Primary studies included in this broad synthesis

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Primary study

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Efficacy of low-level laser therapy applied at acupuncture points in kneeosteoarthritis: a randomised double-blind comparative trial.

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Journal Physiotherapy
Year 2014

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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Primary study

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Efficacy of therapeutic ultrasound for the management of knee osteoarthritis: a randomized, controlled, and double-blind study.

Journal American journal of physical medicine & rehabilitation / Association of Academic Physiatrists
Year 2014
Links Pubmed DOI

This article is included in 12 Systematic reviews Systematic reviews (12 references)

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OBJECTIVE: The aim of this study was to compare whether the effectiveness of continuous ultrasound (US) was superior against pulsed US and against sham US in knee osteoarthritis. DESIGN: A randomized controlled study was carried out on 60 patients diagnosed with knee osteoarthritis according to American College of Rheumatology. The patients were randomized into the following three treatments: (1) continuous US (at a frequency of 1 MHz with intensity of 1 W/cm), (2) pulse US (same frequency and intensity on 1:4 pulse ratio), and (3) sham US. All treatments were applied with 5-cm head US device five times a week for 2 weeks in addition to home exercise program including quadriceps isometric exercise, muscle strength exercises, and stretching exercises of the lower extremity muscles for at least three times per week. Assessments were performed at baseline, at the end of the treatment, and at the end of the treatments and at the sixth month using the following measurements: Western Ontario and McMaster University Osteoarthritis Index-pain, stiffness, function, visual analog scale-pain at rest, visual analog scale-pain on movement, visual analog scale-disease severity, and 20-m walking time. Among these parameters, the Western Ontario and McMaster University Osteoarthritis Index-pain was the primary outcome. RESULTS: All groups showed a significant improvement in all parameters in both following visits (P < 0.05). However, there was no significant difference between the groups. Although the mean reduction percent in Western Ontario and McMaster University Osteoarthritis Index-pain was significantly higher in group I (continuous US) when compared to sham group (46.5% vs 28.9%, P < 0.05) at the end of the treatment, this result was not found in other pain parameters. CONCLUSIONS: The present study demonstrated that all assessment parameters significantly improved in all groups without a significant difference. This result suggested that therapeutic US provided no additional benefit in improving pain and functions in addition to exercise training.

Primary study

Unclassified

High-intensity versus low-level laser therapy in the treatment of patients with knee osteoarthritis: a randomized controlled trial.

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Authors Kheshie AR , Alayat MS , Ali MM
Journal Lasers in medical science
Year 2014
Links Pubmed DOI

This article is included in 8 Systematic reviews Systematic reviews (8 references)

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The aim of this randomized controlled study was to compare the effects of low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) on pain relief and functional improvement in patients with knee osteoarthritis (KOA). A total of 53 male patients participated in this study, with a mean (SD) age of 54.6 (8.49) years. Patients were randomly assigned into three groups and treated with HILT and exercise (HILT + EX), LLLT and exercise (LLLT + EX), and placebo laser plus exercise (PL + EX) in groups 1, 2, and 3, respectively. The outcomes measured were pain level measured by visual analog scale (VAS) and knee function measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Statistical analyses were performed to compare the differences between baseline and posttreatment measurements. The level of statistical significance was set as P < 0.05. The result showed that HILT and LLLT combined with exercise were effective treatment modalities in decreasing the VAS and WOMAC scores after 6 weeks of treatment. HILT combined with exercises was more effective than LLLT combined with exercises, and both treatment modalities were better than exercises alone in the treatment of patients with KOA.

Primary study

Unclassified

Non-invasive electromagnetic field therapy produces rapid and substantial pain reduction in early knee osteoarthritis: a randomized double-blind pilot study.

