Low-level laser therapy and interferential current in patients with knee osteoarthritis: a randomized controlled trial protocol

The effect of balance exercises on central sensitization in patients with knee osteoarthritis

The aim of this study was to evaluate the effectiveness of balance exercises on functional status, pain, balance, and central sensitization in patients with knee osteoarthritis (OA). Patients diagnosed with bilateral Kellgren-Lawrence grade ≥ 2 primary knee OA and associated central sensitization were included in the study. Patients were randomized into two groups. Both groups were provided with verbal and written information on knee OA. In addition, the intervention group received a supervised balance exercise program for 6 weeks, 3 days a week on alternating days. The outcome measures were the changes in the Central Sensitization Inventory (CSI), Visual Analog Scale (VAS) pain, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Berg Balance Scale, and Y Balance Test. Evaluations were performed at baseline, immediately after treatment (6th week) and at 12th week. The study included 40 patients, 20 patients in each group. At the end of the treatment period (6th week), the improvement in CSI score, WOMAC pain, WOMAC physical function, WOMAC total score, Y Balance Test scores, and VAS pain during activity was significantly greater in the intervention group than that in the control group (p < 0.001). Regarding the changes from baseline to the 12th week, the intervention group experienced greater improvement in most of the outcome measures. Yet, the change in WOMAC pain score, Berg Balance Scale score, and VAS pain at rest was similar between the study groups (p = 0.05, p = 0.257, and p = 0.385, respectively). A two-model multiple linear regression analysis revealed that the changes in VAS pain (during activity) after the treatment and at follow-up [(p = 0.004, adjusted R2: 0.346) and (p = 0.002, adjusted R2: 0.391), respectively], as well as changes in WOMAC pain from baseline to follow-up (p = 0.020, ΔR2 = 0.245) significantly affected central sensitization. However, changes in Y Balance Test and WOMAC total scores did not appear to have a significant impact on the improvement in central sensitization (p > 0.05). Balance exercises may provide improvement in central sensitization, functional status, and dynamic balance among patients with knee OA. The improvement in central sensitization depends mostly on the pain relief effect of balance exercises.

Traditional acupuncture and laser acupuncture in chronic nonspecific neck pain: study protocol for a randomized controlled trial

Background

Nonspecific neck pain is a multifactorial and very common condition in adult individuals, traditional acupuncture (TA) and laser acupuncture (LA) may be treatment options for certain individuals in such a condition. However, no reports were found in the literature comparing the effectiveness of TA and LA in cases of chronic nonspecific neck pain. Therefore, the aim of the present study is to investigate the effectiveness of TA and LA therapies in individuals with chronic nonspecific neck pain, noting which one is more efficient for this condition. The result of this research will have direct implications for pain management and, consequently, may benefit individuals suffering from nonspecific chronic neck pain.

Methods/design

This will be a controlled and randomized clinical trial. Eighty-four individuals will be recruited and distributed equally and randomly into 3 groups: TA (which will receive the acupuncture treatment with needles), LA (which will receive the laser acupuncture treatment), and Sham (who will receive the placebo intervention). The acupuncture points (Tianzhu, Fengchi, Jianjing, and Jianzhongshu) will be stimulated bilaterally. The primary outcome will be pain intensity, determined using the Numerical Rating Scale. The secondary outcomes will be pressure pain threshold, temporal summation of pain, conditioned pain modulation, use of analgesic medicines after treatment, and the global perceived effect scale. The assessments will be performed immediately before and after the treatment, which will be a single session, at the follow-up and 1 month after the end of the treatments; evaluation will be made of the pain intensity and the global perceived effect. Statistical analysis of the data obtained will consider a significance level of p < 0.05.

Discussion

This study will provide evidence concerning the effects of LA treatment, in comparison with TA and sham intervention, leading to benefits for individuals suffering from chronic nonspecific neck pain.

Trial registration

Brazilian Registry of Clinical Trials - ReBEC RBR-7vbw5gd. Date of registration: August 06th, 2021.

Photobiomodulation Therapy Restores IL-10 Secretion in a Murine Model of Chronic Asthma: Relevance to the Population of CD4+CD25+Foxp3+ Cells in Lung

It is largely known that photobiomodulation (PBM) has beneficial effects on allergic pulmonary inflammation. Our previous study showed an anti-inflammatory effect of the PBM in an acute experimental model of asthma, and we see that this mechanism is partly dependent on IL-10. However, it remains unclear whether the activation of regulatory T cells is mediated by PBM in a chronic experimental model of asthma. In this sense, the objective of this study was to verify the anti-inflammatory role of the PBM in the pulmonary inflammatory response in a chronic experimental asthma model. The protocol used for asthma induction was the administration of OVA subcutaneously (days 0 and 14) and intranasally (3 times/week, for 5 weeks). On day 50, the animals were sacrificed for the evaluation of the different parameters. The PBM used was the diode, with a wavelength of 660 nm, a power of 100 mW, and 5 J for 50 s/point, in three different application points. Our results showed that PBM decreases macrophages, neutrophils, and lymphocytes in the bronchoalveolar lavage fluid (BALF). Moreover, PBM decreased the release of cytokines by the lung, mucus, and collagen in the airways and pulmonary mechanics. When we analyzed the percentage of Treg cells in the group irradiated with laser, we verified an increase in these cells, as well as the release of IL-10 in the BALF. Therefore, we conclude that the use of PBM therapy in chronic airway inflammation attenuated the inflammatory process, as well as the pulmonary functional and structural parameters, probably due to an increase in Treg cells.

