The role of electrotherapy in reducing the pain of patients with knee osteoarthritis during the COVID-19 pandemic

Measures of Adult Knee Function.

Knee osteoarthritis is prevalent in older adults worldwide. Quality of life was negatively affected by the COVID-19 pandemic. This study was designed to examine osteoarthritis severity and health-related quality of life (QOL) in older adults with knee osteoarthritis before total knee replacement during the COVID-19 pandemic and to identify the related predictors of QOL. This cross-sectional correlation study involved convenience sampling in the orthopedic ward of a regional teaching hospital in central Taiwan from June 2020 to June 2021 using the Western Ontario and McMaster Universities Arthritis Index and the SF-36v2 Health Survey. The data were analyzed using Pearson's correlation coefficient analysis, independent samples t test, and one-way analysis of variance to determine correlations among demographic variables, osteoarthritis severity, and QOL. The predictors of QOL were examined using stepwise multiple linear regression analysis. A total of 60 older adults diagnosed with knee osteoarthritis were sampled. The average age was 70 years and the average osteoarthritis severity score was 70.45. Being male, having comorbidities, and having a relatively high level of monthly disposable income were associated with poorer QOL. Moreover, more severe knee pain, stiffness, and physical dysfunction were associated with better psychological QOL. During the COVID-19 pandemic, the severity of knee osteoarthritis affects preoperative quality of life in older adults. Clinicians should detect signs of pain and physical dysfunction in these patients in advance and intervene in a timely manner to improve their QOL before surgery.

Long-term outcomes on the rates of total knee replacement amongst patients with end-stage knee osteoarthritis who meet surgical criteria and received a non-invasive biomechanical intervention.

Background:The purpose of this research was to study the effects of 8 weeks of Hata yoga exercises on women with knee osteoarthritis. Studies about effects of Yoga on different chronic diseases show that these exercises have positive effects on chronic diseases. As knee osteoarthritis is very common among middle age women we decided to measure effectiveness of these exercises on knee osteoarthritis.Methods:Sample included 30 women with knee osteoarthritis who voluntarily participated in this semi-experimental study and were divided into a control group (15) and a yoga group (15). The yoga group received 60 minutes sessions of Hata yoga, 3 times a week and for 8 weeks. Pain, symptoms, daily activities, sports and spare-time activities, and quality of life were respectively measured by Visual Analog Scale (VAS) and Knee injury and Osteoarthritis Outcome Scale (KOOS) questionnaire. The Analysis of Variance (ANOVA) method for repetitive data was used to analyze the results (P = 0.05).Results:Findings showed that pain and symptoms were significantly decreased and scores of daily activities, sports, spare-time activities, and quality of life were significantly increased in the yoga group.Conclusions:It seems that yoga can be used as a conservative treatment besides usual treatments and medications to improve the condition of people with osteoarthritis.

BackgroundOsteoarthritis (OA) of the hip and knee is one of the most common diagnoses in primary care, about 7% of the population in Sweden over 45 years is seeking outpatient...

Introduction: Knee osteoarthritis is a common age-related disorder. The aim of the present study was to determine the effect of symmetrical involvement of the knee joints on subjects’ report of symptoms, pain intensity, daily activities, and quality of life (QOL) using the Knee Injury and Osteoarthritis Outcome Score (KOOS) in subjects suffering from moderate knee osteoarthritis. Materials and Methods: The 20 subjects suffering from moderate knee osteoarthritis were purposefully divided into two groups of symmetric and asymmetric knee joints involvement. After obtaining informed consent forms, demographic information was obtained and each subject completed the Persian version of KOOS. The scores were compared using Mann-Whitney U test both for each individual item and for each section. Results: The pain intensity in going up stairs (P = 0.030), sitting or lying (P = 0.040), difficulty in getting in and out of the car (P = 0.010), rising from bed (P = 0.009), turning over in bed (P = 0.020), rising from a sitting position, putting on socks/stockings, and bathing (P = 0.050) was higher in the symmetric group. In addition, the symmetric group had more complaints of lack of confidence in their knee (P = 0.030). Thus, daily function and QOL scores were significantly lower in the symmetric group (P = 0.040, P = 0.020, respectively). Conclusion: It seems that the ability to perform daily functions and QOL were significantly lower in the symmetric group than the asymmetric group. Further investigations are recommended in this respect for a better understanding of the functional limitations of these individuals in daily life.

