Physical Agent Modalities in Early Osteoarthritis: A Scoping Review

Pulsed electromagnetic fields inhibit IL-37 to alleviate CD8+ T cell dysfunction and suppress cervical cancer progression

Pulsed electromagnetic field (PEMF) therapy is a potential non-invasive treatment to modulate immune responses and inhibit tumor growth. Cervical cancer (CC) is influenced by IL-37-mediated immune regulation, making PEMF therapy a potential strategy to impede CC progression. This study aimed to elucidate the effects of PEMF on IL-37 regulation and its molecular mechanisms in CC. CC cell-xenografted mouse models, including IL-37 transgenic (IL-37tg) mice, were used to assess tumor growth through in vivo fluorescence imaging and analyze CC cell apoptosis via flow cytometry. TCGA-CESC transcriptome and clinical data were analyzed to identify key inflammation and immune-related genes. CD8+ T cell models were stimulated with PEMF, and apoptosis, oxidative stress, and inflammatory factor expression were analyzed through RT-qPCR, Western blot, and flow cytometry. PEMF treatment significantly inhibited IL-37 expression (p < 0.05), promoted inflammatory factor release (TNF-α and IL-6), and activated oxidative stress, leading to increased CC cell apoptosis (p < 0.05). IL-37 interaction with SMAD3 impacted the p38/NF-κB signaling pathway, modulating CD8+ T cell activity and cytotoxicity. Co-culture of Hela cells with CD8+ T cells under PEMF treatment showed reduced proliferation (by 40%), migration, and invasion (p < 0.05). In vivo experiments with CC-bearing mice demonstrated that PEMF treatment downregulated IL-37 expression (p < 0.05), enhanced CD8+ T cell function, and inhibited tumor growth (p < 0.05). These molecular mechanisms were validated through RT-qPCR, Western blot, and immunohistochemistry. Thus, PEMF therapy inhibits CC progression by downregulating IL-37 and improving CD8+ T cell function via the SMAD3/p38/NF-κB signaling pathway.

Effectiveness of multimodal active physiotherapy for chronic knee pain: a 12-month randomized controlled trial follow-up study

Active physiotherapy (APT) embraces a patient-centered approach, prioritizing self-management within the biopsychosocial model and involving active patient movements. Beyond structured exercise, APT incorporates pain neuroscience education, Mulligan Mobilization (MWM), and active myofascial release techniques to integrate sensory-motor information for functional recovery and pain relief. This study aims to rigorously compare the effectiveness of APT versus conventional physical therapy (CPT) on pain and functional outcomes in patients with chronic knee pain. Eighty-seven patients with symptomatic and radiographically confirmed knee pain were included in this 12-month follow-up of a randomized controlled trial, conducted at a national institute and a rehabilitation clinic. Patients were randomized to either APT (n = 44) or CPT (n = 43). The APT protocol integrated pain neuroscience education, MWM, active myofascial release techniques, and structured exercises focusing on flexibility, stability, neuromuscular control, and coordination. The CPT protocol included health education, laser therapy, ultrasound therapy, and exercise. Both interventions were performed for 60 min twice a week for 3 months. The primary outcome was the Knee Injury and Osteoarthritis Outcome Score-4 domain version (KOOS4). Secondary outcomes included pain intensity (VAS), KOOS-pain, activities of daily living (ADL), function in sport and recreation (Sports/Rec), knee-related quality of life, global rating of change (GROC), quality of life (SF-36), Tampa Scale for Kinesiophobia (TSK), and functional performances measured at different intervals. Intention-to-treat analyses were performed. Of the 87 patients, 70 (80.5%) completed the 12-month follow-up. KOOS4 improved more in the APT group (16.13; 95% CI, 10.39-21.88) than in the CPT group (11.23; 95% CI, 5.42-17.04). APT showed additional improvement in KOOS4 compared to CPT (2.94; 95% CI: 0.04 to 5.85, p = 0.047). The VAS difference was -3.41 mm (95% CI: -6.40 to -0.43, p = 0.025), favoring APT. APT also showed more improvements in KOOS-pain, KOOS-ADL, KOOS-Sports/Rec, and TSK (p < 0.05). No differences between groups were observed in GROC and SF-36. APT significantly improved most functional performance variables compared to CPT (p < 0.05). Active Physiotherapy outshines conventional physical therapy by delivering more substantial reductions in pain intensity and marked enhancements in function among patients with knee pain. This distinctive efficacy underscores the invaluable role of APT in the management of chronic knee pain. By actively involving patients in their recovery journey, APT not only fosters superior results but also emphasizes the critical need to integrate these advanced therapeutic strategies into everyday clinical practices.

