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Abstract Objective The present study verified, through a systematic review with meta-analysis, the effects of a rehabilitation, physical training program for the treatment of pain and muscle strength in knee osteoarthritis (OA). Methods We analyzed studies published between 2008 and 2018 referenced at the Medline (National Library of Medicine) database, selecting 7 randomized controlled clinical trials about exercise programs to improve pain and muscle strength in patients with knee OA with Physiotherapy Evidence Database (PeDro) score higher than 8. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematization was used to prepare this review, and a meta-analysis was carried out to obtain mathematical evidence the outcomes of physical exercise on pain. Results The studies included in the analysis contained a total of 934 participants aged 40 to 73 years-old, with 34.90% males. Most of the exercise sets offered in OA treatment had a significantly positive outcome result in both criteria, but mainly for pain relief (statistically significant difference, p< 0.003). Conclusion We infer that there was an improvement of pain in all articles that performed muscle strengthening, but there is still an obstacle to the protocols used.
Resumo Objetivo O presente estudo verificou por meio de uma revisão sistemática com metanálise os efeitos de um programa de reabilitação, através de um programa de treinamento físico, para o tratamento da dor e força muscular na osteoartrose (OA) de joelho. Métodos Foram analisados os estudos publicados entre 2008 e 2018, tendo como referência a base de dados Medline (National Library of Medicine), da qual foram selecionados 7 ensaios clínicos controlados randomizados que pontuaram acima de 8 na escala Physiotherapy Evidence Database (PeDro, na sigla em inglês), sobre programas de exercícios na melhora da dor e força muscular em paciente com OA de joelho. Foi usada a sistematização Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA, na sigla em inglês) para a elaboração desta revisão e a realização de uma metanálise com o objetivo de evidenciar matematicamente os resultados do exercício físico sobre a dor. Resultados Os estudos incluídos na análise continham um total de 934 participantes com idade entre 40 a 73 anos, sendo que 34,90% desses eram do sexo masculino. A maioria dos conjuntos de exercícios oferecidos no tratamento da OA tiveram resultado significativamente positivo em ambos os quesitos, mas principalmente para o alívio da dor (estatisticamente significativo p< 0, 003). Conclusão Inferimos que houve uma melhora da dor em todos os artigos que realizaram fortalecimento muscular, porém ainda há um óbice sobre os protocolos utilizados.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Exercise , Osteoarthritis, Knee/rehabilitation , Muscle Strength , Pain Management/methodsABSTRACT
Objective:To observe the controlling effect of addition and subtraction therapy of Xuanbi tang on knee osteoarthritis of rheumatic fever arthralgia type (KOA) at attack stage and to investigate the influence to acute inflammation factors. Method:One hundred and twenty-eight patients were randomly divided into control group and observation group (1∶1) by random number table with SAS software. The patients in both groups got celecoxib capsules, 0.2 g/time, 1 time/day, glucosamine hydrochloride capsule, 1 grain/time, 2 times/day. Patients in control group addiiontally got Simiaowan, 6 g/time, 2 times/day. Patients in observation group got addition and subtraction therapy of Xuanbitang, 1 dose/day, with a treatment course of 2 weeks in both groups. Visual analogue scale of pain (VAS) was used to discuss pain degree of knee joint, and the VAS scores during activity and resting state were recorded every day, and the time to pain relief and time to pain disappearance were also recorded. Before and after treatment, the scores of osteoarthritis index visual scale of Western Ontario and McMaster University (WOMAC), scores of swelling degree and scores of rheumatism heat arthralgia syndrome were graded. The levels of high sensitive C-reactive protein (hs CRP), interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and serum matrix metalloproteinase-3 (MMP-3) were detected before and after treatment. In addition, safety was evaluated and discussed. Result:The comprehensive total effective rate in observation group was 95.00% (57/60), higher than 83.05% (49/59) in control group (P<0.05). At the third, seventh, tenth, fourteenth day after treatment, scores of knee joint pain degree in observation group were lower than those in control group (P<0.01). Time to pain relief and time to pain disappearance were shorter than those in control group (P<0.01). Scores of WOMAC, swelling degree and rheumatism heat arthralgia syndrome were all lower than those in control group (P<0.01). Levels of hs-CRP, IL-1β, IL-6, TNF-α and MMP-3 were lower than those in control group (P<0.01). In addition, there was no adverse reaction related to Xuanbitang. Conclusion:Addition and subtraction therapy of Xuanbitang can relieve pain, swelling and other symptoms, improve knee joint function, shorten the course of disease, and control the acute inflammatory reaction, with significant clinical efficacy and safety.