Authors Nelson FR , Zvirbulis R , Pilla AA
Journal Rheumatology international
Year 2013
Links Pubmed DOI

This article is included in 3 Systematic reviews Systematic reviews (3 references)

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This study examined whether a non-thermal, non-invasive, pulsed electromagnetic field (PEMF), known to modulate the calmodulin (CaM)-dependent nitric oxide (NO)/cyclic guanosine monophosphate (cGMP) signaling pathway, could reduce pain in early knee OA. This randomized, placebo-controlled, double-blind pilot clinical study enrolled 34 patients. Patient selection required initial VAS ≥4, 2 h of standing activity per day, and no recent interventions such as cortisone injections or surgery. Results showed VAS pain score decreased in the active cohort by 50 ± 11% versus baseline starting at day 1 and persisting to day 42 (P < 0.001). There was no significant decrease in VAS versus baseline at any time point in the sham cohort (P = 0.227). The overall decrease in mean VAS score for the active cohort was nearly threefold that of the sham cohort (P < 0.001). The results suggest that non-thermal, non-invasive PEMF therapy can have a significant and rapid impact on pain from early knee OA and that larger clinical trials are warranted.

Primary study

Unclassified

Is neuromuscular electrical stimulation effective for improving pain, function and activities of daily living of knee osteoarthritis patients? A randomized clinical trial.

Journal São Paulo medical journal = Revista paulista de medicina
Year 2013
Links Pubmed DOI PubMed Central

This article is included in 7 Systematic reviews Systematic reviews (7 references)

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CONTEXT AND OBJECTIVE: Neuromuscular electrical stimulation (NMES) has been used in rehabilitation protocols for patients suffering from muscle weakness resulting from knee osteoarthritis. The purpose of the present study was to assess the effectiveness of an eight-week treatment program of NMES combined with exercises, for improving pain and function among patients with knee osteoarthritis. DESIGN AND SETTING: Randomized clinical trial at Interlagos Specialty Ambulatory Clinic, Sao Paulo, Brazil. METHODS: One hundred were randomized into two groups: NMES group and control group. The following evaluation measurements were used: numerical pain scale from 0 to 10, timed up and go (TUG) test, Lequesne index and activities of daily living (ADL) scale. RESULTS: Eighty-two patients completed the study. From intention-to-treat (ITT) analysis comparing the groups, the NMES group showed a statistically significant improvement in relation to the control group, regarding pain intensity (difference between means: 1.67 [0.31 to 3.02]; P = 0.01), Lequesne index (difference between means: 1.98 [0.15 to 3.79]; P = 0.03) and ADL scale (difference between means: -11.23 [-19.88 to -2.57]; P = 0.01). CONCLUSION: NMES, within a rehabilitation protocol for patients with knee osteoarthritis, is effective for improving pain, function and activities of daily living, in comparison with a group that received an orientation program. CLINICAL TRIAL REGISTRATION ACTRN012607000357459.

Primary study

Unclassified

Therapeutic Effects of Short-Term Monochromatic Infrared Energy Therapy on Patients With Knee Osteoarthritis: A Double-Blind, Randomized, Placebo-Controlled Study.

Authors Hsieh RL , Lo MT , Lee WC , Liao WC
Journal The Journal of orthopaedic and sports physical therapy
Year 2012
Links Pubmed DOI

This article is included in 3 Systematic reviews Systematic reviews (3 references)