Long COVID Cardiopulmonary Symptoms and Health Resort Treatment: A Retrospective Study

Background/Objectives: Long COVID covers many cardio-pulmonary symptoms, worsening individuals' health status. Health resort treatment applies balneological factors, physical medicine modalities, climate actions, and exercises that may be beneficial for COVID-19 survivors. This study aimed to assess the severity of the cardiopulmonary symptoms in people qualified for health resort treatment and its efficacy in this group of patients. Methods: Medical records of 239 people attending health resort treatment were analysed. A total of 122 people (71 women and 51 men) with a mean age of 64.35 years ± 8.66 years were enrolled in the analysis. The cardiopulmonary symptoms of long COVID were assessed twice: before and after health resort treatment. Results: Persisting COVID-19 symptoms do not differentiate between women and men. Health resort treatment reduces symptoms severity in both sexes. Age does not mediate the efficacy of health resort treatment. Conclusions: The persistent symptoms of COVID-19 are of low intensity in people qualified for health resort treatment and are independent of gender. Health resort treatment effectively mitigates dyspnoea, tightness of chest, and sputum in long COVID patients, so it should be implemented into the standard treatment course for COVID-19 survivors as a continuation of therapy.

A bibliometric analysis of the application of physical therapy in knee osteoarthritis from 2013 to 2022

Background

Knee osteoarthritis (KOA) is one of the most common chronic joint diseases. Physical therapy, a non-invasive approach, is extensively used in its treatment. Although bibliometrics is a reliable method to evaluate the significance and impact of research fields, systematic bibliometric analyses in this area are lacking. This study aims to perform a bibliometric analysis covering 2013 to 2022, to highlight the current state, key focuses, and trends in physical therapy for KOA.

Methods

This study utilizes the Web of Science Core Collection to gather relevant literature on physical therapy and KOA from 2013 to 2022. CiteSpace and VOSviewer software facilitated the visual analysis of the annual publications, geographic and institutional distributions, journals, authors, references, and keywords in this field.

Results

The study analyzed 1,357 articles, showing an overall increase in publications over time from 71 countries and 2,302 institutions. The United States and Australia emerged as leaders in this field. The analysis identified 6,046 authors, with Kim L. Bennell as the most prolific and Bellamy N. receiving the most citations. BMC Musculoskeletal Disorders published the most articles, while Osteoarthritis and Cartilage received the most citations. High-impact articles were authored notably by McAlindon TE, Bannuru RR, Fernandes L, and Bennell KL. Keyword analysis highlighted a strong focus on patient self-management, exercise therapy, physical factor therapy, and remote rehabilitation.

Conclusion

The bibliometric analysis confirms significant interest and ongoing research in physical therapy for KOA treatment from 2013 to 2022, indicating a growing field. Journals and authors in this area show influential and collaborative dynamics. Future research should focus on enhancing international and institutional collaboration and explore emerging trends like internet-guided treatments.

