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Meng QN, Zhu Y, Liu SW, Hu B, Chai DJ, Dong CX. Study on the treatment of dysphagia after stroke with electromyographic biofeedback intensive training. World J Clin Cases 2024; 12:3725-3733. [PMID: 38994319 PMCID: PMC11235442 DOI: 10.12998/wjcc.v12.i19.3725] [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: 02/29/2024] [Revised: 04/23/2024] [Accepted: 05/10/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Dysphagia, or swallowing disorder, is a common complication following stroke, significantly impacting patients' quality of life. Electromyographic biofeedback (EMGBF) therapy has emerged as a potential rehabilitation technique to improve swallowing function, but its efficacy in comparison with conventional treatments remains to be further explored. AIM To investigate the effects of different treatment intensities of EMGBF on swallowing function and motor speed after stroke. METHODS The participants were divided into three groups, all of which received routine neurological drug therapy and motor function rehabilitation training. On the basis of routine swallowing disorder training, the EMGBF group received additional EMGBF training, while the enhanced EMGBF group received two additional training sessions. Four weeks before and after treatment, the degree of swallowing disorder was evaluated using the degree of swallowing disorder score (VGF) and the Rosenbek penetration-aspiration scale (PAS). RESULTS Initially, there was no significant difference in VGF and PAS scores among the groups (P > 0.05). After four weeks, all groups showed significant improvement in both VGF scores and PAS scores. Furthermore, the standardized swallowing assessment and videofluoroscopic dysphagia scale scores also improved significantly post-treatment, indicating enhanced swallowing function and motor function of the hyoid-bone laryngeal complex, particularly in the intensive EMGBF group. CONCLUSION EMGBF training is more effective than traditional swallowing training in improving swallowing function and the movement rate of the hyoid laryngeal complex in patients with post-stroke dysphagia.
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Affiliation(s)
- Qing-Nan Meng
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Qiqihar Medical College, Qiqihar 161000, Heilongjiang Province, China
| | - Yue Zhu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Qiqihar Medical College, Qiqihar 161000, Heilongjiang Province, China
| | - Si-Wen Liu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Qiqihar Medical College, Qiqihar 161000, Heilongjiang Province, China
| | - Bin Hu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Qiqihar Medical College, Qiqihar 161000, Heilongjiang Province, China
| | - De-Jun Chai
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Qiqihar Medical College, Qiqihar 161000, Heilongjiang Province, China
| | - Chun-Xue Dong
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Qiqihar Medical College, Qiqihar 161000, Heilongjiang Province, China
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French HP, Cunningham J, Galvin R, Almousa S. Adjunctive electrophysical therapies used in addition to land-based exercise therapy for osteoarthritis of the hip or knee: A systematic review and meta-analysis. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100457. [PMID: 38516558 PMCID: PMC10956074 DOI: 10.1016/j.ocarto.2024.100457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/27/2024] [Indexed: 03/23/2024] Open
Abstract
Objectives To review evidence for effectiveness of electrophysical therapies (EPTs), used adjunctively with land-based exercise therapy, for hip or knee osteoarthritis (OA), compared with 1) placebo EPTs delivered with land-based exercise therapy or 2) land-based exercise therapy only. Methods Six databases were searched up to October 2023 for randomised controlled trials (RCTs)/quasi-RCTs comparing adjunctive EPTs alongside land-based exercise therapy versus 1) placebo EPTs alongside land-based exercise, or 2) land-based exercise in hip or knee OA. Outcomes included pain, function, quality of life, global assessment and adverse events. Risk of bias and overall certainty of evidence were assessed. We back-translated significant Standardised Mean Differences (SMDs) to common scales: 2 points/15% on a 0-10 Numerical Pain Rating Scale and 6 points/15% on the WOMAC physical function subscale. Results Forty studies (2831 patients) evaluated nine different EPTs for knee OA. Medium-term effects (up to 6 months) were evaluated in seven trials, and one evaluated long-term effects (>6 months). Adverse events were reported in one trial. Adjunctive laser therapy may confer short-term effects on pain (SMD -0.68, 95%CI -1.03 to -0.34; mean difference (MD) 1.18 points (95% CI -1.78 to -0.59) and physical function (SMD -0.60, 95%CI -0.88 to -0.34; MD 12.95 (95%CI -20.05 to -5.86)) compared to placebo EPTs, based on very low-certainty evidence. No other EPTs (TENS, interferential, heat, shockwave, shortwave, ultrasound, EMG biofeedback, NMES) showed clinically significant effects compared to placebo/exercise, or exercise only. Conclusions Very low-certainty evidence supports laser therapy used adjunctively with exercise for short-term improvement in pain and function. No other EPTs demonstrated clinically meaningful effects.