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OBJECTIVES@#To observe the effects of Yougui pill (Traditional Chinese Medicine) on the related factors of Wnt signal pathway of rats with knee osteoarthritis (KOA), and explore its protective mechanism.@*METHODS@#Sixty SPF SD rats were randomly divided into the sham-operative group, model group, glucosamine sulfate group, high-dose, middle-dose, low-dose of Yougui pill treated group (=10). KOA model was established by modified Hulth method for six weeks. The rats in the high, middle and low-dose of Yougui pill group were treated with Yougui pills at the doses of 20,10 and 5 g/kg respectively by gastrogavage once a day for 8 weeks, while equal volume of normal saline was given to those in the sham and model control group and an equal volume of glucosamine sulfate (1.7 g/kg·d) was given to those in glucosamine sulfate group for 8 weeks. The knee joint was removed after the last dose of drug. The pathological changes of cartilaginous tissues were observed under a microscope. The mRNA levels of Dickkopf homolog 1(DKK1), Wnt induced secreted protein 1(WISP1), Wnt1, low density lipoprotein receptor related protein 5(LRP5) and beta -catenin in rats cartilaginous tissues were analyzed by using RT-PCR method, and the protein contents of DKK1, WISP1, Wnt1, LRP5 and beta-catenin in cartilaginous tissues were detected by Western blot.@*RESULTS@#Compared with the sham group, the articular cartilage was severely damaged, the Mankin score was increased significantly (<0. 05), the mRNA and protein expression levels of DKK1 in cartilaginous tissue were markedly decreased(<0.05), while those of WISP, Wnt1, LRP5 and beta-catenin were increased significantly in model group(<0.05). Compared with model group, the articular cartilage lesions was light (<0.05), the Mankin Score was decreased significantly(<0.05), and the mRNA and protein levels of DKK1 in cartilaginous tissue were increased(<0.05), while those of WISP, Wnt1, LRP5 and beta-catenin were decreased in Yougui pill high-dose group and glucosamine sulfate group (<0.05).@*CONCLUSIONS@#Yougui pill has protective effects on the KOA by inhibiting the expressions of WISP, Wnt1, LRP5, beta-catenin and increasing the expression of DKK1 cytokine in the Wnt signaling pathway.
Subject(s)
Animals , Rats , CCN Intercellular Signaling Proteins , Metabolism , Drugs, Chinese Herbal , Pharmacology , Glucosamine , Pharmacology , Intercellular Signaling Peptides and Proteins , Metabolism , Osteoarthritis, Knee , Drug Therapy , Proto-Oncogene Proteins , Metabolism , Random Allocation , Rats, Sprague-Dawley , Wnt Signaling Pathway , Wnt1 Protein , Metabolism , beta Catenin , MetabolismABSTRACT
Introduction: Knee osteoarthritis (OA) is a major public health problem. Knee OA leads to impaired balance and reduction in speed of walking, which is accentuated under dual-task conditions. Walking relies on continuous visual processing to obstacles as one navigates through a visually defined environment. Objectives: The study aimed to compare the speed of walking with and without vis subjects with OA knee and with normal individuals. Material and methods: Fifteen subjects with OA knee and 15 without OA knee of same age and gender were selected. Subjects were selected according to inclusion and exclusion criteria. Experiment was carried out over straight path of 50 m length and 2.5 m width. Subjects walked on two consecutive days at preferred speed 3 times back and forth covering total distance of 300 m. Charts were shown on either of the two days. Subjects passed 12 times through charts of various objects held by two assistants. Some objects were kept upright or inverted and subjects needed to reply by saying ‘yes’ or ‘no’. Charts of various colors were also shown and they were asked to identify them. The speed was noted. They also walked same distance without distraction. Level of significance will be kept at 5%. Results: Wilcoxon test was used for within group analysis for speed of walking with and without distraction. Significant difference was seen for both subjects with OA knee (W= 2.897, p=0.004) and normal subjects (W=-3.266, p=0.001). Mann Whitney U test was used for between groups analysis. With distraction groups showed significant difference (W=2.219, p=0.026). But there was no significant difference in analysis in between groups without distraction (w=-1.701,p=0.089). Conclusion: Visual distraction leads to reduction in speed of walking in subjects with OA knee as compared to normal subjects.
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@# Objective To investigate therapeutic efficiency of high frequency electric therapy combined with movement training on osteoarthritis of knee joint.Methods Eighty-five patients were randomly divided into the high frequency electric therapy group (22 cases including 31 knees), movement training group (33 cases including 45 knees) and high frequency electric therapy combined with movement training group (30 cases including 40 knees). All of the patients were assessed with Visual Analogous Scale (VAS) and Lysholm Knee Score Scale (LKSS) before and after treatment.Results Every group had significant improvements compared with selves after treatment. There were significant differences among the three groups (P<0.01).Conclusion Three ways have different therapeutic effect on osteoarthritis of knee, the high frequency electric therapy can slacken the soft tissue, the movement training has reliable effect in the near future; the therapy by high frequency electric therapy combined with movement training is reliable.