Effectiveness of a Single Intra-articular Injection of High-Molecular-Weight Hyaluronic Acid Versus NSAIDs on the Visual Analog Pain Scale and Western Ontario and McMaster Universities Osteoarthritis Index Scores in Patients With Knee Osteoarthritis

OBJECTIVE

This study aimed to determine the effectiveness of a single intra-articular injection of high-molecular-weight (HMW) hyaluronic acid (HA) at a dose of 4 mL/60 mg to reduce pain in people with knee osteoarthritis (OA) over 12 months.

METHODOLOGY

This retrospective study was conducted after obtaining ethical approval from Dhaka Medical College and Hospital, Bangladesh. From July 2020 to June 2021, a medical professional conducted the investigation. The investigation encompassed patients aged 40 to 70 hospitalized at our facility and diagnosed with Grade 2 or Grade 3 knee OA according to the Kellgren-Lawrence grading method. We divided the patients into two categories based on the treatments they received. Patients in Group A received a single injection of HMW HA (60 mg/4 mL) into the joint, along with instructions on activities of daily living, exercise, and painkillers. Group B patients received conservative therapy, which involved the use of nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, therapeutic exercises, and a knee brace during physical activity.

RESULTS

This study compared the efficacy of a single injection of HMW HA in the joint versus NSAIDs for managing OA-related symptoms over 12 weeks. The HA group initially scored similarly to the comparison group. By week three, however, the group receiving HA had considerably higher Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores (p=0.019). This pattern continued through weeks 6 (p=0.044), 9 (p=0.016), and 12 (p<0.001). Similarly, by week 3 (p=0.029), the visual analog scale (VAS) scores, which were initially identical (p=0.120), demonstrated a significant preference for HA, and this preference persisted through weeks 6, 9, and 12 (all p<0.001). The results show that by the third week, HA is more effective than NSAIDs at relieving pain and improving symptoms.

CONCLUSION

The study's results indicated that over 12 weeks, the use of HMW HA led to statistically significant reductions in pain intensity, as measured by the VAS. Furthermore, HMW HA demonstrated a more significant improvement in WOMAC ratings, which assess physical function, stiffness, and pain, compared to NSAIDs. The findings suggest that administering HMW HA injections can significantly reduce symptoms and improve functionality in individuals with knee OA.

Efficacy of Combining Whole-body Vibration Training and Closed Kinetic Chain Exercises in Early Knee Osteoarthritis: A Preliminary Study

Objectives

We aimed to conduct a preliminary evaluation of the effectiveness of integrating whole-body vibration training (WBVT) into conventional closed kinetic chain (CKC) exercises as an intervention strategy for early knee osteoarthritis (KOA).

Methods

: This non-randomized comparative study conducted at an orthopedic clinic involved 53 patients (with Kellgren-Lawrence grades 1-2); 37 patients received only physical therapy (CKC group), and 16 patients received both physical therapy and WBVT (WBVT group). The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscale score for pain, and the secondary outcomes were the WOMAC subscale score for physical function and muscle-strength assessments [isometric knee extension strength and the 30-second chair-stand test (CS-30) score]. Propensity score matching (PSM) was used to adjust for bias between the control and intervention groups.

Results

: After PSM adjustment, 13 patients were selected from each group. The WBVT group showed a significant improvement in the WOMAC pain score (d=1.16, P=0.007) and a significant increase in the CS-30 score (d=0.81, P=0.049). However, for the WOMAC physical function score, the between-group difference remained statistically insignificant (d=0.59, P=0.146).

Conclusions

: WBVT may be effective in reducing the pain of early KOA. WBVT is a non-invasive and convenient method, underscoring its potential as a novel therapeutic option.

Ultrasound-guided gluteal nerves electrical stimulation to enhance strength and power in individuals with chronic knee pain: a randomized controlled pilot trial

Introduction

Various pathophysiological contexts can be accompanied by weakness, arthrogenic muscle inhibition, and even disability. In this scenario, peripheral nerve stimulation has been studied not only for pain management but also for the improvement of neuromuscular parameters. For this purpose, the use of Transcutaneous Electrical Nerve Stimulation (TENS) has typically been investigated, but recently, the use of ultrasound-guided percutaneous peripheral nerve stimulation (pPNS) has gained popularity. In this regard, electrical stimulation has a predisposition to activate Type II muscle fibers and has been shown to be capable of generating short-term potentiation by increasing calcium sensitivity. However, the evidence of pPNS applied in humans investigating such variables is rather limited.