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Affiliation(s)
- Helen P. French
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Joice Cunningham
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Rose Galvin
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Sania Almousa
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin 2, Ireland
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Sonnery-Cottet B, Hopper GP, Gousopoulos L, Pioger C, Vieira TD, Thaunat M, Fayard JM, Freychet B, Cavaignac E, Saithna A. Incidence of and Risk Factors for Arthrogenic Muscle Inhibition in Acute Anterior Cruciate Ligament Injuries: A Cross-Sectional Study and Analysis of Associated Factors From the SANTI Study Group. Am J Sports Med 2024; 52:60-68. [PMID: 38164669 DOI: 10.1177/03635465231209987] [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] [Indexed: 01/03/2024]
Abstract
BACKGROUND Arthrogenic muscle inhibition (AMI) is a process in which neural inhibition after injury or surgery to the knee results in quadriceps activation failure and knee extension deficit. PURPOSE To determine the incidence and spectrum of the severity of AMI after acute anterior cruciate ligament (ACL) injury using the Sonnery-Cottet classification, to determine the interobserver reliability of the classification system, and to investigate potential important factors associated with AMI after ACL injury. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Consecutive patients who had an acute ACL injury between October 2021 and February 2022 were considered for study inclusion. Eligible patients underwent a standardized physical examination at their first outpatient appointment. This included an assessment of quadriceps inhibition, identification of any extension deficits, and grading of AMI and its reversibility according to the Sonnery-Cottet classification. RESULTS A total of 300 consecutive patients with acute ACL ruptures were prospectively enrolled in the study. Of them, 170 patients (56.7%) had AMI. Patients evaluated with AMI showed a significantly inferior Lysholm score, International Knee Documentation Committee score, Simple Knee Value, and Knee injury and Osteoarthritis Outcome Score than patients without AMI (P < .0001). Multivariate analysis revealed that the presence of effusion, concomitant injuries, and high pain scores were associated with a significantly greater risk of AMI. Additional associations with the presence of AMI included a short duration between injury and evaluation, the use of crutches, and using a pillow as a support at night. In contrast, a previous ACL injury was associated with significantly lower odds of developing AMI (OR, 0.025; 95% CI, 0-0.2; P = .014). Among the 170 patients with AMI, 135 patients (79%) showed a resolution of their inhibition at the end of the consultation after application of simple exercises; the remaining 35 patients required specific rehabilitation. Interobserver reliability of the classification system was almost perfect (95% CI, 0.86-0.99). CONCLUSION AMI occurs in over half of patients with acute ACL injuries. When it occurs, it is easily reversible in the majority of patients with simple exercises targeted at abolishing AMI. The presence of "red flags" should increase the index of suspicion for the presence of AMI, and these include the presence of an effusion, high pain scores, a short time between injury and evaluation, multiligament injuries, the use of crutches, and using a pillow as a support at night. Patients with a history of ipsilateral or contralateral ACL injury are at a significantly lower risk of AMI than those with a first-time ACL injury.
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Affiliation(s)
- Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | | | | | - Charles Pioger
- Department of Orthopedic Surgery, Ambroise Paré Hospital, Paris Saclay University, Paris, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Jean-Marie Fayard
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Benjamin Freychet
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Etienne Cavaignac
- Department of Orthopaedic Surgery, Hôpital Pierre Paul Riquet, CHU de Toulouse, Toulouse, France
| | - Adnan Saithna
- Arizona Brain, Spine & Sports Injuries Center, Scottsdale, Arizona
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Kokic T, Pavic R, Vuksanic M, Jelica S, Sumanovac A, Banic T, Ostović H, Sklempe Kokic I. Effects of Electromyographic Biofeedback-Assisted Exercise on Functional Recovery and Quality of Life in Patients after Total Hip Arthroplasty: A Randomized Controlled Trial. J Pers Med 2023; 13:1716. [PMID: 38138943 PMCID: PMC10744500 DOI: 10.3390/jpm13121716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
The goal of the trial was to examine the effects of adding electromyographic biofeedback (EMG-BF) to the conventional program of physiotherapy after total hip arthroplasty (THA) on functional recovery and quality of life. The trial was designed as a prospective, interventional, single-blinded randomized controlled study. Ninety patients were randomized into an experimental group (EG) (n = 45; mean age 63.9 ± 8.8) and control group (CG) (n = 45; mean age 63.9 ± 9). All patients received 21 days of physiotherapy which consisted of therapeutic exercise (land-based and aquatic), electrotherapy, and education. Electromyographic biofeedback was added to a portion of the land-based exercise in EG. The Hip Disability and Osteoarthritis Outcome Score (HOOS), Numeric Rating Scale (NRS), Short Form Health Survey-36 (SF-36), use of a walking aid, 30 s chair stand test (CST) as well as the Timed Up and Go (TUG) test were used for outcome measurement. A higher proportion of the participants in both groups did not need a walking aid after the intervention (p < 0.05). All participants improved their 30 s CST and TUG results (p < 0.001), as well as their NRS and HOOS scores (p < 0.05). No significant differences between the groups were found. There were no additional benefits from adding EMG-BF to the conventional physiotherapy protocol.
