Does cryotherapy associated with physical exercise add benefits to pain, function and quality of life in knee osteoarthritis? A randomized controlled trial.

Background Osteoarthritis (OA) is the most common rheumatologic disease in the world, resulting primarily in progressive cartilage destruction. OA-induced changes are the main cause of disability and are mostly seen in the knee joint. Objectives To investigate the effects of different rehabilitation practices on the range of motion, muscle strength, pain, physical function and quality of life in patients with knee OA. Methods Thirty patients between the ages of 40-65 with knee OA were included in the study and divided into 3 groups. Transcutaneous Electrical Nerve Stimulation (TENS), ultrasound, hotpack/coldpack and home exercise program were given to the 1. group (n=10) for 15 days. 2. group (n=10) received three doses of Platelet-Rich Plasma (PRP) followed by home exercise program for 15 days. The control group (n=10) received only home exercise program for 15 days. All individuals were evaluated using ‘Goniometer’ for Range of Motion (ROM), ‘Manual Muscle Test’ for M. Quadriceps femoris muscle strength, ‘Visual Analogue Scale’ for pain, ‘The Western Ontario and McMaster Universities Arthritis (WOMAC) Scale’ for physical function and ‘Short Form-12 Quality of Life Scale Mental (SF-12 - MC) and Physical Component (SF-12 - PC)’ for quality of life at baseline and end of treatment. Results Statistically significant difference was found at pain and WOMAC score at the time of activity in all groups (Table 1). Statistically significant difference was found at ROM and SF-12 MC score in group 1 and 2; at resting pain and SF-12 PC score in control group (p Conclusion In addition to electrotherapy treatment and PRP in knee OA treatment, it is thought that home exercise program can be used to relieve symptoms and improve quality of life in knee OA.

Short-term cryotherapy did not substantially reduce pain and had unclear effects on physical function and quality of life in people with knee osteoarthritis: a randomised trial

Knee osteoarthritis is the most common chronic joint disorder in elderly people. However, a population-based, longitudinal study on health-related quality of life in knee osteoarthritis has not been conducted in Japan. We studied 333 women aged 50 years and older at baseline, with 8 to 9 years of follow-up. Anteroposterior weight-bearing knee radiographs were obtained at baseline and graded according to the Kellgren-Lawrence criteria. Definite osteoarthritis was defined as Kellgren-Lawrence grade 2 or higher in at least 1 joint. At baseline, all participants were asked if they had knee pain and comorbidities (heart disease, lung disease, stroke, or diabetes mellitus). Height (m), weight (kg), and chair stand time were measured. At follow-up, quality of life in knee osteoarthritis was evaluated using the Japanese Knee Osteoarthritis Measure score. Multiple linear regression analysis showed that age, knee osteoarthritis, knee pain, comorbidity, and increasing chair stand time were independently related to subsequent health-related quality of life. These findings suggest that treating knee osteoarthritis and comorbidities, managing pain, and optimizing lower extremity muscle strength may be effective targets for intervention.