Objectives

This pilot study aimed to assess the feasibility of the methodology and explore the potential of pPNS in enhancing hip extension performance in individuals suffering from knee pain, comparing it with TENS.

Methods

Twelve participants were divided into pPNS and TENS groups, undergoing pre- and post-intervention assessments of peak concentric power (W), strength (N), execution speed (m/s), and one-repetition maximum (1RM) (kg) estimation. For pPNS, two needles were positioned adjacent to the superior and inferior gluteal nerves under ultrasound guidance. For TENS, electrodes were positioned between the posterosuperior iliac spine and the ischial tuberosity, and halfway between the posterosuperior iliac spine and the greater trochanter. The interventions consisted of 10 stimulations of 10 s at a frequency of 10 Hz with a pulse width of 240 μs, with rest intervals of 10 s between stimulations.

Results

Peripheral nerve stimulation significantly improved concentric power at 30% (p = 0.03) and 50% (p = 0.03) of 1RM, surpassing TENS, which showed minimal changes. No significant strength differences were observed post-intervention in either group.

Conclusion

This work presents evidence where pPNS applied to the gluteal nerves results in an enhanced performance of hip extension at submaximal loads. However, this improvement does not seem to be reflected in short-term changes in the estimation of the 1RM by the force-velocity profile.

Evaluation of single and multiple hyaluronic acid injections at different concentrations with high molecular weight in the treatment of knee osteoarthritis

BACKGROUND

Knee osteoarthritis is severe progressive and most commonly diagnosed articular disease and its incidence is increasing around the world depending on age. This pathologic condition which limits daily activity of patients can be characterized by degeneration of cartilage and inflammation. Although non-steroidal anti-inflammatory (NSAII) agents and other analgesics are routinely used treatment options, the potential effects of intraarticular injections including hyaluronic acid (HA) have also been demonstrated by various studies. However, few studies compare the efficacy of a single high molecular weight (HMW) high dose and a triple HMW low dose. This study aimed to compare the efficacy of single high molecular weight (HMW) high dose (2 mL / 60 mg) and triple HMW low dose (2 mL /30 mg) intra-articular injection of HA in knee osteoarthritis (OA) patients by evaluating function and pain parameters during 12 months.

METHODS

This is a single-center, retrospective clinical study that included and involved 128 patients. Group I (n=64) patients received triple 30 mg HA injections (SEMICAL®) with one-week intervals, while Group II (n=64) patients received a single 60 mg HA injection (SEMICAL®). Lequesne Index, WOMAC and VAS scores were recorded to assess pain and function during a 12-month period.

RESULTS

There was no significant difference in characteristics of patient demographics. Our finding indicate that WOMAC, VAS score, and Lequesne Index values during follow-up visits exhibited a decrease, signifying improvement in the clinical condition. Notably, scores were significantly more favorable with the 30 mg of HA injection compared to the 60 mg of HA injection.

CONCLUSION

This study suggests that the triple low-dose injection of HMW HA is more effective in improving WOMAC, VAS scores and Lequesne Index values than a single high-dose injection.

Effectiveness of cryo plus ultrasound therapy versus diathermy in combination with high-intensity laser therapy for pain relief in footballers with muscle injuries: A prospective study

BACKGROUND

Muscle injuries are common traumatic events in the clinical practice of the rehabilitation field. There is still a gap in the scientific literature on the effectiveness of physical agent modalities in the management of muscle injuries in athletes.

OBJECTIVE

The aim of this study was to assess the effectiveness of cryo plus ultrasound therapy com-pared to diathermy in combination with high-intensity laser therapy (HILT) for pain relief in professional footballers with muscle injuries.