Background Globally, osteoarthritis (OA) is the third condition associated with disability. Science holds the key to finding better treatments and a cure. Still, it is essential to learn whats important to patients from the patients to implement the most effective global management of OA. The International Osteoarthritis Task Force, an initiative of the Osteoarthritis Foundation International (Barcelona, Spain) and the Arthritis Foundation (Atlanta, United States) with participation from member organizations in additional countries created the Global Osteoarthritis Patient Perception Survey (GOAPPS)-the first global survey to directly compare quality of life (QoL) & patient perceptions of care in the same OA patient survey across languages and cultures. Objectives The goal of the survey was to help all stakeholders in OA healthcare develop a better understanding of patients perceptions and how they may differ between cultures by collecting data on adult OA patient perceptions regarding their OA care. The survey will also collect data on patient demographics, OA symptomology, and impact of OA on daily functioning and QoL. Understanding patients needs and perceptions of care is the first step in optimizing global OA management. Methods Observational, cross-sectional study by online survey data collection translated into three languages. We collected data on patient demographics, symptomology, OA impact on daily activity and QoL to investigate the relationship between patient perceptions of their OA care, symptoms and impacts, and QoL. The questionnaire comprised of 4 sections: clinical characteristics, relationship with physicians and treatment, perception of attention, treatment and information received and auto-evaluation of QoL. Inclusion criteria included resident age 18 or older with an OA Results A total of 1485 surveys were completed from 7 countries. 1264 surveys were answered in English, 218 in Spanish and 3 in Italian; analysis of cultural differences was unable to be carried out in this pilot. Data show that the majority of the respondents were female (90%) and more than 55 years of age (82%). The majority (73%) of patients had knee OA, followed by hand (57%) and spine (54%). Comorbidities included hypertension (50%) and obesity (43%). Nearly all patients reported limitations related to physical activities (97%), followed by work activities (49%), social interaction (43%) and sex life (23%). 37% of patients experience emotional or mental health issue. The 58% says their doctor adequately explained their diagnosis and 55% understand the treatment options. Importantly, 41% of respondents are not satisfied with their OA treatment and 79% would like access to non-drug/non-surgical treatments. While 52% of respondents rate their QoL as good, 95% would rate it better if their OA was eliminated. Conclusion The results emphasize the significant impact of OA disease on patients daily activities and their desire to play an active role in managing their disease. Notably the majority asks for access to additional options for non-drug/non-surgical treatments stressing the need for an OA management improvement. This is a pilot survey and the results do not permit analysis of cultural differences. Continued survey distribution & analysis will determine differences in patient perception of QoL between OA patients living in different countries to further optimize global OA management. Disclosure of Interests Angie Botto-van Bemden: None declared, Guy Eakin: None declared, Rosa Sciortino: None declared, Maritza Quintero: None declared, Jordi Monfort Speakers bureau: Bioibrica Procare Health, Patrick du Souich: None declared, Francisco de Abajo: None declared, Ingrid Mller: None declared, Elizabeth Oswald: None declared, Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Pfizer, BMS, Chemomab, Sanipedia, Speakers bureau: Actelion, BMS; MSD, Janssen, Deborah Scotton: None declared, Marco Bibas: None declared, Marianna Vitaloni: None declared, Josep Verges: None declared

Knee osteoarthritis (OA) is a common form of arthritis in elders which can lead to reduced daily activity and quality of life. It is important to administer a proper treatment with high efficacy and low side effects. In this study, we evaluated the efficacy of duloxetine and gabapentin in patients with moderate to severe knee OA. In this randomized clinical trial, 150 patients with moderate to severe knee OA were randomly allocated to receive duloxetine 30mg (n = 50), gabapentin 300mg (n = 50), or acetaminophen 1000mg (n = 50) all twice a day for 12weeks. Pain severity using visual analogue scale (VAS) and functional status using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were measured before, 2weeks, 1month, and 3months after intervention. WOMAC total and its subscale score were significantly lower in duloxetine compared to gabapentin in 2weeks and 1months after intervention, with no significant difference at the end of the third month. Both gabapentin and duloxetine groups had significantly more reduction in pain VAS and WOMAC and its subscales compared to acetaminophen group, with no significant difference between groups. Both gabapentin and duloxetine have similar and acceptable effects in pain reduction and improvement of functional status in patients with knee OA at the end of the third month's treatment. Duloxetine effects begin from the first weeks, while gabapentin effects begin gradually with the best at the end of the third month. • Medical treatment is used for releiving pain in knee osteoarthritis. • Gabapentin and duloxetine are both effective in reducing pain in knee osteoarthritis.

