties for the treatment of KOA. In order to standardize the massage techniques and procedures, we organized multi-disciplinary experts in China to acquire an evidence-based traditional Chinese medicine massage treatment of knee osteoarthritis. The purposes of this study will be to provide clinicians a complementary and alternative therapy for patients and to evaluate the efficacy and safety of evidence-based traditional Chinese medicine massage treatment of KOA compared to External Diclofenac Diethylamine Emulgel.

METHODS AND DESIGN

A randomized controlled trial in which 300 participants diagnosed with KOA will be recruited and randomly allocated to either the experimental group or the control group in a ratio of 2:1. Two hundred participants will receive evidence-based traditional Chinese medicine massage 2 sessions per week for 10 weeks as the experimental group, and 100 participants will receive External Diclofenac Diethylamine Emulgel 3-4 times per day for 10 weeks as the control group. The patients in the two groups will receive follow-up at two time points at 5 weeks and 10 weeks from the beginning of treatment, respectively. The MRI scans and X-ray will be performed at baseline and at the end of the intervention. The primary outcome will be the changes in the Western Ontario and McMaster Osteoarthritis Index (WOMAC). Secondary outcomes will be measured by the PRO scale for knee osteoarthritis based on the concept of traditional Chinese medicine (Chinese scale for knee osteoarthritis (CSKO)), X-ray evaluation, and MRI scan evaluation. The data of WOMAC and CSKO will be analyzed at the baseline, 5 weeks, and 10 weeks from the beginning of treatment. The data from MRI scans and X-rays will be analyzed at baseline and at the end of the intervention. The significance level sets as 5%. The safety of interventions will be evaluated after each treatment session.

DISCUSSION

This study will provide clinicians with much-needed knowledge for the treatment of KOA through a controlled trial.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR1800014400 . Registered on 10 January 2018.

The effects on pain and quality of life of traditional Chinese manual therapy for knee osteoarthritis: A protocol for systematic review and meta-analysis

BACKGROUND

Knee osteoarthritis (KOA) is a common disease with the high occurrence in the world. The symptoms of pain and dysfunction decrease quality of life in KOA patients. Several studies reported traditional Chinese manual therapy showed beneficial effects in improving pain and dysfunction of patient with KOA, but most previous reviews did not focus on the effects on quality life of traditional Chinese manual therapy for KOA. However, better quality of life is important for patients suffering KOA. Therefore, the current review and meta-analysis will be conducted to assess the effects on clinical symptoms and quality of life of traditional Chinese manual therapy for KOA.

METHODS

Eight electronic databases including PubMed, Embase, the Cochrane Library, Web of Science, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Data, and Chinese Scientific Journal Database will be searched from the beginning to December 2021. Two reviewers will independently select included studies and extract data. Heterogeneity will be evaluated by I2 statistic before the data synthesis. Subgroup analysis will be performed by duration of KOA, different types of traditional Chinese manual therapy, different outcomes, and different intervention time. The primary outcome is quality of life in KOA patients, and the secondary outcomes include pain and dysfunction due to KOA. Rev Man 5.3 software will be used for meta-analysis.

RESULTS

The results of this review will be reported in a peer-reviewed journal.

CONCLUSION

The results of this review will provide reliable evidence for the effects on quality of life and clinical symptoms of traditional Chinese manual therapy for KOA.

INPLASY REGISTRATION NUMBER

INPLASY2021120043.

Patellar inward pushing method relieves knee osteoarthritis via regulating cytokines

BACKGROUND

Knee osteoarthritis (KOA) is a chronic degenerative disease characterized by pain, morning stiffness and swelling in the knee joints. And KOA is common in the elderly and seriously affects the exercise function and physical health of patients. This study aimed to explore the curative effects of patellar inward pushing method (PIPM) on KOA.

MATERIAL AND METHOD

In this study, we established rabbit animal models of KOA for the research by using the New Zealand white rabbits. 30 New Zealand white rabbits were divided into 5 groups by random number table method: blank group, model group, glucosamine hydrochloride (GH) group, PIPM group and PIPM combined with GH group, then the rabbits were modeled.