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Affiliation(s)
- Tomislav Kokic
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Orthopaedics and Trauma Department, General County Hospital Vinkovci, 32100 Vinkovci, Croatia
- Faculty of Kinesiology Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Roman Pavic
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Clinical Hospital of Traumatology, University Hospital Centre “Sestre Milosrdnice”, 10000 Zagreb, Croatia
| | - Matko Vuksanic
- Bizovacke Toplice Rehabilitation Hospital, 31222 Bizovac, Croatia
- Department of Health Studies, College of Applied Sciences “Lavoslav Ruzicka” in Vukovar, 32000 Vukovar, Croatia
| | - Stjepan Jelica
- Department of Health Studies, College of Applied Sciences “Lavoslav Ruzicka” in Vukovar, 32000 Vukovar, Croatia
| | - Antun Sumanovac
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Orthopaedics and Trauma Department, General County Hospital Vinkovci, 32100 Vinkovci, Croatia
| | - Tihomir Banic
- Faculty of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Surgery, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Helena Ostović
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Iva Sklempe Kokic
- Faculty of Kinesiology Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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Norozian B, Arabi S, Marashipour SM, Khademi Kalantari K, Akbarzadeh Baghban A, Kazemi SM, Jamebozorgi AA. Recovery of Quadriceps Strength and Knee Function Using Adjuvant EMG-BF After Primary ACL Reconstruction. J Lasers Med Sci 2023; 14:e6. [PMID: 37089769 PMCID: PMC10114001 DOI: 10.34172/jlms.2023.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/17/2022] [Indexed: 04/25/2023]
Abstract
Introduction: Immobility and limited usage of operated limbs lead to weakness and atrophy of the muscle after anterior cruciate ligament (ACL) reconstruction. However, training programs for preventing biomechanical risk factors such as lower limb alignment and increased muscular contraction are very limited. Thus, the current study was carried out to evaluate the recovery of quadriceps muscle strength and the improvement of knee function using adjuvant electromyographic biofeedback (EMG-BF) after ACL reconstruction. Methods: This prospective randomized controlled trial was conducted among 40 patients (20=EMG-BF group, 20=Control group) with ACL reconstruction, who were referred to Akhtar Hospital from 2021 to 2022. In the EMG-BF group, EMG BFB was added to the standard rehabilitation protocol, and in the control group, the standard rehabilitation protocol with full postoperative weight-bearing, knee brace (zero degree of extension, 90 degrees of flexion), and electrical stimulation with maximal voluntary isometric knee extension was performed. Each group was intervened for 4 weeks and three sessions of 30 minutes per week. It should be noted that each patient participated in 16 outpatient physiotherapy sessions after surgery. Nicholas Hand-Held Dynamometer (HHD) was used for measuring quadriceps strength, and Knee Outcome Survey-Activities of Daily Living (KOS-ADLs) and Knee Outcome Survey Sports Activities Scale (KOS-SAS) questionnaires were used for assessing the knee function. Results: Four weeks after the treatment, the EMG-BF group showed a significant increase in quadriceps strength (P=0.0001). Quadriceps strength had a significant difference before and after 4 weeks of intervention (P=0.0001), but in the control group, no significant difference was observed (P=0.368). The EMG-BF group had a significant increase in KOS-ADLs and KOS-SAS scores after 4 weeks of intervention (P=0.0001). Conclusion: In our study, isometric strengthening of quadriceps with adjuvant EMG-BF significantly increased the strength of quadriceps and knee function during 4 weeks. EMG-BF is a low risk, low cost, and less invasive intervention and has high safety and adjustment ability. It is a valuable adjuvant method for achieving better functional recovery in a shorter time.
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Affiliation(s)
- Bahman Norozian
- Department of Occupational Therapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Arabi
- Department of Occupational Therapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Mahta Marashipour
- Department of Occupational Therapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosro Khademi Kalantari
- Department of Physiotherapy Therapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed Morteza Kazemi
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedics hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Asghar Jamebozorgi
- Department of Occupational Therapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Correspondence to Ali Asghar Jamebozorgi,
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French HP, Abbott JH, Galvin R. Adjunctive therapies in addition to land-based exercise therapy for osteoarthritis of the hip or knee. Cochrane Database Syst Rev 2022; 10:CD011915. [PMID: 36250418 PMCID: PMC9574868 DOI: 10.1002/14651858.cd011915.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Land-based exercise therapy is recommended in clinical guidelines for hip or knee osteoarthritis. Adjunctive non-pharmacological therapies are commonly used alongside exercise in hip or knee osteoarthritis management, but cumulative evidence for adjuncts to land-based exercise therapy is lacking. OBJECTIVES To evaluate the benefits and harms of adjunctive therapies used in addition to land-based exercise therapy compared with placebo adjunctive therapy added to land-based exercise therapy, or land-based exercise therapy only for people with hip or knee osteoarthritis. SEARCH METHODS We searched CENTRAL, MEDLINE, PsycINFO, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro) and clinical trials registries up to 10 June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) or quasi-RCTs of people with hip or knee osteoarthritis comparing adjunctive therapies alongside land-based exercise therapy (experimental group) versus placebo adjunctive therapies alongside land-based exercise therapy, or land-based exercise therapy (control groups). Exercise had to be identical in both groups. Major outcomes were pain, physical function, participant-reported global assessment, quality of life (QOL), radiographic joint structural changes, adverse events and withdrawals due to adverse events. We evaluated short-term (6 months), medium-term (6 to 12 months) and long-term (12 months onwards) effects. