Exercise program combined with electrophysical modalities in subjects with knee osteoarthritis: a randomised, placebo-controlled clinical trial

Cid André Fidelis de Paula Gomes,Fabiano Politti,Daniela Aparecida Biasotto-Gonzalez,Aron Charles Barbosa da Silva,Cheila de Souza Bacelar Pereira,Almir Vieira Dibai-Filho,Adriano Rodrigues de Oliveira

doi:10.1186/s12891-020-03293-3

Cid André Fidelis de Paula Gomes, Fabiano Politti + Show 5 more

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https://doi.org/10.1186/s12891-020-03293-3

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Abstract

BackgroundIt is not yet clear which of the various electrophysical modalities used in clinical practice is the one that contributes most positively when added to an exercise program in patients with knee osteoarthritis (OA). The aim of the present study was to analyze the clinical effects of the inclusion of interferential current therapy (ICT), shortwave diathermy therapy (SDT) and photobiomodulation (PHOTO) into an exercise program in patients with knee OA.MethodsThis prospective, five-arm, randomised, placebo-controlled trial was carried out with blinded participants and examiners. We recruited 100 volunteers aged 40 to 80 years with knee OA. Participants were allocated into five groups: exercise, exercise + placebo, exercise + ICT, exercise + SDT, and exercise + PHOTO. The outcome measures included Western Ontario and McMaster Universities (WOMAC), numerical rating pain scale (NRPS), pressure pain threshold (PPT), self-perceived fatigue and sit-to-stand test (STST), which were evaluated before and after 24 treatment sessions at a frequency of three sessions per week.ResultsIn all groups, there was a significant improvement (p < 0.05) in all variables over time, except pressure pain threshold. We observed significant differences (p < 0.05) between the groups for WOMAC function (exercise vs. exercise + placebo, mean difference [MD] = 5.55, 95% confidence interval [CI] = 3.63 to 7.46; exercise vs. exercise + ICT, MD = 3.40, 95% CI = 1.46 to 5.33; exercise vs. exercise + SDT, MD = 4.75, 95% CI = 1.85 to 7.64; exercise vs. exercise + PHOTO, MD = 5.45, 95% CI = 3.12 to 7.77) and WOMAC pain, with better scores achieved by the exercise group. However, these differences were not clinically relevant when considering the minimum clinically important difference.ConclusionThe addition of ICT, SDT or PHOTO into an exercise program for individuals with knee OA is not superior to exercise performed in isolation in terms of clinical benefit. clinicaltrials.gov: NCT02636764, registered on March 29, 2014.

Highlights

It is not yet clear which of the various electrophysical modalities used in clinical practice is the one that contributes most positively when added to an exercise program in patients with knee osteoarthritis (OA)
The addition of interferential current therapy (ICT), shortwave diathermy therapy (SDT) or PHOTO into an exercise program for individuals with knee OA is not superior to exercise performed in isolation in terms of clinical benefit. clinicaltrials.gov: NCT02636764, registered on March 29, 2014
We observed significant differences (p < 0.05) between the groups, with the exercise group showing the greatest improvement in the variables Western Ontario and McMaster Universities (WOMAC) pain and WOMAC function; these differences were not clinically relevant when considering the minimum clinically important difference, and should be disregarded

Summary

Introduction

It is not yet clear which of the various electrophysical modalities used in clinical practice is the one that contributes most positively when added to an exercise program in patients with knee osteoarthritis (OA). Osteoarthritis (OA) is a multifactorial disease related to genetic, hormonal, aging, mechanical and metabolic factors, which promote changes in focal areas causing loss of articular cartilage within synovial joints, associated with bone hypertrophy (osteophytes and subchondral bone sclerosis) and capsule thickening [1, 2]. It is one of the major causes of disability worldwide, predominantly affecting the population over 60 years old, 9.6% of men and 18% of women [3], which is only expected to increase along with increased life expectancy, overweight rates and reduced mobility of the world’s population [4]. These gains are sustained from 2 to at least 6 months after cessation of treatment [10], and exercises aimed at increasing quadriceps muscle strength [11], flexibility and aerobic capacity are highlighted in the management of individuals diagnosed with lower limb OA [12]

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