RESULTS

After 9-weeks cultured in groups, 5 ml blood was collected from the heart, and cytokines were detected. The result suggested that iNOS, NO and TNF-α were the pathogenic inflammatory factor of KOA, and aggravated cartilage damage and degeneration. Besides, this study indicated that PIPM combined with GH treatment significantly reduced the activity of inflammatory cytokines in serum and joint fluid of KOA models in rabbits. In addition, PIPM combined with GH therapy exhibited the best therapeutic effect among these treatments, which was working on KOA better than PIPM treatment alone or GH treatment alone.

CONCLUSIONS

PIPM could effective treat KOA via regulating cytokines, and the PIPM combined with GH therapy could be a novel therapeutic strategy of KOA.

Effects of Swedish massage on gait spatiotemporal parameters in adult women with medial knee osteoarthritis: A randomized controlled trial

BACKGROUND

Patients with knee osteoarthritis (OA) are always faced with functional limitations in daily activities due to knee pain. They are also at risk of falling because of compensatory kinetics and kinematics changes in walking, which is why they are seeking complementary therapies to deal with their problems.

OBJECTIVE

The present research aimed to evaluate whether Swedish massage is effective in relieving the symptoms of knee OA and improving the gait spatiotemporal parameters of patients with knee OA.

METHODS

Thirty adult women with knee OA participated in this study voluntarily. The intervention group (n = 15) received Swedish massage on their quadriceps for 20-30 min per session (12 sessions). During this period, the control group (n = 15) received their regular treatment. Osteoarthritis symptoms were evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index. The spatiotemporal parameters of gait were also captured by the motion analysis system during barefoot walking.

RESULTS

The intervention group demonstrated significantly more pain relief and improved function compared to the control group. A significant increase was observed in the gait speed, total support time, and single support time (P < 0.05). Moreover, there was a significant decrease in the step width and initial double support time of the patients after receiving Swedish massage (P < 0.05).

CONCLUSION

It can be concluded that Swedish massage may positively affect pain relief and function improvement in patients with knee OA. Also, Swedish massage was found to improve the spatiotemporal parameters in the patients. This may have important clinical implications regarding the rehabilitation of patients with knee OA.

The effects on pain and disability of traditional Chinese non-pharmacological therapy for knee osteoarthritis: A protocol for systematic review and meta-analysis

BACKGROUND

Knee osteoarthritis (KOA) is a common chronic joint disease with serious health economic burden. More and more randomized controlled trials have indicated that traditional Chinese non-pharmacological therapy, including acupuncture, Tai Chi, Tuina, etc can significantly improve pain and physical function of patients with KOA. However, the effects of traditional Chinese non-pharmacological therapy for KOA remain controversial. Most previous systematic reviews did not focus on the effects of traditional Chinese non-pharmacological therapy for KOA as a whole. In Chinese community hospital, however, acupuncture, Tuina, and Tai Chi are usually in the management of KOA as whole-body treatment.

METHODS

The electronic databases (PubMed, Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, China Knowledge Resource Integrated Database, and Wanfang Data) will be searched. The search will include all documents from their inception to December 2021. Two reviewers independently extracted the data and assessed the risk of bias by the Cochrane Risk of Bias Tool for randomized controlled trials. The meta-analysis will be conducted with a random or fixed effect model to calculate the standardized mean difference and 95% confidence intervals based on different heterogeneity using the Review Manager Version 5.3 software. The heterogeneity will be examined by Higgins I2 statistic. The subgroup analysis will be conducted based on different types of traditional Chinese non-pharmacological therapy and different outcomes. Quality of evidence will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation.

RESULTS

The current systematic review and meta-analysis will be conducted to investigate the effects of traditional Chinese non-pharmacological therapy in the management of KOA. The main outcomes will include pain and disability. The secondary outcomes will include quality of life and adverse events.

CONCLUSION

To provide evidence for evidence-based medicine and clinical researchers to choose more effective traditional Chinese non-pharmacological therapy for KOA.

INPLASY REGISTRATION NUMBER

INPLASY202170098.