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, and assessed risk of bias and certainty of evidence for major outcomes using GRADE. MAIN RESULTS We included 62 trials (60 RCTs and 2 quasi-RCTs) totalling 6508 participants. One trial included people with hip osteoarthritis, one hip or knee osteoarthritis and 59 included people with knee osteoarthritis only. Thirty-six trials evaluated electrophysical agents, seven manual therapies, four acupuncture or dry needling, or taping, three psychological therapies, dietary interventions or whole body vibration, two spa or peloid therapy and one foot insoles. Twenty-one trials included a placebo adjunctive therapy. We presented the effects stratified by different adjunctive therapies along with the overall results. We judged most trials to be at risk of bias, including 55% at risk of selection bias, 74% at risk of performance bias and 79% at risk of detection bias. Adverse events were reported in eight (13%) trials. Comparing adjunctive therapies plus land-based exercise therapy against placebo therapies plus exercise up to six months (short-term), we found low-certainty evidence for reduced pain and function, which did not meet our prespecified threshold for a clinically important difference. Mean pain intensity was 5.4 in the placebo group on a 0 to 10 numerical pain rating scale (NPRS) (lower scores represent less pain), and 0.77 points lower (0.48 points better to 1.16 points better) in the adjunctive therapy and exercise therapy group; relative improvement 10% (6% to 15% better) (22 studies; 1428 participants). Mean physical function on the Western Ontario and McMaster (WOMAC) 0 to 68 physical function (lower scores represent better function) subscale was 32.5 points in the placebo group and reduced by 5.03 points (2.57 points better to 7.61 points better) in the adjunctive therapy and exercise therapy group; relative improvement 12% (6% better to 18% better) (20 studies; 1361 participants). Moderate-certainty evidence indicates that adjunctive therapies did not improve QOL (SF-36 0 to 100 scale, higher scores represent better QOL). Placebo group mean QOL was 81.8 points, and 0.75 points worse (4.80 points worse to 3.39 points better) in the placebo adjunctive therapy group; relative improvement 1% (7% worse to 5% better) (two trials; 82 participants). Low-certainty evidence (two trials; 340 participants) indicates adjunctive therapies plus exercise may not increase adverse events compared to placebo therapies plus exercise (31% versus 13%; risk ratio (RR) 2.41, 95% confidence interval (CI) 0.27 to 21.90). Participant-reported global assessment was not measured in any studies. Compared with land-based exercise therapy, low-certainty evidence indicates that adjunctive electrophysical agents alongside exercise produced short-term (0 to 6 months) pain reduction of 0.41 points (0.17 points better to 0.63 points better); mean pain in the exercise-only group was 3.8 points and 0.41 points better in the adjunctive therapy plus exercise group (0 to 10 NPRS); relative improvement 7% (3% better to 11% better) (45 studies; 3322 participants). Mean physical function (0 to 68 WOMAC subscale) was 18.2 points in the exercise group and 2.83 points better (1.62 points better to 4.04 points better) in the adjunctive therapy plus exercise group; relative improvement 9% (5% better to 13% better) (45 studies; 3323 participants). These results are not clinically important. Mean QOL in the exercise group was 56.1 points and 1.04 points worse in the adjunctive therapies plus exercise therapy group (1.04 points worse to 3.12 points better); relative improvement 2% (2% worse to 5% better) (11 studies; 1483 participants), indicating no benefit (low-certainty evidence). Moderate-certainty evidence indicates that adjunctive therapies plus exercise probably result in a slight increase in participant-reported global assessment (short-term), with success reported by 45% in the exercise therapy group and 17% more individuals receiving adjunctive therapies and exercise (RR 1.37, 95% CI 1.15 to 1.62) (5 studies; 840 participants). One study (156 participants) showed little difference in radiographic joint structural changes (0.25 mm less, 95% CI -0.32 to -0.18 mm); 12% relative improvement (6% better to 18% better). Low-certainty evidence (8 trials; 1542 participants) indicates that adjunctive therapies plus exercise may not increase adverse events compared with exercise only (8.6% versus 6.5%; RR 1.33, 95% CI 0.78 to 2.27). AUTHORS' CONCLUSIONS Moderate- to low-certainty evidence showed no difference in pain, physical function or QOL between adjunctive therapies and placebo adjunctive therapies, or in pain, physical function, QOL or joint structural changes, compared to exercise only. Participant-reported global assessment was not reported for placebo comparisons, but there is probably a slight clinical benefit for adjunctive therapies plus exercise compared with exercise, based on a small number of studies. This may be explained by additional constructs captured in global measures compared with specific measures. Although results indicate no increased adverse events for adjunctive therapies used with exercise, these were poorly reported. Most studies evaluated short-term effects, with limited medium- or long-term evaluation. Due to a preponderance of knee osteoarthritis trials, we urge caution in extrapolating the findings to populations with hip osteoarthritis.