METHODS

A case-control study was conducted on 31 professional footballers with a muscle injury of the lower limbs. Of these, 17 patients, assigned to a Group A (AG), were treated with HILT and cryoultrasound therapy; the remaining 14 patients, assigned to a Group B (BG), underwent HILT and diathermy. We assessed the extent of the pain, the size of the muscle injury, frequency of recurrence and number of days to recovery, at the time of recruitment, at the end of the rehabilitation and 3 months after the injury.

RESULTS

Group A athletes had a greater benefit on pain (4.65 ± 0.61 vs 3.24 ± 0.63; p< 0.05) and muscle injury recurrence. The return to play in the athletes of group A took place 4.73 days earlier.

CONCLUSION

HILT and cryo plus ultrasound therapy, in combination with therapeutic exercise, rep-resent a valid strategy in the treatment of muscle injuries in professional footballers.

Devices for osteoarthritis symptoms treatment: a patent review

INTRODUCTION

Osteoarthritis is a musculoskeletal disease that can lead to the loss and inability of those affected to perform normal daily functions, which leads to a decrease in quality of life. The main symptoms of osteoarthritis are tenderness, joint pain, stiffness, crepitus, limited movement, and local inflammation.

AREAS COVERED

The selected patents were deposited from 2010 to April 2022 involving 57 documents that were in line with the study objective in the final selection. The patents were classified in years, country, and applicants. Also, the therapeutic fields that presented the most documents were electrical stimulation, phototherapy, and ultrasound, followed by magnetic, electromagnetic, and thermotherapy. Therefore, the most current therapies used in the documents are already on the market.

EXPERT OPINION

Although the OA is cureless, non-surgical treatments are classified as the primary management approach for this disease. The pharmacological and non-pharmacological therapies are employed to reduce its prevalence and ensure the effectiveness of treatments. A strategy for relieving OA symptoms is non-pharmacological treatment, which can be based on exercise and patient education, combined with other alternative therapies. These therapies are used as supplements to the main OA treatments, enhancing the effectiveness of treatment outcomes.

Pulsed Electromagnetic Fields (PEMF)-Physiological Response and Its Potential in Trauma Treatment

Environmental biophysical interactions are recognized to play an essential part in the human biological processes associated with trauma recovery. Many studies over several decades have furthered our understanding of the effects that Pulsed Electromagnetic Fields (PEMF) have on the human body, as well as on cellular and biophysical systems. These investigations have been driven by the observed positive clinical effects of this non-invasive treatment on patients, mainly in orthopedics. Unfortunately, the diversity of the various study setups, with regard to physical parameters, molecular and cellular response, and clinical outcomes, has made it difficult to interpret and evaluate commonalities, which could, in turn, lead to finding an underlying mechanistic understanding of this treatment modality. In this review, we give a birds-eye view of the vast landscape of studies that have been published on PEMF, presenting the reader with a scaffolded summary of relevant literature starting from categorical literature reviews down to individual studies for future research studies and clinical use. We also highlight discrepancies within the many diverse study setups to find common reporting parameters that can lead to a better universal understanding of PEMF effects.

A scalable 12-week exercise and education programme reduces symptoms and improves function and wellbeing in people with hip and knee osteoarthritis

Introduction

Osteoarthritis is a chronic musculoskeletal condition that impacts more than 300 million people worldwide, with 43 million people experiencing moderate to severe disability due to the disease. This service evaluation provides the results from a tailored blended model of care on joint health, physical function, and personal wellbeing.

Methods

1,593 adult participants with osteoarthritis completed the Nuffield Health Joint Pain Programme between February 2019 and May 2022. The 12-week programme included two 40-min exercise sessions per week. All exercise sessions were conducted face-to-face and were followed by 20 min of education to provide information and advice on managing osteoarthritis.