To observe the clinical efficacy of acupotomy at trigger points combined with meridian sinew manipulation in treatment of early and mid-term knee osteoarthritis (KOA), and investigate whether its therapeutic mechanism is related to the regulation of inflammatory response. Seventy-four patients with early and mid-term KOA were randomly divided into the control group (37 cases, with 2 cases dropouts) and the observation group (37 cases, with 1 case dropout). The control group was treated with meridian sinew manipulation for 30 min each time, 5 times a week, for 4 consecutive weeks. The observation group was given acupotomy at trigger points on the basis of the treatment of control group, once a week, for 4 consecutive weeks. Western Ontario and McMaster University osteoarthritis index (WOMAC) scores, short-form McGill pain questionnaire (SF-MPQ) scores, the medical outcome 36-item short form health survey (SF-36) scores, serum inflammatory factors content before and after treatment were compared between the two groups. The clinical efficacy were assessed after the treatment. Compared with those before treatment, the total scores and the scores of pain, stiffness and activity impairment of WOMAC, the pain rating index (PRI), visual analog scale (VAS) and present pain intensity (PPI) scores of SF-MPQ, and the contents of serum tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10 in both groups were significantly decreased after treatment (P<0.05), while the scores of the physical component summary (PCS) and the mental component summary (MCS) of SF-36 were significantly increased (P<0.05). Compared with the control group, the total scores, scores of pain, stiffness and activity impairment of WOMAC, the PRI, VAS and PPI scores of SF-MPQ, and the contents of serum TNF-α, IL-6 and IL-10 in the observation group were significantly decreased after treatment (P<0.05), while the scores of PCS and MCS of SF-36 were significantly increased (P<0.05). The total effective rate of the observation group was 94.4% (34/36) after treatment, which was significantly higher than that of the control group (74.3%, 26/35, P<0.05). Acupotomy at trigger points combined with meridian sinew manipulation can significantly improve the clinical symptoms such as joint pain, stiffness and limited activity in patients with KOA, improve the quality of life, and its mechanism may be related to reducing the inflammatory response.

Degenerative knee osteoarthritis (KOA) shows an increase in morbidity with improvement in the living conditions and extended lifespans. Treatment for degenerative KOA has been gaining attention since it significantly affects the life of the elderly population and is also associated with increased expenses for medical services and high socioeconomic costs. Treatments for degenerative KOA include nondrug therapy, drug therapy, and surgical treatment. For cases that show little response to conservative treatment but have not involved severe deformation of the knee, procedures such as arthroscopic surgery, autologous chondrocyte implantation, or autologous osteochondral transplantation can be performed. However, effective treatment is required for patients experiencing sustained knee pain after surgery. Although studies confirming the therapeutic effects of acupuncture or thread-embedding acupuncture (TEA) treatment for degenerative KOA have been reported, clinical studies on a combination of TEA and electroacupuncture (EA) in patients complaining of knee pain after arthroscopic surgery, autologous chondrocyte implantation, or autologous osteochondral transplantation have not yet been reported. Therefore, this study aimed to evaluate the effectiveness and safety of this combination treatment in patients with persistent knee pain after arthroscopic surgery, autologous chondrocyte implantation, or autologous osteochondral transplantation. This study has been designed as a 2-group, parallel, single-center, randomized, controlled, assessor-blinded trial. Thirty-six patients with degenerative KOA who complained of pain even after arthroscopic surgery, autologous chondrocyte implantation, or autologous osteochondral transplantation will be randomized to either the (TEA + EA + Usual care) group or the (Usual care only) group in a 1:1 ratio. The patients in the (TEA + EA + Usual care) group will receive TEA treatment once a week for 4 weeks for a total of 4 sessions and EA twice a week for a total of 8 sessions while continuing usual care. The (Usual care only) group will only receive usual care for 4 weeks. To assess the efficacy of the TEA and EA combination treatment, the visual analogue scale, the Korean version of the Western Ontario and McMaster Universities Osteoarthritis Index, the EuroQol 5-Dimension 5-Level, and the doses of the rescue drug taken will be evaluated at baseline (1W) and weeks 2 (2W), 4 (4W), 6 (6W), and 8 (8W). The primary efficacy endpoint is the mean change in visual analogue scale at week 4 (4W) compared to baseline. Adverse events will be assessed at every visit. This study will provide useful data for evaluating the clinical efficacy and safety of TEA and electroacupuncture combination treatment for improving pain and quality of life after surgery for degenerative KOA. Clinical Research Information Service of Republic of Korea (CRIS- KCT0004804), March 6, 2020.

