Preliminary results of integrated therapy for patients with knee osteoarthritis

Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Arthritis & Rheumatology (Impact Factor: 7.76). 12/2005; 53(6):812-20. DOI: 10.1002/art.21590
Source: PubMed


To investigate the effects of integrated therapy on the functional status of patients with knee osteoarthritis (OA).
A total of 140 subjects with bilateral knee OA (Altman grade II) were randomized sequentially into 4 groups (groups I-IV). Group I received isokinetic exercises; group II received isokinetic exercise and pulse ultrasound for periarticular soft tissue pain; group III received isokinetic exercise, pulse ultrasound, and intraarticular hyaluronan therapy; and group IV acted as the control group. The therapeutic effects of the interventions were evaluated by changes in Lequesne's index, knee range of motion, peak muscle torques of knee flexion and extension, and ambulation speed after 8 weeks of treatment and at followup 1 year later. In addition, changes in visual analog scale pain and rates of attrition in each group were also recorded.
Patients in groups I-III exhibited increased muscle peak torques and significantly reduced pain and disability after treatment and at followup. Groups II and III showed significant improvements in range of motion and ambulation speed after treatment. Group III also showed the greatest increase in walking speed and decrease in disability after treatment and at followup. Both group II and group III had significant gains in muscular strength after treatment and at followup; group III showed the greatest gains.
An integrated therapy deals with the extra- and intraarticular progressive pathologic changes, and kinesiologic management of OA is suggested for the management of knee OA.

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Available from: Rei-Cheng Yang, Oct 08, 2015
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    • "Low intensity pulsed US (varying from 0.375 to 0.625 W/cm2  delivered over 10 to 24 sessions) appeared to produce greater benefit and eliminated the heterogeneity of the pooled data [5, 6]. However these results must be interpreted with caution because only 3 of the 6 trials available for synthesis used low intensity pulsed US [27, 31, 32], and these were all conducted by the same research group. A systematic review published in 2012 added one new trial to the meta-analysis (387 participants; pulsed or continuous US) and found statistical and clinical improvements in both pain and physical function [7]. "
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    ABSTRACT: Recent high-level evidence favours therapeutic ultrasound (US) for reducing pain in people with knee osteoarthritis (OA). It is unknown how current practice patterns align with current evidence regarding US efficacy and whether physical therapists perceive a need for further high-level evidence. We conducted a descriptive electronic survey to characterize the beliefs and use of US among physical therapists in Ontario treating people with nonsurgical knee OA. Most of the 123 respondents (81%) reported at least some use of US with 45% using it often or sometimes. The main goal for using US was to reduce pain in the surrounding soft tissue (n = 66) and/or the knee joint (n = 43). Almost half (46%) endorsed the belief that US is likely to be beneficial for clients with nonsurgical knee OA. Most respondents (85%) expressed interest in the results of a randomized controlled trial evaluating the effectiveness of US on pain and physical function. Patterns of use reflect the respondents' belief that US is likely to be beneficial for knee OA pain.
    The Scientific World Journal 06/2013; 2013:348014. DOI:10.1155/2013/348014 · 1.73 Impact Factor
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    • "Here, we discuss our findings in the light of some recent intervention studies in this research area. Periarticular muscles may help to stabilize the knee during gait (Huang et al., 2005b). As OAk patients show a decrease in quadriceps strength, it is believed that further deterioration may be prevented by means of improving knee extensor strength through strengthening exercises. "
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    ABSTRACT: The effectiveness of exercise to reduce pain and improve functioning in osteoarthritis of the knee (OAk) is well substantiated. Underlying mechanisms are still under debate and better understanding of the pathways involved may contribute to more targeted treatment strategies. The present qualitative analysis of the literature aims to provide an overview of theoretical models that are put forward to explain the beneficial treatment effects of exercise in OAk. An inductive qualitative approach, based on the 'grounded theory' of Glaser and Straus, was used. Twenty-two studies emphasizing on exercise therapy for OAk, collected from three Cochrane reviews and nine guidelines of the Physiotherapy Evidence Database (PEDRO) published between 2000 and 2012, were included. The introduction and discussion parts of these papers were screened for explanations of exercise-induced benefits in OAk patients. Seventy-three key points were identified which were subdivided into 16 core theoretical concepts. Finally, 5 categories were formed: neuromuscular, peri-articular, intra-articular, psychosocial components, and general fitness and health. We referred to scientific evidence that was used in the included studies to describe and categorize the concepts. Future research on exercise in OAk should allow distinguishing the contribution of different potential pathways to the treatment effects.
    Ageing research reviews 01/2013; 12(1):226-236. DOI:10.1016/j.arr.2012.09.005 · 4.94 Impact Factor
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