Results

The 12-week joint pain programme significantly improved Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) global scores (Week 0: 37.5 [17.2]; Week 12: 24.0 [16.6]; p < 0.001), as well as subscales for pain (Week 0: 7.6 [3.7]; Week 12: 4.9 [3.7]; p < 0.001), function (Week 0: 26.0 [13.0]; Week 12: 16.3 [12.4]; p < 0.001), and stiffness (Week 0: 3.9 [1.6]; Week 12: 2.8 [1.7]; p < 0.001). Significant improvements in health-related outcomes including systolic and diastolic blood pressure (Week 0: 139 [18] mmHg; Week 12: 134 [17] mmHg, and Week 0: 82 [11] mmHg; Week 12: 79 [19] mmHg; both p < 0.001), body mass index (Week 0: 29.0 [4.5] kg/m2; Week 12: 28.6 [4.4] kg/m2; p < 0.001), waist to hip ratio (Week 0: 0.92 [0.23]; Week 12: 0.90 [0.11], p < 0.01) and timed up and go (Week 0: 10.8 s [2.9]; Week 12: 8.1 s [2.0]; p < 0.001) were also observed. On completion of the joint pain programme, participants also reported significant improvements in all assessed aspects of self-reported wellbeing (all p < 0.001).

Discussion

With reductions in physical symptoms of osteoarthritis and improvements in personal wellbeing, the joint pain programme delivered by personal trainers in a gym-setting offers a nationally scalable, non-pharmacological treatment pathway for osteoarthritis.

Passive stiffness of the quadriceps predicts the incidence of clinical knee osteoarthritis in twelve months

BACKGROUND

Quadriceps weakness is a known risk factor for the onset of knee osteoarthritis (OA). In addition to muscle weakness, increased passive stiffness of the quadriceps may affect knee biomechanics and hence contribute to the pathogenesis of knee OA. However, the association between quadriceps stiffness and the risk of knee OA development has not been prospectively investigated.

AIM

The aim of this study was to investigate how baseline quadriceps passive stiffness predicts the incidence of clinical knee OA at the 12-month follow-up.

DESIGN

Prospective cohort study.

SETTING

University laboratory.

POPULATION

Community-dwelling adults aged 60-80 years were recruited. We excluded participants with: 1) knee pain or known arthritis; 2) knee injury; 3) knee or hip joint replacement, 4) cognitive impairment; or 5) neurological conditions.

METHODS

At baseline, passive stiffness of the three superficial quadriceps muscle heads (rectus femoris [RF], vastus lateralis [VL], and vastus medialis oblique [VMO]) was evaluated using shear-wave ultrasound elastography. Knee muscle (quadriceps and hamstrings) strength was tested using a Cybex dynamometer. Knee OA was defined based on clinical criteria 12 months after baseline measurements. Generalized estimating equations were used to examine the associations of quadriceps stiffness and knee muscle strength with the risk of knee OA, controlling for age, sex, Body Mass Index, comorbidities, and activity level.

RESULTS

The analyses included 158 knees (58.2% females, age: 65.6±4.1 years). Twenty-eight knees (17.7%) were classified as having clinical OA at 12 months. Compared with the lowest stiffness tertiles, the highest stiffness tertiles of the RF (relative risk =5.31, 95% CI: 1.34-21.0), VMO (4.15, 1.04-16.6), and total superficial quadriceps (6.35, 1.48-27.3) at baseline were significantly associated with a higher risk of knee OA at the follow-up. The highest strength tertile of quadriceps has a trend of association with a lower risk of knee OA than the lowest tertile (0.18, 0.03-1.25, P=0.083).

CONCLUSIONS

Greater passive stiffness of the quadriceps at baseline was associated with a higher risk of clinical knee OA incidence at the 12-month follow-up.

CLINICAL REHABILITATION IMPACT

Interventions for reducing the passive stiffness of the quadriceps should be included in preventative training programs for older adults.