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Affiliation(s)
- Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - J Haxby Abbott
- Orthopaedics: Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Armshaw B, Vaidya M, Mehta S. Surface electromyography‐based biofeedback and knee rehabilitation: A review of the literature. BEHAVIORAL INTERVENTIONS 2022. [DOI: 10.1002/bin.1907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Brennan Armshaw
- Department of Behavior Analysis University of North Texas Denton Texas USA
| | - Manish Vaidya
- Department of Behavior Analysis University of North Texas Denton Texas USA
| | - Sacheen Mehta
- Comprehensive Orthopaedics and Rehabilitation Richardson Texas USA
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Feasibility of a Novel Video Game-Based Electromyography Biofeedback System in Patients With Knee Osteoarthritis. J Sport Rehabil 2022; 31:937-942. [PMID: 35690390 DOI: 10.1123/jsr.2021-0397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/07/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022]
Abstract
CONTEXT A novel virtual game system Knee Biofeedback Rehabilitation Interface for game-based home therapy (KneeBright) was developed for strength training using integrated electromyography biofeedback of the quadriceps muscle to control the game. The study aimed to compare the KneeBright and electromyography biofeedback interface among patients with knee osteoarthritis. DESIGN Controlled before and after design. METHODS Nineteen patients with knee osteoarthritis took part in this laboratory-based study. Exercise sessions took place on 2 separate days. During session 1, participants used a conventional electromyography biofeedback system while performing 3 sets of lower body exercises with emphasis on maximal muscle activation, endurance, and precision. During session 2, participants used the KneeBright game to match the exercise sets in the first session. For both sessions, knee extension torque during the isometric muscle activation exercises and time to voluntary additional exercise were recorded. Patient engagement was assessed using the technology acceptance model and System Usability Score questionnaires. RESULTS The peak knee extension torque produced during the control exercise session and the KneeBright exercise session were positively correlated. Knee extension torque generated during KneeBright game exercise sessions was increased by an average of 25% compared to the control sessions (2.14 vs 1.77 N·m/kg, P = .02). The mean technology acceptance model score for the KneeBright system was 3.4/5 and the mean System Usability Score was 79, both indicating positive patient engagement. CONCLUSIONS Patients using the KneeBright game produced greater knee torque than patients using the conventional system, had positive levels of engagement, and exercised longer with the KneeBright game.
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Morales-Sánchez V, Falcó C, Hernández-Mendo A, Reigal RE. Efficacy of Electromyographic Biofeedback in Muscle Recovery after Meniscectomy in Soccer Players. SENSORS 2022; 22:s22114024. [PMID: 35684645 PMCID: PMC9185253 DOI: 10.3390/s22114024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/17/2022] [Accepted: 05/23/2022] [Indexed: 12/10/2022]
Abstract
Electromyographic biofeedback (EMG-BF) is a therapeutic technique that has been used successfully in the rehabilitation of injuries. Although it has been applied to athletes, its use in this field is not very widespread. The objective of this study is to analyze its effectiveness in the recovery of electromyographic activity of the quadriceps after meniscectomy, evaluated through isometric contraction of the vastus lateralis. The sample comprised ten professional footballers in the Spanish League (2nd Division A) who had previously suffered a meniscus injury in their knee and had undergone a meniscectomy. The intervention consisted of EMG-BF treatment lasting between 6 and 10 sessions. The electromyographic signal was recorded using a Thought Technology ProComp Infiniti 8-channel biofeedback unit with a sampling rate of 2048 samples/second. For each session, a within-subject ABA design of 6 or 10 trials per session was used, with three pre- and three post-measures, which determined the gain for each session. The results indicated (1) improvements in all cases, (2) EMG-BF was effective, (3) the working model was statistically significant with an explained variance of between 67% and 75%, and (4) the generalizability analysis showed that the results are reliable and generalizable. The results indicate that EMG-BF is effective in neuromuscular rehabilitation after this type of intervention.
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Affiliation(s)
- Verónica Morales-Sánchez
- Department of Social Psychology, Social Anthropology, Social Work and Social Services, University of Málaga, 29071 Málaga, Spain; (V.M.-S.); (A.H.-M.)
| | - Coral Falcó
- Department of Sport, Food and Natural Sciences, Western Norway University of Applied Sciences, 5020 Bergen, Norway;
| | - Antonio Hernández-Mendo
- Department of Social Psychology, Social Anthropology, Social Work and Social Services, University of Málaga, 29071 Málaga, Spain; (V.M.-S.); (A.H.-M.)
| | - Rafael E. Reigal
- Department of Social Psychology, Social Anthropology, Social Work and Social Services, University of Málaga, 29071 Málaga, Spain; (V.M.-S.); (A.H.-M.)
- Correspondence:
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Alonazi A, Hasan S, Anwer S, Jamal A, Parvez S, Alfaiz FAS, Li H. Efficacy of Electromyographic-Biofeedback Supplementation Training with Patellar Taping on Quadriceps Strengthening in Patellofemoral Pain Syndrome among Young Adult Male Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094514. [PMID: 33922866 PMCID: PMC8123081 DOI: 10.3390/ijerph18094514] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 11/24/2022]
Abstract
This study compares the effects of electromyographic-biofeedback (EMG-BF)-guided isometric quadriceps strengthening with patellar taping and isometric exercise alone in patellofemoral pain syndrome (PFPS) among young adult male athletes. Sixty young adult male athletes with PFPS participated in the study. Participants were randomly divided into two groups: (1) EMG-BF-guided isometric exercise training with patellar taping (experimental group, n = 30), and (2) sham EMG-BF training with an isometric exercise program (control group, n = 30). Participants conducted their respective exercise programs for five days per week across four weeks. Study outcomes were pain (measured by the visual analog scale), functional disability (measured by the Kujala Anterior Knee Pain scale), and quadriceps strength (measured by an ISOMOVE dynamometer). Measurements were taken at baseline, Week 2, Week 4, and during a follow-up at Week 6. The experimental group demonstrated significantly lower VAS score at Weeks 2 and 4 compared to that of the control group (p = 0.008 and 0.0005, respectively). The score remained significantly lower at the Week 6 follow-up compared to the control group (p = 0.0005). There were no differences in knee function at Weeks 2 and 4 between the two groups (p = 0.086 and 0.171, respectively); however, the experimental group showed significantly better knee function at Week 6 compared to the control group (p = 0.002). There were no differences in quadriceps strength at Week 2 between the two groups (p = 0.259); however, the experimental group demonstrated significantly higher quadriceps strength at Weeks 4 and 6 compared to the control group (p = 0.0008). Four weeks of EMG-BF supplementation training with patellar taping demonstrated significant improvements in pain intensity, functional disability, and quadriceps muscle strength in young adult male athletes with PFPS.