BackgroundLower limb strengthening, especially the quadriceps training, is of much necessity for patients with knee osteoarthritis (KOA). Previous studies suggest that strengthening of the hip muscles, especially the hip abductor, can potentially relieve the KOA-associated symptoms. Nevertheless, the effects of quadriceps combined with hip abductor strengthening remain unclear. Therefore, the current randomized controlled trial is designed aiming to observe whether quadriceps in combination with hip abductor strengthening can better improve the function and reduce pain in KOA patients than quadriceps training alone.MethodsA total of 80 subjects with symptomatic KOA will be recruited from the communities and hospital outpatient, and will be randomly assigned to the experiment group (Quadriceps-plus-hip-abductor-strengthening) or the control group (Quadriceps-strengthening). Specifically, participants in the experiment group will complete 4 exercises to train the quadriceps and hip abductor twice a day for 6 weeks at home, while those in the control group will only perform 2 exercises to strengthen the quadriceps. Besides, all patients will also receive usual care management, including health education and physical agent therapy when necessary. Knee pain will be measured using the Visual Analogue Scale (VAS) at baseline, in every week during the course of treatment, as well as 8 and 12 weeks after randomization. Furthermore, knee function will be measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale, and the quality of life will be measured using the MOS Item Short-form Health Survey (SF-36). In this study, several simple tests will be applied to assess the objective function. All the assessments except for VAS will be carried out at baseline, and in the 6th, 8th and 12th weeks respectively.DiscussionOur findings will provide more evidence for the effects of hip abductor strengthening on relieving pain and improving function in KOA patients. Hip abductor strengthening can be added into the muscle training program for KOA patients as a supplementary content if it is proved to be effective.Trial registrationThe current study has been registered with the Chinese Clinical Trials Registry (the registration number is ChiCTR-IOC-15007590, 3rd December, 2015).

Background and Objectives: This study aimed to examine the longitudinal impact of multisite musculoskeletal pain on physical and mental health-related quality of life among individuals with or at risk of knee osteoarthritis. Materials and Methods: This study is a prospective longitudinal design over 8 years of follow-up. Data from 4796 participants aged between 45 and 79 years were acquired from the Osteoarthritis Initiative. Based on self-reported physician-diagnosed osteoarthritis and grade ≥2 in either knee using Kellgren and Lawrence grade at baseline, individuals at risk were classified as those who did not have knee osteoarthritis at baseline but could develop osteoarthritis throughout the study. Physical and mental components of health-related quality were assessed over an 8-year follow-up period using both knee injury and osteoarthritis outcome scores and the 12-item Short-Form Health Survey. Multisite pain was examined using a self-reported questionnaire for 20 sites. Two separate generalized estimating equations modeled with a linear regression analysis were utilized. Results: The results showed that participants with one painful site (Beta [B] = -0.92, p = 0.01), two painful sites (B = -1.94, p < 0.001), and multisite pain (≥3 painful sites) (B = -4.68, p < 0.001) were significantly associated with declined physical health-related quality of life over time when compared to those with no painful site at baseline after adjustments for covariates. However, there was no significant association with declined mental health-related quality of life over time. Conclusions: This study revealed that baseline multisite musculoskeletal pain was linked to declining physical and knee injury and osteoarthritis outcome score quality of life among individuals with or at risk of knee osteoarthritis. Moreover, having baseline multisite pain and two painful sites were associated with a decline in physical and knee injury and osteoarthritis outcome score quality of life, while mental health-related quality of life did not show a significant association with multisite pain. Therefore, it is imperative for primary healthcare settings to prioritize the assessment of multisite musculoskeletal pain and develop interventions aimed at preserving and enhancing physical health-related quality of life in people with or at risk of osteoarthritis.

BackgroundHand osteoarthritis (OA) is associated with pain, reduced grip strength, loss of range of motion (ROM), and joint stiffness, leading to impaired hand function and difficulty in performance of daily...