Intra-Articular Injection of Botulinum Toxin for the Treatment of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials

The purpose of the present paper was to review the available evidence on intra-articular botulinum toxin (BTX) injection in the treatment of knee osteoarthritis and to compare it to other conservative treatment options. A systematic review of the literature was performed on the PubMed, Scopus, Cochrane Library, Web of Science, Pedro and Research Gate databases with the following inclusion criteria: (1) randomized controlled trials (RCTs), (2) written in the English language, and (3) published on indexed journals in the last 20 years (2001-2021) dealing with the use of BTX intra-articular injection for the treatment of knee OA. The risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs. Nine studies involving 811 patients in total were included. Patients in the control groups received different treatments: conventional physiotherapy, hyaluronic acid injection or prolotherapy or a combination thereof in 5 studies, steroid infiltrative therapy (triamcinolone) in 1 study, placebo in 2, and local anesthetic treatment in 1 study. Looking at the quality of the available literature, two of the included studies reached "Good quality" standard, three were ranked as "Fair", and the rest were considered "Poor". No major complications or serious adverse events were reported following intra-articular BTX, which provided encouraging pain relief, improved motor function, and quality of life. Based on the available data, no clear indication emerged from the comparison of BTX with other established treatments for knee OA. The analysis of the available RCTs on BTX intra-articular injection for the treatment of knee OA revealed modest methodological quality. However, based on the data retrieved, botulinum toxin has been proven to provide good short-term outcomes, especially in patients with pain sensitization, by modulating neurotransmitter release, peripheral nociceptive transduction, and acting on the control of chronic pain from central sensitization.

The effects of low-level laser therapy on muscle strength and functional outcomes in individuals with knee osteoarthritis: a double-blinded randomized controlled trial

The purpose of this study was to compare the therapeutic effects of low-level laser therapy (LLLT) with 808 and 660 nm wavelength on muscle strength and functional outcomes in individuals with knee osteoarthritis (OA). A total of 47 participants were randomly assigned to the 808 nm, 660 nm, and sham control groups. Two LLLT groups received continuous LLLT with a mean power of 300 mW in different wavelengths at the knee joint 15 min a session three days per week for eight weeks, while the control group received the sham LED treatment. The knee strength and functional performance involving 30-s sit-to-stand, 40 m fast-paced walk, stair climbing, and the TUG test were measured at the baseline and one week after the interventions were completed. The results showed that knee extensor strength was more improved in the 808 nm group as compared to the 660 nm group (p < 0.001, d = 0.57) and the sham control (p < 0.001, d = 0.40), while increased flexor strength was demonstrated in the 808 nm (p = 0.009, d = 0.67) and sham control groups (p < 0.001, d = 0.97). The number of 30-s sit-to-stand was increased only in the 660 nm group (p = 0.006, d = 0.49). All three groups exhibited improvements in the other three functional performance-based tests after the interventions with no statistically significant differences among the groups. In conclusion, both intervention groups improved muscle strength and functional performance as compared to the control group. The 808 nm wavelength group showed better results in knee extensor strength. Therefore, laser therapy is suggested to be integrated into rehabilitation programs to improve muscle strength and functional performance in the population with knee OA.

What is the believability of evidence that is read or heard by physical therapists?

BACKGROUND

Physical therapists obtain information from a variety of sources. The sources may influence their believability and use in clinical practice.

OBJECTIVES

In this hypothesis-based study, we queried physical therapists (PTs) on the believability of evidence across six musculoskeletal treatment domains and analyzed variables that predicted the strength of beliefs.

METHODS

This international survey included six different language portals and used a snowball dispensation strategy. PTs who were credentialed, licensed, or who practiced in the field, were queried on the believability of six treatment domains (i.e., exercise, manual therapy, psychologically-informed practice, sports/occupational performance, thermal/electrical agents, and pain science/patient education) and potential predictors of believability (i.e., social media use, years of practice, time and access to literature, specialization, confidence in reviewing literature and attributions of the researcher).