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Affiliation(s)
- Asma Alonazi
- Department of Physiotherapy, College of Applied Medical Sciences, Majmaah University, Majmaah 11952, Saudi Arabia;
| | - Shahnaz Hasan
- Department of Physiotherapy, College of Applied Medical Sciences, Majmaah University, Majmaah 11952, Saudi Arabia;
- Correspondence: or
| | - Shahnawaz Anwer
- Department of Building and Real Estate, The Hong Kong Polytechnic University, Hung Hom, Hong Kong; (S.A.); (H.L.)
| | - Azfar Jamal
- Health and Basic Science Research Centre, Majmaah University, Majmaah 11952, Saudi Arabia;
- Department of Biology, College of Science, Al-Zulfi, Majmaah University, Majmaah 11952, Saudi Arabia;
| | - Suhel Parvez
- Department of Medical Elementology and Toxicology, Jamia Hamdard, New Delhi 110062, India;
| | | | - Heng Li
- Department of Building and Real Estate, The Hong Kong Polytechnic University, Hung Hom, Hong Kong; (S.A.); (H.L.)
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Raeissadat SA, Ghazi Hosseini P, Bahrami MH, Salman Roghani R, Fathi M, Gharooee Ahangar A, Darvish M. The comparison effects of intra-articular injection of Platelet Rich Plasma (PRP), Plasma Rich in Growth Factor (PRGF), Hyaluronic Acid (HA), and ozone in knee osteoarthritis; a one year randomized clinical trial. BMC Musculoskelet Disord 2021; 22:134. [PMID: 33536010 PMCID: PMC7860007 DOI: 10.1186/s12891-021-04017-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 01/26/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Our study compare the short and long-term efficacy of the intra articular injections (IAIs) of hyaluronic acid (HA), platelet-rich plasma (PRP), plasma rich in growth factors (PRGF), and ozone in patients with knee osteoarthritis (OA). METHODS In this randomized clinical trial, 238 patients with mild to moderate knee OA were randomized into 4 groups of IAIs: HA (3 doses weekly), PRP (2 doses with 3 weeks interval), PRGF (2 doses with 3 weeks interval), and Ozone (3 doses weekly). Our outcome measures were the mean changes from baseline (immediately from the first injections) until 2,6, and 12 months post intervention in scores of visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne index. RESULTS A total of 200 patients enrolled in the final analysis. The mean age of patients was 56.9 ± 6.3 years, and 69.5% were women. In 2 months follow up, significant improvement of pain, stiffness, and function were seen in all groups compared to the baseline, but the ozone group had the best results (P < 0.05). In 6 month follow up HA, PRP, and PRGF groups demonstrated better therapeutic effects in all scores in comparison with ozone (P < 0.05). At the end of the 12th month, only PRGF and PRP groups had better results versus HA and ozone groups in all scores (P < 0.05). Despite the fact that ozone showed better early results, its effects begin to wear off earlier than other products and ultimately disappear in 12 months. CONCLUSIONS Ozone injection had rapid effects and better short-term results after 2 months, but its therapeutic effects did not persist after 6 months and at the 6-month follow up, PRP,PRGF and HA were superior to ozone. Only patients in PRP and PRGF groups improved symptoms persisted for 12 months. Therefore, these products could be the preferable choices for long-term management. TRIAL REGISTRATION Registered in the Iranian Center of Clinical Trials ( www.irct.ir ) in 11/11/2017 with the following code: IRCT2017082013442N17.