Introduction: The advantages of physical activities have recently been recommended in preventing such chronic diseases as osteoarthritis. However, the risks that severe physical activity may have on musculoskeletal system of athletes are still unknown. The purpose of this study was to compare the radiographic grading scales of osteoarthritis, knee pain, existing symptoms, physical functions in activities of daily living, sports and recreation, and the quality of life of ex - elite soccer players with the same factors in non-athlete controls. Materials and Methods: 15 ex-elite male soccer athletes and 15 non-athletes were purposefully selected in this study. The clinical and radiological methods (Kellgren-Lawrence) along with an internationally-known and translated questionnaire called “Knee Injury and Osteoarthritis Outcome Score” (KOOS) were used to diagnose the disease. Statistical analysis of data was performed via independent t test at significance level of P ≤ 0.05. Results: Mean scores of radiographic grading scales for osteoarthritis of the knee (P = 0.001) was significantly higher in ex-professional athletes than in non-athlete controls. There was, however, a significant lower mean scores of knee pain (P = 0.002), symptoms (P < 0.001), physical function in daily activities (P = 0.001), sport, recreation (P < 0.001) and quality of life (P < 0.001) in athletes as compared to non - athletes. Conclusion: Having a professional soccer-playing career can result in high risk of knee osteoarthritis in former elite athletes. Keywords: Knee osteoarthritis, Soccer, Ex-elite retiree

To determine the efficacy of community water-based therapy for the management of lower limb osteoarthritis (OA) in older patients. A pre-experimental matched-control study was used to estimate efficacy of water-based exercise treatment, to check design assumptions and delivery processes. The main study was a randomised controlled trial of the effectiveness of water-based exercise (treatment) compared with usual care (control) in older patients with hip and/or knee OA. The latter was accompanied by an economic evaluation comparing societal costs and consequences of the two treatments. Water exercise was delivered in public swimming pools in the UK. Physical function assessments were carried out in established laboratory settings. 106 patients (93 women, 13 men) over the age of 60 years with confirmed hip and/or knee OA took part in the preliminary study. A similar, but larger, group of 312 patients (196 women, 116 men) took part in the main study, randomised into control (159) and water exercise (153) groups. Control group patients received usual care with quarterly semi-structured telephone interview follow-up only. The intervention in the main study lasted for 1 year, with a further follow-up period of 6 months. Pain score on the Western Ontario and McMaster Universities OA index (WOMAC). Additional outcome measures were included to evaluate effects on quality of life, cost-effectiveness and physical function measurements. Short-term efficacy of water exercise in the management of lower limb OA was confirmed, with effect sizes ranging from 0.44 [95% confidence interval (CI) 0.03 to 0.85] on WOMAC pain to 0.76 (95% CI 0.33 to 1.17) on WOMAC physical function. Of 153 patients randomised to treatment, 82 (53.5%) were estimated to have complied satisfactorily with their treatment at the 1-year point. This had declined to 28 (18%) by the end of the 6-month follow-up period, during which support for the intervention had been removed and those wishing to continue exercise had to pay their own costs for maintaining their exercise treatment. High levels of co-morbidity were recorded in both groups. Nearly two thirds of all patients had a significant other illness in addition to their OA. Fifty-four control and 53 exercise patients had hospital inpatient episodes during the study period. Water exercise remained effective in the main study but overall effect size was small, on WOMAC pain at 1 year, a reduction of about 10% in group mean pain score. This had declined, and was non-significant, at 18 months. Mean cost difference estimates showed a saving in the water exercise group of pound123--175 per patient per annum and incremental cost-effectiveness ratios ranged from pound3838 to pound5951 per quality-adjusted life-year (QALY). Net reduction in pain was achieved at a net saving of pound135--175 per patient per annum and the ceiling valuation of pound580--740 per unit of WOMAC pain reduction was favourably low. Group-based exercise in water over 1 year can produce significant reduction in pain and improvement in physical function in older adults with lower limb OA, and may be a useful adjunct in the management of hip and/or knee OA. The water-exercise programme produced a favourable cost--benefit outcome, using reduction in WOMAC pain as the measure of benefit. Further research is suggested into other similar public health interventions. Investigation is also needed into how general practice can best be supported to facilitate access to participants for research trials in healthcare, as well as an examination of the infrastructure and workforce capacities for physical activity delivery and the potential extent to which healthcare may be supported in this way. More detailed research is required to develop a better understanding of the types of exercise that will work for the different biomechanical subtypes of knee and hip OA and investigation is needed on access and environmental issues for physical activity programmes for older people, from both a provider and a participant perspective, the societal costs of the different approaches to the management of OA and longer term trends in outcome measures (costs and effects).

