Cryotherapy associated with tailored land-based exercises for knee osteoarthritis: a protocol for a double-blind sham-controlled randomised trial

Analysis of the Application Effect of Exercise Rehabilitation Therapy Based on Data Mining in the Prevention and Treatment of Knee Osteoarthritis

Objective. To analyze the application effect of exercise rehabilitation therapy based on data mining in the prevention and treatment of knee osteoarthritis. Methods. Based on clinical data mining technology, that is, using complex network technology and association rules, the medical records of 1612 patients with KOA in the Department of Rheumatology and Immunology of our hospital were retrospectively analyzed, and they were divided into groups according to whether they used exercise rehabilitation therapy ( $n=786$ ), and the control treatment group ( $n=826$ ), the curative effect, the improvement of inflammatory factors and immune factors, the visual analogue scale (VAS), the knee joint function score (Lysholm), and the quality of life (WOMAC) scale were compared between the two groups score, analyze the relationship between VAS and Lysholm score and prognosis quality of life, and compare the recurrence within 12 months between the two groups. Results. The data mining results showed that the curative effect of the exercise rehabilitation therapy group was significantly higher than that of the control treatment group ( $P<0.05$ ); the improvement of VAS and Lysholm scores of the exercise rehabilitation therapy group was significantly better than that of the control treatment group ( $P<0.05$ ). The improvement effect of inflammatory indexes and immune cytokines was significantly better than that of the control treatment group ( $P<0.05$ ); the improvement of WOMAC in the exercise rehabilitation therapy group was significantly better than that of the control treatment group ( $P<0.05$ ); VAS and WOMAC scores were significantly positively correlated ( $r=0.579$ , $P<0.05$ ); Lysholm score was positively correlated with WOMAC score ( $r=-0.563$ , $P<0.05$ ); the recurrence rate of exercise rehabilitation therapy group was 5.09%, which was significantly lower than that of control treatment group (17.63% ( ${\chi }^2=11.967$ ), $P<0.05$ ). Conclusion. Exercise rehabilitation therapy for KOA patients can effectively improve inflammatory and immune factors in patients, enhance knee joint function and prognosis quality of life, and reduce readmission rate, which is worthy of clinical application.

Rehabilitation of Patients with Moderate Knee Osteoarthritis Using Hyaluronic Acid Viscosupplementation and Physiotherapy

Knee osteoarthritis (KOA) is one of the most common public health problems which cannot be cured and ultimately leads to disability. Current management is largely limited to the treatment of the symptoms. To avoid the late stages of KOA that lead to knee replacement, the key point is to control and reduce destructive processes using efficient pharmacological products combined with physiotherapy (PT). Herein, we perform a monocentric observational study to compare the effect of combining a multi-modal physiotherapy regime and intra-articular (IA) injection with hyaluronic acid (HA) on the non-surgical treatment of KOA. Patients with mild KOA were randomly assigned to two groups to receive an HA injection with PT or an HA injection only. The assessment tools for pain, clinical disease severity, and disability were the total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (scores range from 0 to 96, with higher scores indicating worse pain, function, and stiffness), knee range of motion (ROM), pain on the visual analog scale (VAS), and muscle strength testing (MST). All tests were evaluated every 3 months up to 1 year from the baseline. The study enrolled 52 patients with ages between 47 and 61 years who were divided into two groups. Thirty-seven (n = 37) patients were randomized in the pilot group (PG) and received IA injections with the viscoelastic hyaluronic acid product (HA) combined with a multi-modal PT regime. The PT program included 10 sessions of transcutaneous electrical nerve stimulation, low-level laser therapy, ultrasound, physical exercise, and cryotherapy. Fifteen patients (n = 15) from the control group (CG) received the IA HA injections only. All patients were confirmed with mild KOA of Kellgren–Lawrence grade 2 on radiographs at the beginning of the treatment. The baseline characteristics, including the severity of pain and level of disability, were similar in the two groups. At baseline, the mean (±SD) WOMAC scores reported were 64.6 ± 4.08 in the CG and 64.5 ± 2.99 in the PG. Notably, at only 3 months into the study, the mean scores were significantly improved to 56.7 ± 5 in the CG and 48.27 ± 2.13 in the PG (mean between-group difference = 16.19 points; 95% confidence interval), finding favor for the combination of HA injections and physiotherapy. At the study’s endpoint (12 months), the scores were improved in both groups, with the mean between-group difference remaining significant (7.08 points, 95% confidence interval). A decrease in pain, as evaluated by the VAS scale, was reported for both groups, with the PG reporting a better VAS score that decreased from 5.7 to 2 when compared to the CG, which decreased from 5.7 to 3. The physical assessment parameters (ROM and MST) followed the same trend, with a rapid improvement in the ROM in the PG, changing from 98° to 115° in the first 3 months, and a slower and more steady evolution in the CG group, changing from 100° to 112° in 9 months. Herein, we report on the combination therapy of an intra-articularly administered HA viscoelastic product and a multi-modal physiotherapy regime, which can play a key role in the non-surgical treatment of KOA, effectively controlling pain, stiffness, and the ROM value and improving patients’ quality of life.

Knee osteoarthritis: key treatments and implications for physical therapy

BACKGROUND

Knee osteoarthritis (OA) is a chronic progressive disease that imparts a substantial socioeconomic burden to society and healthcare systems. The prevalence of knee OA has dramatically risen in recent decades due to consistent increases in life expectancy and obesity worldwide. Patient education, physical exercise, and weight loss (for overweight or obese individuals) constitute the first-line knee OA treatment approach. However, less than 40% of patients with knee OA receive this kind of intervention. There is an unmet need for healthcare professionals treating individuals with knee OA to understand the current recommended treatment strategies to provide effective rehabilitation.

OBJECTIVE

To guide physical therapists in their clinical decision making by summarizing the safest and most efficacious treatment options currently available, and by delineating the most traditional outcome measures used in clinical research for knee OA.

CONCLUSION

There is a need for healthcare providers to abandon low-quality and ineffective treatments and educate themselves and their patients about the current best evidence-based practices for knee OA.