Proprioceptive neuromuscular facilitation improves pain and descending mechanics among elderly with knee osteoarthritis

PURPOSE

Knee osteoarthritis (KOA) is a common disease that causes pain and limits functionality in the elderly during daily activities, especially during stair descent. Proprioceptive neuromuscular facilitation (PNF) practices promote multiple-plane joint movements, which relieve pain and increase joint range of motion (ROM). This study aims to examine the effects of a 12-week PNF intervention on pain relief, passive and active joint ROM, external knee adduction moment (KAM), and hip adduction moment (HAM) in the elderly with KOA during stair descent.

MATERIALS AND METHODS

Seventy-six elderly who were diagnosed with KOA were assessed for eligibility and, 36 of them met the inclusive criteria, were randomly divided into two groups: the twelve-week PNF intervention group and the control group. Pain score was measured by the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Passive joint ROM was measured using a goniometer. Active joint ROM, KAM, and HAM during stair descent were measured using a motion analysis system with a force platform. All the data were recorded at weeks 0, 6, and 12.

RESULTS

Compared to the control group, the PNF group showed a decreased pain score; increased passive hip, knee, and ankle ROM; a decreased minimum knee flexion angle, and increased HAM during stair descent.

PERSPECTIVE

Proprioceptive neuromuscular facilitation intervention is a successful method to relieve symptoms of KOA. It relieves pain without increasing KAM, enhances passive ROM, increases active knee flexion ROM, and increases HAM during stair descent in the elderly with KOA.

Efficacy of pulsed Nd:YAG laser in the treatment of patients with knee osteoarthritis: a randomized controlled trial

The purpose of this study was to investigate the effects of pulsed Nd:YAG laser plus glucosamine/chondroitin sulfate (GCS) in patients with knee osteoarthritis (KOA) by examining changes in pain and knee function, as well as synovial thickness (ST) and femoral cartilage thickness (FCT). Sixty-seven male patients participated, with a mean (SD) age of 53.85 (4.39) years, weight of 84.01 (4.70) kg, height of 171.51 (3.96) cm, and BMI of 28.56 (1.22). Group 1 was treated with high-intensity laser therapy (HILT), GCS, and exercises (HILT + GCS + EX). Group 2 was treated with GCS plus exercises (GCS + EX), and group 3 received placebo laser plus exercises (PL + EX). The outcomes measured were pain level and functional disability using the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. ST and FCT were measured by ultrasound examination. Statistical analyses were performed to compare differences between baseline and after 6 weeks of treatment and then after 3 months of follow-up. Statistical significance was set at p < 0.05. VAS and WOMAC were significantly decreased in all groups after 6 weeks, with nonsignificant differences between 6 weeks and 3 months of follow-up. ST was significantly decreased in the HILT + GCS + EX group posttreatment, with nonsignificant decreases in the GCS + EX and PL + EX groups, as well as nonsignificant differences to FCT in all groups. Overall, pulsed Nd:YAG laser combined with GCS and exercises was more effective than GCS + EX and exercises alone in the treatment of KOA patients.

Massage therapy research review

In this review, massage therapy has been shown to have beneficial effects on varying conditions including prenatal depression, preterm infants, full-term infants, autism, skin conditions, pain syndromes including arthritis and fibromyalgia, hypertension, autoimmune conditions including asthma and multiple sclerosis, immune conditions including HIV and breast cancer and aging problems including Parkinson's and dementia. Although many of the studies have involved comparisons between massage therapy and standard treatment control groups, several have compared different forms of massage (e.g. Swedish versus Thai massage), and different active therapies such as massage versus exercise. Typically, the massage therapy groups have experienced more positive effects than the control or comparison groups. This may relate to the massage therapy providing more stimulation of pressure receptors, in turn enhancing vagal activity and reducing cortisol levels. Some of the researchers have assessed physical, physiological and biochemical effects, although most have relied exclusively on self-report measures. Despite these methodological problems and the dearth of research from the U.S., the massage therapy profession has grown significantly and massage therapy is increasingly practiced in traditional medical settings, highlighting the need for more rigorous research.