This study aimed to investigate the association of self-reported knee stability with symptoms, function, and quality of life in individuals with knee osteoarthritis after anterior cruciate ligament reconstruction (ACLR). Cross-sectional. Twenty-eight individuals with knee osteoarthritis, 5 to 12 years after ACLR. Self-reported knee stability was assessed using visual analogue scales (VAS) during hop for distance (HD), side-to-side hop (SSH), and one-leg rise (OLR). Symptoms [Knee Injury and Osteoarthritis Outcome Score (KOOS) pain, Anterior Knee Pain Scale (AKPS), and International Knee Documentation Committee form], self-reported function (KOOS-sport/rec), performance-based function (hopping and OLR), and quality of life (KOOS-QOL) were assessed. K-means clustering categorized individuals into low (n = 8) and high self-reported knee stability (n = 20) groups based on participants' VAS scores during functional tasks. The low self-reported knee stability group had worse knee symptoms than the high self-reported knee stability group [KOOS-pain: mean difference -17 (95% confidence interval, -28 to -5); AKPS: -10 (-20 to -1)], and worse self-reported function [KOOS-sport/rec: -33 (-48 to -18)] and performance-based function [HD: -28 (-53 to -3); SSH: -10 (-20 to -1), OLR: -18 (-32 to -50)]. Low self-reported stability is associated with worse symptoms, and worse self-reported and performance-based function. Further research is required to determine the causation relation of self-reported knee stability to knee symptoms and function in individuals with knee osteoarthritis after ACLR.

This study examined the relationships between leg muscle strength, power, and perceived disease severity in subjects with knee osteoarthritis (OA) in order to determine whether dynamic leg extensor muscle power would be associated with pain and quality of life in knee OA. Baseline data on 190 subjects with knee OA (mean ± SD age 60.2 ± 10.4 years, body mass index 32.7 ± 7.2 kg/m(2) ) were obtained from a randomized controlled trial. Knee pain was measured using the Western Ontario and McMaster Universities Osteoarthritis Index, and health-related quality of life was assessed using the Short Form 36 (SF-36). One-repetition maximum (1RM) strength was assessed using the bilateral leg press, and peak muscle power was measured during 5 maximum voluntary velocity repetitions at 40% and 70% of 1RM. In univariate analysis, greater muscle power was significantly associated with pain (r = -0.17, P < 0.02) and also significantly and positively associated with SF-36 physical component summary (PCS) scores (r = 0.16, P < 0.05). After adjustment for multiple covariates, muscle power was a significant independent predictor of pain (P ≤ 0.05) and PCS scores (P ≤ 0.04). However, muscle strength was not an independent determinant of pain or quality of life (P ≥ 0.06). Muscle power is an independent determinant of pain and quality of life in knee OA. Compared to strength, muscle power may be a more clinically important measure of muscle function within this population. New trials to systematically examine the impact of muscle power training interventions on disease severity in knee OA are particularly warranted.