Osteoarthritis is the most prevalent arthritic disease and a leading cause of disability. The pathogenesis of osteoarthritis involves multiple etiologies, including variable degree of synovial inflammation. Metformin and pioglitazone could potentially reduce the levels and activity of inflammatory mediators. This may consider as a new therapeutic approach added to the current used drugs in an attempt to decrease the pain, inflammation, and improve daily activity and quality of life in patients with knee osteoarthritis.&#x0D; This study designed to evaluate the clinical utility of using metformin or pioglitazone as anti-inflammatory agents in combination with non-steroidal anti-inflammatory drugs (NSAID) of selective type of cyclooxygenase-2 (COX-2) inhibitor, meloxicam, in the treatment of knee osteoarthritis (OA).&#x0D; Randomized, double blinded clinical study was performed on 98 patients who have symptomatic and radiologic evidence of painful OA of the knee (57 patients only completed the study). Patients were allocated into three groups, group (A); 20 patients treated with meloxicam (15mg/day) alone, group (B); 20 patients treated with metformin (1000mg/day) + meloxicam (15mg/day) and group (C); 17 patients treated with pioglitazone (15mg/day) + meloxicam (15mg/day). The treatment was followed for 12 weeks through measurement of the clinical effects of drugs each 7 days, using the Knee Injury and Osteoarthritis Outcome Score (KOOS) system.&#x0D; The results showed that metformin or pioglitazone, when used in combination with NSAID resulted in significant improvement in the components of KOOS, higher than that produced by meloxicam when used alone. In conclusion, administration of metformin or pioglitazone as adjuvant therapy to NSAID, meloxicam, in OA patients produced very well characterized analgesic and anti-inflammatory activities, and improves the therapeutic profile of meloxicam.&#x0D; Keywords: Metformin, Pioglitazone, Osteoarthritis, Knee injury, KOOS.

The beneficial effects of leukocyte-rich platelet-rich plasma (LR-PRP) on subjective functional outcomes in knee osteoarthritis (KOA) is limiting, to this end there is a paucity of data about its efficacy on objective functional outcomes. PURPOSE: To examine the therapeutic efficacy of LR-PRP on gait and balance in patients with KOA. METHODS: Eight patients with unilateral and bilateral KOA (4 men; 55.3 ± 10.9 years; 31.22 ± 8.35 kg/m2) participated after signing a written informed consent. Participants visited the outpatient clinic in Baylor College of Medicine H. Ben Taub Department of Physical Medicine and Rehabilitation two times (baseline and follow-up; six to eight weeks apart). At baseline, the study physiatrist (PJ) provided a single ultrasound guided intra-articular LR-PRP injection. Our primary endpoint was balance using previously validated wearable sensors (BioSensics, Newton, MA) at 6-8 weeks post LR-PRP injection. Secondary endpoints included: pain symptoms, activity of daily life and quality of life using the 12-item Knee Injury and Osteoarthritis Score (KOOS-12), and gait speed. RESULTS: Results for outcome parameters are shown in Table 1. Pain symptoms, activity of daily life and quality of life improved 31%, 33% and 46%, respectively, but the improvements did not reach statistical significance level (all p > 0.05). Gait speed was very similar between baseline and follow-up (p > 0.05). Some balance parameters tended to improve. Medio-lateral center-of-mass sway and center-of-mass sway area decreased 34% and 41%, respectively. Medio-lateral hip sway and hip sway area decreased 40% and 46%, respectively. However, the improvements in balance parameters did not reach statistical significance level (all p > 0.05). CONCLUSIONS: Results suggest potential of LR-PRP on gait and balance. Based on the results, further study with a larger sample size is warranted.