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Of all 58 cases of knee osteoarthritis treated by acupuncture and moxibustion, 42 cases were recovered,(accounting for 72.5%), 14 cases were obviously improved (accounting for 24.1%), and 2 cases were ineffective (accounting for 3.4%). The total effective rate was 96.6%. This result demonstrated that acupuncture and moxibnstiou therapy has the good functions of dredging meridians and collaterals, activating qi and blood circulation, dispelling cold and dampness, and removing swollen to stop pain.
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Purpose: To observe the long-term and recent clinical effect of needle-warming method plus functional training in the treatment of osteoarthritis of the knee joint. Methods:After 106 cases of the patients were divided into the needle-warming group and comprehensive group by the order of their first visit, the needle-warming group was treated by the needle-wanning method and the comprehensive group was treated by the needle-warming method plus functional training. After ten treatments, the clinical data in the two groups were evaluated upon Lequesne scale before and after the treatments. Three months later, follow-up survey was given to process the statistic management of the reoccurrence rate of the symptoms.Results: In the two groups after the treatment, the symptoms of the knee joint and daily life ability were obviously improved than the respective conditions before the treatment, and the integral decreased (P＜0.05), with no significant difference (P＞0.05) between the two groups. In the follow-up survey, there was a difference (P＜0.05) between the two groups in the positive rate of the recurrent symptoms. Conclusion: Certain therapeutic effect exists in the treatment of osteoarthritis of the knee joint by the needle-warming method. If functional training is combined,the therapeutic effect would be more stable, without easy reoccurrence.
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OBJECTIVE: This study was conducted to assess the analgesic effect of intraarticular injection with morphine and hyaluronic acid in comparison with intraarticular injection with hyaluronic acid only in the patients with osteoarthritis of knee. METHOD: Twenty four patients with degenerative osteoarthritis of the knee were assigned randomly to a morphine group (morphine+hyaluronic acid) and a hyaluronic acid group. In the morphine group, intraarticular injection with morphine and hyaluronic acid at first was applied to the knee 2 times. Then intraarticular injection with hyaluronic acid without morphine was applied in the remaining 3times. In the hyaluronic acid group, intraarticular injection with hyaluronic acid was applied to the knee 5 times. Effects were assessed on the 1st week, 5th week after treatment, and on the last follow up day by pain rating score (PRS). RESULTS: Significant change of PRS improvement was noticed in the morphine group in the 1st week after treatment compared with the hyaluronic acid group. CONCLUSION: These results showed that intraarticular injection with morphine and hyaluronic acid was a more effective treatment method than intraarticular injection with hyaluronic acid only for pain control in patients with osteoarthritis of knee.
Subject(s)
Humans , Follow-Up Studies , Hyaluronic Acid , Injections, Intra-Articular , Knee , Morphine , Osteoarthritis , Osteoarthritis, KneeABSTRACT
@#Objective To explore the effect of acupuncture and moxibustion combined with quadriceps exercise on osteoarthritis of knee joint. Methods 82 cases of knee osteoarthritis were randomly divided into the acup-moxibustion group (41 cases, treated with acup-moxibustion and quadriceps exercise treatment) and routine treatment group (41 cases). Lower limb ability of daily life respectively and knee pain of patients before and 30 days after treatment were evaluated. Results Clinical symptoms of patients in both groups were improved significantly after treatment. The acup-moxibustion group was better than traditional group in relieving pain and improving the lower limb ability of daily life (P<0.01). Conclusion The acup-moxibustion therapy combined with quadriceps exercise has preferable clinical curative effect on knee osteoarthritis.
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Treatment of tender points has widely been used for diagnosis and treatment, but there are few studies elucidating the usefulness of this approach to diagnosing knee pain. This study investigated the diagnostic importance of tender points. The symptoms and the pressure pain threshold (PPT) in osteoarthritis of the knee (pain and motion of knee joint) were measured in 45 patients being treated at the Acupuncture Center of Meiji University of Oriental Medicine. The change in PPT was related to symptoms of knee pain (staircase and flexion pain). It is suggested that changes in PPT around the knee joints are a useful indicator for evaluating knee pain.
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Objective To observe the clinical effect of herbal decoction Sishen Jian on acute osteoarthritis of knee joint.Methods The 60 osteoarthritis cases in the attack stage were randomized into treatment group(30 cases)and control group(30 cases).The treatment group was given the decoction Sishen Jian and Diclofenac Sodium Sustained Release Capsules and the control group was given the capsules only.Two weeks made one course of treatment.Before and after treatment,the symptoms such as pain and morning stiff- ness,the signs including joint swelling and tenderness,and the erythrocyte sedimentation rate(ESR)and C reactive protein were ob- served for comparison.Results The total effective rate of the treatment group and control group was 96.66% and 53.26% respec- tively.The difference of two groups was significant(P