Analgesic Effects of Interferential Current Therapy: A Narrative Review

Background and Objectives: Transcutaneous electrical stimulation of low- and medium-frequency currents is commonly used in pain management. Interferential current (IFC) therapy, a medium frequency alternating current therapy that reportedly reduces skin impedance, can reach deeper tissues. IFC therapy can provide several different treatment possibilities by adjusting its parameters (carrier frequency, amplitudemodulated frequency, sweep frequency, sweep mode or swing pattern, type of application (bipolar or quadripolar), time of application and intensity). The objective of this review article is to discuss the literature findings on the analgesic efficacy of IFC therapy. Conclusions: According to the literature, IFC therapy shows significant analgesic effects in patients with neck pain, low back pain, knee osteoarthritis and post-operative knee pain. Most of the IFC parameters seem not to influence its analgesic effects. We encourage further studies to investigate the mechanism of action of IFC therapy.

[The use of stability training in rehabilitation programs in patients after total knee replacement in the late recovery period]

All over the world, total joint replacement is one of the most common and popular surgical technology. The frequency of knee replacement is steadily increasing. The development of new rehabilitation technologies for patients after total knee replacement is an urgent problem of modern healthcare.

OBJECTIVE

To evaluate the effect of physical training using a stabiloplatform and a standard scheme of medical rehabilitation on the restoration of the walking stereotype, the state of locomotor function and hemodynamic parameters of the affected lower limb in patients after total knee replacement in the late recovery period.

MATERIAL AND METHODS

60 patients were examined three months after total arthroplasty of the joints of the lower limb aged 55 to 80 years, who were divided into two groups comparable in clinical and functional characteristics: the 1^st group - 30 people, who in addition to the standard scheme of medical rehabilitation, were trained using a stabilometric complex with biofeedback for recovery functions of balance and symmetry of movements; the 2^nd group - 30 people, who have undergone a course of medical rehabilitation (physical therapy and medical massage according to the standard method). The state of the microcirculatory bed in the affected limb was assessed using laser Doppler flowmetry, data on static-locomotor disorders (before and after treatment) were analyzed.

RESULTS

The data obtained indicate the advantage of including physical training aimed at restoring impaired locomotor function, balance and symmetry of movements in the standard scheme of medical rehabilitation of patients after total knee replacement of the lower limb. In the course of the study, it was revealed that training with biofeedback helps to improve the overall capillary blood flow in the affected lower limb and normalize the indicators of static-locomotor functions.

CONCLUSION

The inclusion of physical training to restore static balance and symmetry of movements in the standard complex of medical rehabilitation of patients after total knee replacement in the late recovery period significantly improves microcirculation in the affected limb and normalizes motor functions and skills.

[The use of rehabilitation programs for patients in the early recovery period after total knee arthroplasty]

Rehabilitation of patients after total knee arthroplasty is still a challenge for modern medicine. At the same time, there are few publications in the medical literature on rehabilitation programs for patients after total knee arthroplasty. Available scientific studies have proven the effectiveness of low-intensity laser therapy and a pulsed low-frequency electrostatic field (PLFEF) in tissue repair by modulating the inflammatory process and relieving pain.

OBJECTIVE

Scientific substantiation of the feasibility of the combined use of low-intensity laser radiation (LILR) and PLFEF in patients after total knee arthroplasty.

MATERIAL AND METHODS

90 patients aged from 55 to 80 years after total knee arthroplasty were examined. All patients were randomly assigned to three groups. Patients of the 1st group underwent therapeutic exercises with an instructor and low-intensity laser exposure; in the 2nd group, therapeutic exercises with an instructor, low-intensity laser therapy, and PLFEF were performed without a time interval; patients of the 3rd group received only therapeutic exercises with an instructor.

RESULTS

After the course of treatment, a positive dynamics of the state of microcirculation was noted in all patients, which correlated with a significant regression of the pain syndrome and an improvement in the performance of the 10-meter walk test with external support on crutches. However, a more significant decrease in pain intensity after the first procedures and at the end of the course of treatment was found in the group of patients who received complex therapy, which included LILR, PLFEF, and therapeutic exercises.