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Affiliation(s)
- Seyed Ahmad Raeissadat
- Clinical Development Research Center of Shahid Modarres Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parsa Ghazi Hosseini
- Clinical Development Research Center of Shahid Modarres Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hasan Bahrami
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Shohada-e-Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Salman Roghani
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Mohammad Fathi
- Critical Care Fellowship, Department of Anesthesiology, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Critical Care Quality Improvement Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azadeh Gharooee Ahangar
- Clinical Development Research Center of Shahid Modarres Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mahtab Darvish
- Clinical Development Research Center of Shahid Modarres Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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12
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Bahrami MH, Raeissadat SA, Cheraghi M, Rahimi-Dehgolan S, Ebrahimpour A. Efficacy of single high-molecular-weight versus triple low-molecular-weight hyaluronic acid intra-articular injection among knee osteoarthritis patients. BMC Musculoskelet Disord 2020; 21:550. [PMID: 32799851 PMCID: PMC7429877 DOI: 10.1186/s12891-020-03577-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 08/06/2020] [Indexed: 12/27/2022] Open
Abstract
Background To compare intra-articular (IA) knee injections of a cross-linked high-molecular-weight hyaluronic acid (HMW-HA) with a linear low-molecular weight HA (LMW-HA) in terms of pain and functional improvement among knee osteoarthritis (OA) patients. Methods In this single-blinded RCT, the patients were randomly divided into two groups for HA injections. The first group received an HMW-HA (Arthromac) injection, while the other received three weekly LMW-HA (Hyalgan) injections. Pain and function were assessed using the outcome measures including WOMAC, Lequesne and VAS indices, once prior to injection, as well as 2 and 6 months after injections. Results A total of 90 patients were included. There was no significant difference in baseline characteristics including age and sex between the two groups. Our analysis showed that total WOMAC, Lequesne and VAS mean scores remarkably improved at both follow-up time-points compared to the baseline measurements (p < 0.001). There was no significant superiority between the two therapeutic protocols according to our outcome measures at any time-point of follow-up. The only except was about the improvement in WOMAC stiffness subscale that was significantly higher in LMW-HA group compared to HMW-HA (p = 0.021). Moreover, no significant difference was observed in minor complications and injection-induced pain scores between the two groups. Conclusion This study proved that a single HMW-HA injection is as effective as multiple injections of LMW-HA counterparts in periods of 2 and 6 months follow-up. This study protocol was registered in Iranian database of RCTs (IRCT; www.irct.ir) with the trial registration number IRCT20130523013442N24 and registration date 2018-07-13.
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Affiliation(s)
- Mohammad Hasan Bahrami
- Physical Medicine and Rehabilitation Department and Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Seyed Ahmad Raeissadat
- Clinical Development Research Center of Shahid Modarres Hospital, Physical Medicine and Rehabilitation Department and Research Center, Shahid Beheshti University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Mohsen Cheraghi
- Physical Medicine and Rehabilitation Department and Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Shahram Rahimi-Dehgolan
- Physical Medicine and Rehabilitation Department, Tehran University of Medical Sciences (TUMS), School of Medicine, Tehran, Iran
| | - Adel Ebrahimpour
- Orthopedic surgery Department, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, School of Medicine, No. 1998734383, Velenjak, Tehran, Iran.
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13
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Raeissadat SA, Gharooee Ahangar A, Rayegani SM, Minator Sajjadi M, Ebrahimpour A, Yavari P. Platelet-Rich Plasma-Derived Growth Factor vs Hyaluronic Acid Injection in the Individuals with Knee Osteoarthritis: A One Year Randomized Clinical Trial. J Pain Res 2020; 13:1699-1711. [PMID: 32753945 PMCID: PMC7354951 DOI: 10.2147/jpr.s210715] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/27/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE In this study, we aimed at performing a comparison between intra-articular injections of PRP-derived growth factor (PGRF) and hyaluronic acid regarding their effect on pain and patient's function in knee osteoarthritis, as well as their safety profiles. METHODS During our single-masked randomized clinical trial, the candidates with symptomatic knee osteoarthritis received two intra-articular injections of PRGF with 3 weeks apart or received three weekly injections of HA. The mean improvements from before treatment until the second, sixth, and twelfth months post-intervention in scores obtained by visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne index were our primary outcomes. RESULTS A total of 102 candidates were finally included in the study. Patients' mean age was 57.08±7.3 years old in the PRGF group compared to the mean age of 58.63±7.09 years old in HA patients. In the PRGF group, total WOMAC index decreased from 41.96±11.71 to 27.10±12.3 (P = 0.02), and from 39.71±10.4 to 32.41±11.8 in the HA group after 12 months (P > 0.05). Regarding the Lequesne index, pain, ADL, and global scores significantly decreased after 12 months in the PRGF group compared to the HA group (P<0.001). There was also a meaningful higher rate of satisfaction in the PRGF group compared to the HA group after 12 months of treatment (P<0.001). CONCLUSION Besides significantly higher satisfaction belonging to the PRGF group, there was a statistically significant improvement in VAS score and global, pain, and ADL score of Lequesne by passing 12 months from injection in PRGF compared to HA.