There is limited evidence on the comparative effectiveness of different exercise modalities, such as yoga and strengthening exercises, for managing knee osteoarthritis (OA). To compare the effectiveness of yoga vs strengthening exercise for reducing knee pain over 12 weeks in patients with knee OA. This single-center, assessor-blinded (for nonpatient-reported outcomes), parallel-arm, active-controlled, superiority randomized clinical trial included adults aged 40 years or older with knee OA and knee pain levels of 40 or higher on a 100-mm visual analog scale (VAS) in Southern Tasmania, Australia. Participants were recruited from April 2021 to June 2022, and follow-up was completed in December 2022. Data were analyzed from May 2023 to July 2024. Participants were randomized 1:1 to the yoga and strengthening exercise groups. Both groups attended 2 supervised and 1 home-based session per week for 12 weeks followed by 3 unsupervised home-based sessions per week for weeks 13 to 24. The primary outcome was the between-group difference in VAS score over 12 weeks assessed using a range of 0 (no pain) to 100 (worst possible pain) with a prespecified noninferiority margin of 10 mm. Secondary outcomes included knee pain over 24 weeks; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain, function, and stiffness; patient global assessment; Osteoarthritis Research Society International-Outcome Measures in Rheumatology Clinical Trials response; physical performance measures; leg muscle strength; health-related quality of life assessed via the Assessment of Quality of Life-8 Dimensions (AQol-8D) utility score; depression assessed with the Patient Health Questionnaire-9; and neuropathic pain assessment over 12 and 24 weeks. Analyses were based on the intention-to-treat principle. In total, 117 participants were randomized to the yoga (n = 58) or strengthening exercise (n = 59) program. Baseline characteristics of the participants were similar, with a mean (SD) age of 62.5 (8.3) years, and 85 participants (72.6%) were female. The mean (SD) baseline VAS knee pain score of 53.8 (16.0) indicated moderate knee pain. Over 12 weeks, the between-group mean difference in VAS knee pain change was -1.1 mm (95% CI, -7.8 to 5.7 mm), which was not statistically significant but remained within the prespecified noninferiority margin. Of 27 secondary outcomes assessed over 12 and 24 weeks, 7 were statistically significant in favor of yoga. The yoga group showed modestly greater improvements than the strengthening exercise group (between-group differences) over 24 weeks for WOMAC pain (-44.5 mm [95% CI, -70.7 to -18.3 mm]), WOMAC function (-139 mm [95% CI, -228.3 to -49.7 mm]), WOMAC stiffness (-17.6 mm [95% CI, -30.9 to -4.3 mm]), patient global assessment (-7.6 mm [95% CI, -15.1 to -0.2 mm]), and 40-m fast-paced walk test (1.8 [95% CI, 0.4-3.2]). In addition, the yoga group had a modestly greater improvement than the strengthening exercise for depression at 12 weeks (between-group difference in PHQ-9 score, -1.1 [95% CI, -1.9 to -0.2]) and quality of life at 24 weeks (between-group difference in AQoL-8D score, 0.04 [95% CI, 0.0 to 0.07]). Adverse events were similar in both groups and mild. In this randomized clinical trial, yoga did not significantly reduce knee pain compared with strengthening exercises. However, yoga was found to be noninferior to strengthening exercises, suggesting that integrating yoga as an alternative or complementary exercise option in clinical practice may help in managing knee OA. ANZCTR.org Identifier: ACTRN12621000066886.

Introduction/Objective. Pain, stiffness and limited mobility are the main factors that lead to difficulties in performing daily activities and are also responsible for the decline in the quality of life in people with knee osteoarthritis (OA). The aim of this study was to evaluate the functional capacity and health related quality of life (HRQoL) compared to pain in patients with knee OA, as well as to determine the correlation between these three clinical variables. Methods. The study involved 931 patients diagnosed with knee OA. In all patients, pain was evaluated by a short form of the McGill pain questionnaire (SF-MPQ), functional status was assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC), while life quality was evaluated using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Results. The average age of patients was 61.21 ? 4.62 years, while 71.3% of them were women. The quality of life in patients with knee OA and all pain parameters contained in the SF-MPQ were highly statistically positively associated (p ? 0.01). In addition, the physical functioning was mostly affected by emotional pain (rho = -0.585). A high statistical correlation (p ? 0.01) was noted between stiffness and physical functioning from the WOMAC questionnaire and all of the parameters from the SF-MPQ. The physical functioning from the WOMAC questionnaire had the strongest correlation with total pain incorporated into the McGill questionnaire (rho = 0.530). Conclusion. Knee pain has a significant impact on functional capacity and HRQoL in patients with knee OA. Therefore, one of the main therapy goals for OA of the knee should be to reduce the pain in the affected knee, which can help to improve the functionality and HRQoL of these patients.