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STUDY DESIGN: Randomized, double-blind, placebo-controlled study. OBJECTIVES: To examine the short-term therapeutic effects of monochromatic infrared energy (MIRE) on participants with knee osteoarthritis (OA). Patients were assessed according to the International Classification of Functioning, Disability and Health. BACKGROUND: MIRE is commonly used in therapy for patients with peripheral neuropathies. However, research has not focused intensively on the therapeutic effects of MIRE in patients with knee OA. METHODS: This study enrolled 73 participants with knee OA. Participants received six 40-minute sessions of active or placebo MIRE treatment (890-nm wavelength; power, 6.24 W; energy density, 2.08 J/cm2/min; total energy, 83.2 J/cm2) over the knee joints for 2 weeks. International Classification of Functioning, Disability and Health-related outcomes were collected weekly over 4 weeks using the Knee injury and Osteoarthritis Outcome Score, Lysholm Knee Scale, Hospital Anxiety and Depression Scale, Multidimensional Fatigue Inventory, Chronic Pain Grade questionnaire, World Health Organization Quality of Life-brief version, and OA Quality of Life Questionnaire. Data were analyzed by repeated-measures analysis of variance. RESULTS: No statistically significant differences were found for the interaction of group by time for Knee injury and Osteoarthritis Outcome Score scores, including pain, other symptoms, function in daily living, function in sport and recreation, and knee-related quality of life. Scores on the Lysholm Knee Scale, Hospital Anxiety and Depression Scale, Multidimensional Fatigue Inventory, Chronic Pain Grade questionnaire, World Health Organization Quality of Life-brief version, and OA Quality of Life Questionnaire also showed no significant differences between the 2 groups at any of the 4 follow-up assessments. CONCLUSION: Short-term MIRE therapy provided no beneficial effects to body functions, activities, participation, and quality of life in patients with knee OA.

Primary study

Unclassified

Influence of various laser therapy methods on knee joint pain and function in patients with knee osteoarthritis.

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Journal Ortopedia, traumatologia, rehabilitacja
Year 2012
Links Pubmed DOI

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND: The aim of the study was to estimate the influence of various laser therapy methods on knee joint pain and function in patients with knee osteoarthritis. MATERIAL AND METHODS: 125 patients were randomly assigned to 4 groups: • group I received one-wave laser irradiation (wave length 810 nm, dose 8 J/point) • group II received two-wave MLS laser irradiation (power 1100 mW, frequency 2000 Hz, dose 12.4 J/point) • group III received a similar regimen of two-wave MLS laser irradiation, but at a dose of 6.6 J per point • group IV was a placebo group where laser therapy procedures were simulated without actual irradiation. The effectiveness of the therapy was evaluated by means of Lequesne's scale, a modified Laitinen questionnaire and a visual analogue scale (VAS). Statistical analysis utilised non-parametric Wilcoxon's and Mann-Whitney's tests. Calculations were carried out with MedCalc v. 11.6.1.0. RESULTS: Statistically significant improvements in knee joint function and pain relief were seen in all groups (I, II and III). When groups I, II and III were compared, the largest improvement was found in group II (MLS laser, dose 12.4 J/point). The degrees of improvement in groups I and III were similar. CONCLUSIONS: One-wave laser irradiation at a dose of 8 J per point and two-wave laser irradiation with doses of 12.4 J and 6.6 J per point significantly improved knee joint function and relieved knee pain in patients with osteoarthritis.

Primary study

Unclassified

Therapeutic ultrasound versus sham ultrasound for the management of patients with knee osteoarthritis: a randomized double-blind controlled clinical study.

Journal International journal of rheumatic diseases
Year 2012
Links Pubmed DOI

This article is included in 8 Systematic reviews Systematic reviews (8 references)

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AIM: The aim of this trial was to evaluate the short-term effectiveness of ultrasound (US) therapy on pain, physical function, ambulation activity, disability and psychological status in patients with knee OA. METHODS: Forty-two inpatients with bilateral knee OA were randomized by an independent researcher not involved in the data assessment, to receive either therapeutic continuous US (group 1) or sham US (group 2). A 1-MHz US head was used, set to an intensity of 1 W/cm(2) for 10 min. All patients received 20 min of hot packs, 10 min of interferential current, and 15 min of quadriceps isometric exercise of both knees. Patients in each group received treatments five times weekly for 3 weeks. Patients were evaluated at baseline and at the end of the treatment sessions. Outcome measures included visual analogue scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), 50-m walking speed, Lequesne index, Hospital Anxiety and Depression Scale (HADS). RESULTS: The patients with knee OA had significant improvements in pain, stiffness, functional activity, walking time, disability, depression and anxiety scores with therapeutic US and sham US (P < 0.05). The improvement in pain VAS scores, WOMAC scores, Lequesne index and HADS scores were not significantly different in patients treated with US and sham US (P > 0.05). No side-effects were reported during or after the US treatment periods. CONCLUSION: US therapy is safe but use of US in addition to conventional physical therapy programs seems to have no further significant effect in people with knee OA.