BACKGROUND: Knee osteoarthritis (OA) is a common form of arthritis in elders which can lead to reduced daily activity and quality of life. It is important to administer a proper treatment with high efficacy and low side effects. In this study, we evaluated the efficacy of co-treatment with oral duloxetine and intraarticular (IA) injection of hyaluronic acid (HA) and corticosteroid (CS) in patients with knee OA. OBJECTIVES: This study aimed to test the hypothesis that an IA injection of CS+HA combined with duloxetine could achieve pain management superior to that of an IA injection of CS+HA alone in patients experiencing knee OA related pain. STUDY DESIGN: This study adopted a prospective, randomized, open-label blind endpoint study design. SETTING: The investigation was performed at Beijing Tiantan Hospital Affiliated with the Capital Medical University from October 2019 to December 2021. The study plan was approved by the Ethics Committee of Beijing Tiantan Hospital (KY 2019-086-02). METHODS: A total of 150 patients were randomly allocated to receive either duloxetine combined with an IA injection (n = 75) or a single IA injection alone (n = 75). All patients were followed for 24 weeks. The primary outcome was the change in the weekly 24 hours average mean pain scores, and the secondary outcomes included the proportion of patients with &gt;= 30% or &gt;= 50% pain reduction, Brief Pain Inventory (BPI) items, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, Patient Global Impression Improvement (PGI-I) ratings, hospital anxiety and depression scale (HADS) scores and adverse events (AEs). RESULTS: Patients in the experimental group had significantly greater improvement in the change of weekly mean of the 24 hours average pain scores, BPI pain severity ratings (P &lt; 0.001) and WOMAC scores (P &lt; 0.001) at the study endpoint. A significantly greater percentage of patients in the experimental group rated PGI-I of &lt;= 2 (P = 0.021) and &gt;= 50% pain reduction (P = 0.029) at 24 weeks. There was no difference in the proportion of patients with &lt;= 30% pain reduction, the HADS scores or frequency of AEs between the 2 groups. LIMITATIONS: The effectiveness and safety were examined only up to 24 weeks after treatment, and we did not perform a long-term follow-up as most previous studies have. Optimum dosage of duloxetine, as well as different molecular-weight HA, should be investigated in future studies. CONCLUSION: Patients receiving co-treatment with oral duloxetine and IA (HA+CS) injections experienced considerable improvement in pain and knee function compared to those who received an IA injection alone. KEY WORDS: Pain management, co-treatment, duloxetine, intraarticular injection, knee osteoarthritis, hyaluronic acid, corticosteroid

Pre-treatment pain sensitivity is associated with outcome following exercise therapy in patients with knee osteoarthritis - an observational study

Osteoarthritis (OA) and sarcopenia are significant health concerns in the elderly, substantially impacting their daily activities and quality of life. However, the relationship between them remains poorly understood. This study aims to uncover common biomarkers and pathways associated with both OA and sarcopenia. Gene expression profiles related to OA and sarcopenia were retrieved from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) between disease and control groups were identified using R software. Common DEGs were extracted via Venn diagram analysis. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted to identify biological processes and pathways associated with shared DEGs. Protein-protein interaction (PPI) networks were constructed, and candidate hub genes were ranked using the maximal clique centrality (MCC) algorithm. Further validation of hub gene expression was performed using 2 independent datasets. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of key genes for OA and sarcopenia. Mouse models of OA and sarcopenia were established. Hematoxylin-eosin and Safranin O/Fast Green staining were used to validate the OA model. The sarcopenia model was validated via rotarod testing and quadriceps muscle mass measurement. Real-time reverse transcription PCR (real-time RT-PCR) was employed to assess the mRNA expression levels of candidate key genes in both models. Gene set enrichment analysis (GSEA) was conducted to identify pathways associated with the selected shared key genes in both diseases. A total of 89 common DEGs were identified in the gene expression profiles of OA and sarcopenia, including 76 upregulated and 13 downregulated genes. These 89 DEGs were significantly enriched in protein digestion and absorption, the PI3K-Akt signaling pathway, and extracellular matrix-receptor interaction. PPI network analysis and MCC algorithm analysis of the 89 common DEGs identified the top 17 candidate hub genes. Based on the differential expression analysis of these 17 candidate hub genes in the validation datasets, AEBP1 and COL8A2 were ultimately selected as the common key genes for both diseases, both of which showed a significant upregulation trend in the disease groups (all P<0.05). The value of area under the curve (AUC) for AEBP1 and COL8A2 in the OA and sarcopenia datasets were all greater than 0.7, indicating that both genes have potential value in predicting OA and sarcopenia. Real-time RT-PCR results showed that the mRNA expression levels of AEBP1 and COL8A2 were significantly upregulated in the disease groups (all P<0.05), consistent with the results observed in the bioinformatics analysis. GSEA revealed that AEBP1 and COL8A2 were closely related to extracellular matrix-receptor interaction, ribosome, and oxidative phosphorylation in OA and sarcopenia. AEBP1 and COL8A2 have the potential to serve as common biomarkers for OA and sarcopenia. The extracellular matrix-receptor interaction pathway may represent a potential target for the prevention and treatment of both OA and sarcopenia.