Knee osteoarthritis is aprogressive inflammatory musculoskeletal disease with aprevalence of approximately 15-23% and limited treatment options. In recent years, transcatheter genicular artery embolization (GAE) has been proposed due to promising results concerning symptomatic knee pain relief and mobility. This systematic review and meta-analysis aimed to evaluate the aggregated data on the safety and efficacy of GAE for pain reduction in the treatment of knee osteoarthritis. Asystematic search of the three major databases (MEDLINE, Embase, and CENTRAL) from inception to 27February 2024 was conducted according to the PRISMA guidelines. Studies reporting pain reduction according to the Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-Total, WOMAC-Pain, and Knee Injury and Osteoarthritis Outcome Score (KOOS)-Pain scales and adverse event rates were included. Meta-analysis was performed by estimating the mean differences and by fitting random-effect models. Overall, 21studies were included, comprising of 633 patients and 758 knees treated. The combined data analysis showed that patients who underwent GAE demonstrated mean declines in the VAS score of -38.5 points (95% confidence interval [CI]: -44.9, -32.0) at 1month, -36.2 points (95%CI -43.0, -29.5) at 3months, -40.3 points (95%CI: -49.0, -31.7) at 6months, and -40.5 points (95%CI: -54.5, -26.6) at 12months. Similarly, significant differences at all time points were also found for the WOMAC-Total, WOMAC-Pain, and KOOS-Pain scores. No difference between permanent and non-permanent embolic material was found in the subgroup analysis for all time points. Genicular artery embolization is safe and effective for the treatment of painful knee osteoarthritis. This result was not affected by the type of embolic material used (permanent vs. non-permanent).

System Physical Function (PROMIS-PF) measure based on rising popularity and the amount of research dedicated for its use in a variety of knee conditions. A basic summary of the properties of the different measures is displayed in table 1. Psychometric data pertaining to the floor and ceiling effects, validity, reliability, responsiveness, and minimum clinically important difference of each patient reported outcome is displayed in table 2. Floor and ceiling effects were considered to be absent if no participants scored the bottom or top score, respectively, and acceptable if <15% of the cohort scored the bottom or top score, respectively. Validity was measured by assessing content, face, and construct validity. Content validity was present if patients were involved in development. Face validity was present if expert reviewers made a similar assessment and considered the measured items adequate. Construct validity was considered adequate if expected correlations were found with existing measures that assess similar (convergent construct validity) and dissimilar (divergent construct validity) constructs. Internal consistency was considered adequate if Cronbach's alpha was at least 0.7 (1), and test-retest (intrarater) reliability was adequate if the intraclass correlation coefficient was at least 0.8 for groups and 0.9 for individuals. Responsiveness was determined with a measures ability to detect change over a period of time or intervention. Minimum clinically important difference is the amount of change of a patient-reported outcome that represents a meaningful change to the patient. Since 2011, there have been numerous studies evaluating the psychometric properties of the above studies. There has also been ample research assessing the utility and psychometric properties of the PROMIS-PF function. Extensive work has been performed to add available translations and culturally adapted versions of the above measures. Our review summarizes the available information about how these measures perform for different patient populations in different settings.

Background: Knee osteoarthritis (KOA) is a prevalent degenerative joint disorder that leads to chronic pain and disability. Conventional therapies provide only limited long-term relief and are often associated with adverse effects and high cost. In Unani medicine, KOA is closely related to Wajaʹ al-Rukba, categorized under joint disorders, and managed through various regimenal therapies. Objective: This scoping review aimed to evaluate the effectiveness of Unani regimenal therapies in the management of KOA. Methods: A systematic search was conducted across PubMed, Google Scholar, and other relevant databases for studies published between January 2009 and March 2024. Keywords included “Knee osteoarthritis, Wajaʹ al-Rukba, Unani medicine, Greco-Arab medicine.” Eligible studies consisted of clinical trials, observational studies, and case studies assessing outcomes such as the Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS). Results: A total of relevant Unani regimenal therapies were identified, including Hijama (cupping), Dalk (massage), Tadhīn (oiling), Takmīd (fomentation), Ḍimād (poultice), Irsaal-e-‘Alaq (leech therapy), and Qai (emesis). Across multiple studies, these therapies demonstrated statistically significant improvements in pain reduction and functional outcomes (p&lt;0.001 in several trials). Notably, no major adverse effects were reported. Conclusion: Existing evidence suggests that Unani regimenal therapies are effective and safe in improving pain and function among KOA patients. However, most studies to date are small-scale, single-center, and methodologically heterogeneous. Larger, well-designed randomized controlled trials are needed to validate these findings and establish Unani therapies as cost-effective, complementary options in KOA management. Keywords: Wajaʹ al-Rukba, Unani medicine, Cupping, Massage, Fomentation, Traditional medicine