Use of Ultrasound to Increase Effectiveness of Isokinetic Exercise for Knee Osteoarthritis

Department of Physical Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Archives of Physical Medicine and Rehabilitation (Impact Factor: 2.57). 09/2005; 86(8):1545-51. DOI: 10.1016/j.apmr.2005.02.007
Source: PubMed


To investigate the effects of ultrasound (US) in isokinetic muscle strengthening exercises on functional status of patients with knee osteoarthritis (OA).
Effectiveness of isokinetic muscle strengthening exercises for treatment of periarticular soft tissue disorders was compared with and without pulsed and continuous US.
Outpatient exercise program in a Taiwan medical university hospital.
One hundred twenty subjects with bilateral knee OA (Altman grade II).
Subjects were randomized sequentially into 1 of 4 groups. Group I received isokinetic muscular strengthening exercises, group II received isokinetic exercise and continuous US, group III received isokinetic exercise and pulsed US treatment, and group IV was the control group.
Therapeutic effects of isokinetic exercise were evaluated by changes in ambulation speed and the Lequesne index. In addition, changes in knee range of motion (ROM), visual analog scale for pain, and muscle peak torques during knee flexion and extension were compared. Compliance in each group was recorded.
Each treated group had increased muscle peak torques and significantly reduced pain and disability after treatment and at follow-up. However, only patients in groups II and III had significant improvement in ROM and ambulation speed after treatment. Fewer participants in group III discontinued treatment due to knee pain during exercise. Patients in group III also showed the greatest increase in walking speed and decrease in disability after treatment and at follow-up. Gains in muscular strength in 60 degrees /s angular velocity peak torques were also noted in groups II and III. However, group III showed the greatest muscular strength gains with 180 degrees /s angular velocity peak torques after treatment and follow-up.
US treatment could increase the effectiveness of isokinetic exercise for functional improvement of knee OA, and pulsed ultrasound has a greater effect than continuous US.

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    • "In the last two decades, many advances have been made in the field of drug delivery, with resulting enhancements in the efficacy and safety of treatment, some of the more dramatic developments are technologies that allow the non-invasive transdermal delivery of several ionizable drugs (Huang et al. 2005). Many treatment options, including non-pharmacological and pharmacological measures, have been recommended in the management of OA. "
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    ABSTRACT: The purpose of this study was to examine the effect of phonophoresis in the management of patients with knee osteoarthritis (OA). Subjects: Sixty male patients with knee OA were assigned randomly into two equal groups .Their ages were ranged from 40-50 years old. Methods: The patients were evaluated for the following parameters: Pain and knee joints kinematics, kinetics and spatiotemporal parameters by 3-D motion analysis Lab before and after three months of treatment program. patients in the control group received selected physical therapy program in the form of stretching exercises, strengthening exercises, transcutaneous electrical nerve stimulation (TENS), ultrasound whereas patients in the study group received the same selected physical therapy program in addition to phonophoresis therapy. The data were collected and analyzed using a paired and un-paired t-test to compare the difference between the results within each group pre test and post test and between the two groups. Results: this study revealed that there were significant differences (p<0.05) of all of the measured variables (pain score, cadence, stride length, knee flexion ROM at stance and swing phase, knee flexion and extension moment) between pre test and post test in the control and experimental groups for right and left knees. There were significant differences between post test of control and experimental groups for right and left knees except knee extension moment there was no significant differences. Conclusion: Phonophoresis has got clear effect when added to treatment program in reducing the pain and improving mechanics of knee joint in patients with osteoarthritis.
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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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    • "It was discovered that therapeutic US frequently used in physiotherapies was more effective than the control treatment, and none of them was found to be superior to any other.[47] The effectiveness of US was also shown by Mao-Hsiung Huang et al., who stated that US treatment could increase the effectiveness of isokinetic exercise for functional improvement of knee OA, and pulsed US had a greater effect than continuous US.[49] "
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    ABSTRACT: Osteoarthritis (OA) is progressive joint disease characterized by joint inflammation and a reparative bone response and is one of the top five most disabling conditions that affects more than one-third of persons > 65 years of age, with an average estimation of about 30 million Americans currently affected by this disease. Global estimates reveal more than 100 million people are affected by OA. The financial expenditures for the care of persons with OA are estimated at a total annual national cost estimate of $15.5-$28.6 billion per year. As the number of people >65 years increases, so does the prevalence of OA and the need for cost-effective treatment and care. Developing a treatment strategy which encompasses the underlying physiology of degenerative joint disease is crucial, but it should be considerate to the different age ranges and different population needs. This paper focuses on different exercise and treatment protocols (pharmacological and non-pharmacological), the outcomes of a rehabilitation center, clinician-directed program versus an at home directed individual program to view what parameters are best at reducing pain, increasing functional independence, and reducing cost for persons diagnosed with knee OA.
    Journal of Pharmacy & Bioallied Sciences 03/2013; 5(1):30-8. DOI:10.4103/0975-7406.106561
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