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Affiliation(s)
- Seyed Ahmad Raeissadat
- Physical Medicine and Rehabilitation Research Center, Clinical Research Development Center of Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Seyed Mansoor Rayegani
- Physical Medicine and Rehabilitation Research Center, Clinical Research Development Center of Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Adel Ebrahimpour
- Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pegah Yavari
- Physical Medicine and Rehabilitation Research Center, Clinical Research Development Center of Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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14
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Eslamian F, Jahanjoo F, Dolatkhah N, Pishgahi A, Pirani A. Relative Effectiveness of Electroacupuncture and Biofeedback in the Treatment of Neck and Upper Back Myofascial Pain: A Randomized Clinical Trial. Arch Phys Med Rehabil 2020; 101:770-780. [PMID: 31954696 DOI: 10.1016/j.apmr.2019.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To determine the differences between clinical effects of electroacupuncture and biofeedback therapy in addition to conventional treatment in patients with cervical myofascial pain syndrome (MPS). DESIGN Randomized clinical trial. SETTING Physical medicine and rehabilitation clinic of a university hospital. PARTICIPANTS Fifty patients (N=50) aged 25-55 years of both sexes with chronic neck pain diagnosed with MPS (characterized by trigger points within taut bands) were randomly assigned to 2 equal groups of 25 individuals. INTERVENTIONS The patients in electroacupuncture group were treated with standard acupuncture and concomitant electrical stimulation; those in biofeedback group received visual electromyography biofeedback therapy for muscle activity and relaxation. Both groups received the intervention 2 times a week for a total of 6 sessions. Basic exercise training and medicines were administered for all the patients. MAIN OUTCOME MEASURES Pain severity based on the visual analog scale (VAS), functional status using Neck Disability Index (NDI), cervical range of motion (ROM) using and inclinometer, and pressure pain threshold (PPT) using an algometer were evaluated before and at 3 and 12 weeks after the treatment. Primary outcome was defined as 20% reduction in the 3-month neck pain and dysfunction compared to baseline, assessed through the NDI. RESULTS Fifty patients (39 women, 11 men) with a mean age (years) ± SD of 39.0±5.5 and neck pain duration (weeks) of 6.0±2.2 were analyzed. All parameters, except for PPT of the lower trapezius and paravertebral muscles were improved significantly in both groups, while baseline values were controlled. The primary outcome was achieved more significantly in the acupuncture group than in the biofeedback group: 20 (80.0%) vs 10 (40.0%); rate ratio=2 with 95% confidence interval (CI), 1.19-3.36; number needed to treat (NNT)=2.5 with 95% CI, 1.54-6.58. Advantages of acupuncture over biofeedback were observed according to values obtained from the NDI, VAS, extension and left lateral-bending ROM, and PPT on the left upper trapezius after the last session of intervention until 3 months (P<.05). CONCLUSIONS Both electroacupuncture and biofeedback therapies were found to be effective in management of MPS when integrated with conventional treatment. However, intergroup differences showed priority of acupuncture in some parameters vs biofeedback. Thus, electroacupuncture seems to be a better complementary modality for treatment of MPS in the neck and upper back area.
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Affiliation(s)
- Fariba Eslamian
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Fatemeh Jahanjoo
- Road Traffic Injury Research Center, Department of Biostatistic and Epidemiology,Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Dolatkhah
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Pishgahi
- Physical Medicine and Rehabilitation Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Pirani
- Physical Medicine and Rehabilitation Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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15
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Raeissadat SA, Ghorbani E, Sanei Taheri M, Soleimani R, Rayegani SM, Babaee M, Payami S. MRI Changes After Platelet Rich Plasma Injection in Knee Osteoarthritis (Randomized Clinical Trial). J Pain Res 2020; 13:65-73. [PMID: 32021396 PMCID: PMC6959502 DOI: 10.2147/jpr.s204788] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 11/29/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose Few papers have studied the objective effects of PRP on cartilage. In this study, we investigated the effect of PRP on cartilage characteristics by special MRI sequencing in knee osteoarthritis (IRCT registration number: 2014020413442N6). Patients and methods In this double blind randomized clinical trial, patients with bilateral knees osteoarthritis-grade 1, 2, and 3 were included in the study. Each patient's knees were randomly allocated to either control or treatment groups. PRP was injected in two sessions with 4 week intervals in PRP group. The VAS (visual analog scale) and WOMAC (Western Ontario and McMaster Universities Arthritis Index) were utilized and MRI was performed for all patients, before, and 8 months after treatment. The MRI sequences taken were transverse 3D TRUFISP and coronal and sagittal fat saturated proton-density. Imaging was scored according to four cartilage characteristics. Results 46 knees (from 23 patients) were included in this study. 23 knees in the case group and 23 knees in control group were studied. All patients were female with mean age of 57.57±5.9 years. Mean total WOMAC and VAS changes before and after treatment in control group were 11.61±8.5 and 1.3±1.1 respectively. In PRP group, mean total WOMAC and VAS changes showed better improvement with 20±12.3 and 3.2±1.6 respectively (P-value <0.05). In PRP group, all of the radiologic variables (patellofemoral cartilage volume, synovitis and medial and lateral meniscal disintegrity), with the exception of subarticular bone marrow abnormality, had significant improvement (P-value <0.05). In a comparison between the two groups, patellofemoral cartilage volume and synovitis had significantly changed in the PRP group (P-value <0.05). Conclusion In this study, in addition to the effect of PRP on VAS and WOMAC, there was a significant effect on radiologic characteristics (patellofemoral cartilage volume and synovitis). For further evaluation, a longer study with a larger sample size is recommended.
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Affiliation(s)
- Seyed Ahmad Raeissadat
- Physical Medicine and Rehabilitation Department, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Ghorbani
- Physical Medicine and Rehabilitation Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Sanei Taheri
- Radiology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Soleimani
- Radiology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mansoor Rayegani
- Physical Medicine and Rehabilitation Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Babaee
- Physical Medicine and Rehabilitation Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Payami
- Department of Emergency Medicine, Amir al momenin Hospital, Tehran Azad University of Medical Sciences, Tehran, Iran
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