Primary study

Unclassified

Interferential Current Therapy in Patients with Knee Osteoarthritis...Comparison of the effectiveness of different amplitude-modulated frequencies

Journal American journal of physical medicine & rehabilitation / Association of Academic Physiatrists
Year 2012
Links Pubmed DOI

This article is included in 4 Systematic reviews Systematic reviews (4 references)

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OBJECTIVE: This study aimed to compare the effectiveness of different amplitude-modulated frequencies of interferential current (IFC) and sham IFC on knee osteoarthritis. DESIGN: A randomized and single-blind study was performed on 60 patients diagnosed with knee osteoarthritis. The patients were allocated to three active IFC groups (40, 100, and 180 Hz), and one sham IFC group. Treatments were performed 5 times a week for 3 wks consecutively. Each patient was assessed at the end of the treatments and at the first month using the following measurements: visual analog scale (pain at rest, pain on movement and disability), physician and patient judgments regarding treatment effectiveness, 15-m walking time (in minutes), range of motion (ROM), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and paracetamol intake (g/wk). RESULTS: Although there were significant improvements in all variables, except WOMAC stiffness and range of motion, measured in all groups at the end of the treatment and during the follow-up, this improvement was greater in active IFC groups than in the sham group. The improvement in WOMAC stiffness was observed only in active IFC treatment groups (P < 0.05). No significant difference between different amplitude-modulated frequencies of IFC treatments was observed. CONCLUSIONS: This study demonstrated the superiority of the IFC with some advantages on pain and disability outcomes when compared with sham IFC for the management of knee osteoarthritis. However, the effectiveness of different amplitude-modulated frequencies of IFC was not superior when compared with each other.

Primary study

Unclassified

Comparison of the efficacy of transcutaneous electrical nerve stimulation, interferential currents, and shortwave diathermy in knee osteoarthritis: a double-blind, randomized, controlled, multicenter study.

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Journal Archives of physical medicine and rehabilitation
Year 2012
Links Pubmed DOI

This article is included in 12 Systematic reviews Systematic reviews (12 references)

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OBJECTIVE: To compare the effectiveness of transcutaneous electrical nerve stimulation (TENS), interferential currents (IFCs), and shortwave diathermy (SWD) against each other and sham intervention with exercise training and education as a multimodal package. DESIGN: A double-blind, randomized, controlled, multicenter trial. SETTING: Departments of physical medicine and rehabilitation in 4 centers. PARTICIPANTS: Patients (N=203) with knee osteoarthritis (OA). INTERVENTIONS: The patients were randomized by the principal center into the following 6 treatment groups: TENS sham, TENS, IFCs sham, IFCs, SWD sham, and SWD. All interventions were applied 5 times a week for 3 weeks. In addition, exercises and an education program were given. The exercises were carried out as part of a home-based training program after 3 weeks' supervised group exercise. MAIN OUTCOME MEASURES: Primary outcome was a visual analog scale (0-100mm) to assess knee pain. Other outcome measures were time to walk a distance of 15m, range of motion, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Nottingham Health Profile, and paracetamol intake (in grams). RESULTS: We found a significant decrease in all assessment parameters (P<.05), without a significant difference among the groups except WOMAC stiffness score and range of motion. However, the intake of paracetamol was significantly lower in each treatment group when compared with the sham groups at 3 months (P<.05). Also, the patients in the IFCs group used a lower amount of paracetamol at 6 months (P<.05) in comparison with the IFCs sham group. CONCLUSIONS: Although all groups showed significant improvements, we can suggest that the use of physical therapy agents in knee OA provided additional benefits in improving pain because paracetamol intake was significantly higher in the patients who were treated with 3 sham interventions in addition to exercise and education.