CONCLUSION

Thus, based on the data of this study, it is possible to recommend the combined use of LILR and PLFEF for the treatment of patients after total knee arthroplasty.

Detection of Changes on Parameters Related to Heart Rate Variability after Applying Current Interferential Therapy in Subjects with Non-Specific Low Back Pain

Interferential current therapy (ICT) is an electrotherapeutic intervention that combines the advantages of high permeability from middle frequency currents and efficient tissue stimulation from low frequency currents, delivering the maximum current with high tissue permeability. The aim was to evaluate the effects of ICT on heart rate variability (HRV) and on pain perception in patients with non-specific chronic low back pain (NSCLBP). In the study, 49 patients with NSCLBP were randomly divided into an experimental (EG) and a sham group (SG). All participants received a single intervention, ICT, or simulated intervention. Outcome measures including baseline (sit-down position) and postintervention (prone position) pain, heart rate (HR), time domain parameter (rMSSD), diameters of the Poincaré plot (SD1, SD2), stress score (SS), and sympathetic/parasympathetic (S/PS) ratio were investigated. In both groups, significant statistical differences were found in perceived pain and in all HRV parameters except in HRmax. Between-group comparisons showed statistically significant differences in all variables except for HRmin and HRmean in favor of the experimental group. These changes reported an increase in parasympathetic activity (rMSSD) (p < 0.05) and a decrease in sympathetic activity (increase in SD2 and decrease in SS) (p < 0.001) and perceived pain (p < 0.001), with a greater size effect (η2 = 0.44) in favor of the experimental group. In conclusion, a single session of ICT can shift the autonomic balance towards increase parasympathetic dominance and decrease the sympathetic dominance and intensity of pain perceived by patients with NSCLBP.

Interferential current and photobiomodulation in knee osteoarthritis: A randomized, placebo-controlled, double-blind clinical trial

OBJECTIVES

To evaluate the effects of interferential current and photobiomodulation in patients with knee osteoarthritis.

DESIGN

A randomized, placebo-controlled, double-blind clinical trial.

SETTING

Physiotherapy Clinic of City University of São Paulo.

SUBJECTS

A total of 184 patients with knee osteoarthritis were recruited and, of these, 168 were included and randomized into four groups with 42 each: interferential current, photobiomodulation, interferential current plus photobiomodulation or placebo groups. One hundred and sixty-four patients completed the study.

INTERVENTION

Patients received 12 sessions (three times a week) of treatment: 30 minutes of interferential current (active or placebo) followed by photobiomodulation (active or placebo).

MAIN MEASURES

Primary outcome: pain intensity at rest and during movement (numeric rating scale) after 12 sessions. Secondary outcomes: functional capacity (Timed Up & Go and Sit and Lift tests and Lequesne and WOMAC questionnaires), pressure pain threshold, conditioned pain modulation, and muscle strength production (isokinetic evaluation). Patients were assessed at baseline, after 12 sessions, and three and six months after the end of the treatment.

RESULTS

Interferential current plus photobiomodulation reduced pain intensity at rest and during movement compared to placebo and interferential current at all time points (P < 0.05). Photobiomodulation reduced pain intensity at rest compared to placebo at all time points (P < 0.05) and compared to interferential current at six months follow-up (P < 0.05). Photobiomodulation reduced pain intensity during movement compared to placebo at six months follow-up (P < 0.05).

CONCLUSION

Interferential current plus photobiomodulation or isolated photobiomodulation improve pain intensity in knee osteoarthritis.

Low Level Laser Therapy in Knee Osteoarthritis: A Narrative Review

Knee osteoarthritis (KOA) is the most common musculoskeletal disorder, especially in middle up to old age. KOA also results in many complications like changes in gait. Nowadays, changes in lifestyle and the reduced physical activity make people more vulnerable to KOA. Therefore, considering the increasing prevalence of KOA in many societies and the costs imposed on the afflicted people and their governments, providing conservative management approaches with a view to saving time and money is important. There are an assortment of conservative strategies in the management of KOA including low level laser therapy (LLLT). Since the introduction of lasers in the medical field in 1960, various types of lasers with widespread administration programs are used for medical conditions from cosmetics to surgery. However, there are conflicting findings on the application of lasers in osteoarthritis. To discuss the basis of the highest level of evidence, only systematic reviews with or without meta-analyses published up to January 2019 were included in the present work. In this regard, Scopus, PEDro, Medline, ISI Web of Science, Cochrane, PubMed, Irandoc, Iran Medex, Magiran, and SID were searched to retrieve articles in English or Persian. A total of 22 systematic reviews and meta-analyses were found, 14 of which were included in this study. The accepted articles were published between 1991 and up to 2019. The purpose of this narrative review was to investigate the effect of LLLT on pain and function in subjects with KOA. The result of the present review may help clinicians in making evidence-based decisions on optimal care in relation to administering LLLT.