RESULTS

In total, 1098 PTs from 36 countries completed the survey. PTs had strong beliefs in what they read or hear about exercise, sports/occupational performance, pain science/patient education, and psychologically-informed interventions. There was only moderate believability regarding manual therapy treatment and weak believability associated with thermal/electrical agents. Multiple linear regression analyses revealed that the most robust predictor to outcome relationships included time and access to literature and believability of pain science/patient education, years of clinical practice and believability of psychologically informed practice, and believability of thermal/electrical agents.

CONCLUSION

An important takeaway from this study is that believability was influenced by several factors (primarily by years of practice, attributions of the researcher, and time and access to literature) and appeared to vary across treatment domains.

Effectiveness of Interventions Based on Pain Neuroscience Education on Pain and Psychosocial Variables for Osteoarthritis: A Systematic Review

Osteoarthritis (OA) is the most common joint condition. It affects more than 300 million people worldwide, who suffer from pain and physical disability. Objective: To determine the results of cognitive educational interventions for pain management and psychosocial variables in adults with OA. Method: A systematic review was conducted based on searches in MEDLINE, OVID, LILACS, Scopus, PEDro, OTseeker, The Cochrane Library, EBSCO, and Google Scholar. The search strategy included the main terms neuroscience education and osteoarthritis, without any re-strictions with regard to dates or study type (PROSPERO register CRD42021222763). Results: We included four articles that implemented the intervention in 1–6 sessions, addressing concepts related to goal orientation and providing strategies for understanding pain. The results suggest that there is an improvement between the groups (PNE) when compared, but this cannot necessarily be attributed to pain neuroscience education (PNE), as small effect sizes for variables such as pain catastrophizing and kinesiophobia were observed. The response in the modulation of acute pain following the surgical procedure may produce a variation in the responses and this may be mediated by medications. Conclusion: The study revealed an improvement in favor of the groups managed with PNE, although more studies documenting the topic are warranted.

Challenges and Solutions for Musculoskeletal Disorders in Athletes

The etymology of the word "athlete" derives from the ancient Greek ἀθλητής (athletés, from âthlos that is, fight, competition) [...].

Therapeutic Exercise and Conservative Injection Treatment for Early Knee Osteoarthritis in Athletes: A Scoping Review

Background and Objectives: Recent evidence highlighted a higher prevalence of knee osteoarthritis (kOA) among young and former ex-professional athletes. Although the practice of a highly demanding sport is considered a predisposing factor for the knee joint cartilage degeneration, articular cartilage seems to positively respond to a moderate load increase. We aim to investigate recent evidence on the conservative management of early kOA in athletes, with a particular emphasis on therapeutic exercise and injection treatment, in order to highlight whether there are any indications that can influence clinical and rehabilitation practice. Materials and Methods: A scoping review was conducted, screening MEDLINE and PEDro databases for studies published over the past twenty years on the topic. Studies in English, with accessible abstracts, were included in the review. The PICO framework was used (P—patient: athletes, I—Intervention: conservative treatment with therapeutic exercise or injection therapies, C—Comparison: not needed, O—Outcomes: clinical outcomes). Clinical trials, randomized controlled trials, and longitudinal studies were considered. Results: Four studies were finally included in the review. Therapeutic exercise seems to have beneficial effects on prevention of cartilage degeneration, on pain reduction, and on physical function enhancement. On the other hand, in mild to moderate stages of kOA the intra-articular viscosupplementation with Hyaluronic Acid showed a medium to long-term improvement in joint pain and function. The Platelet Rich Plasma treatment also showed a significant improvement in pain and function up to 12 months. Conclusions: Despite the heterogeneity of the studies considered, a multimodal treatment combining therapeutic exercise and moderate aerobic activity (such as running) should be indicated to prevent kOA development. In cases of symptomatic kOA it may be indicated to add minimally invasive injection therapy that seems to contribute to the improvement of motor function and symptomatology.