Effects of kinesiotherapy, ultrasound and electrotherapy in management of bilateral knee osteoarthritis: prospective clinical trial

Naryana Cristina Mascarin, Rodrigo Luiz Vancini, Marã Lia Dos Santos Andrade, Eduardo de Paiva Magalhães, Claudio Andre Barbosa de Lira, Ibsen Bellini Coimbra, Naryana Cristina Mascarin, Rodrigo Luiz Vancini, Marã Lia Dos Santos Andrade, Eduardo de Paiva Magalhães, Claudio Andre Barbosa de Lira, Ibsen Bellini Coimbra

Abstract

Background: Although recent advances in knee osteoarthritis (OA) treatment and evaluation were achieved, to the best of our knowledge, few studies have evaluated the longitudinal effect of therapeutic modalities on the functional exercise capacity of patients with knee OA. The purpose was to investigate the effects of kinesiotherapy and electrotherapy on functional exercise capacity, evaluated using the six-minute walk test (6-MWT) in patients with bilateral knee OA. Secondary measurements included range of motion (ROM), severity of knee pain (VAS), and a measure of perceived health and physical function, evaluated using the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index.

Methods: A total of 40 women with bilateral knee OA were assigned to three groups: kinesiotherapy (KIN, n = 16), transcutaneous electrical nerve stimulation (TENS, n = 12), or ultrasound (US, n = 10). The groups underwent 12 weeks of intervention twice per week. The participants were subjected to the 6-MWT, ROM, VAS and WOMAC index. These tests were performed before and after the intervention. The study was focused on outpatients and was carried out at Universidade Estadual de Campinas, Brazil.

Results: At follow-up, the KIN and US groups had significantly higher 6-MWT distances (19.8 ± 21.7 and 14.1 ± 22.5%, respectively) compared with their respective pre-intervention values. All treatments were effective for reducing pain and improving the WOMAC index.

Conclusions: We demonstrated that the 6-MWT is a tool that can be used to evaluate improvements in the functional exercise capacity of patients submitted to a clinical intervention.

References

    1. Bennell KL, Egerton T, Wrigley TV, Hodges PW, Hunt M, Roos EM, Kyriakides M, Metcalf B, Forbes A, Ageberg E, Hinman RS. Comparison of neuromuscular and quadriceps strengthening exercise in the treatment of varus malaligned knees with medial knee osteoarthritis: a randomised controlled trial protocol. BMC Musculoskelet Disord. 2011;12:276. doi: 10.1186/1471-2474-12-276.
    1. Hunter DJ, Sharma L, Skaife T. Alignment and osteoarthritis of the knee. J Bone Joint Surg Am. 2009;1(Suppl 1):85–89.
    1. Cooper C. In: Rheumatology. Klippel J, Dieppe P, editor. CV Mosby, New York; 1994. The epidemiology of osteoartbritis; p. 7.3.1-4.
    1. Osiri M, Welch V, Brosseau L, Shea B, McGowan J, Tugwell P, Wells G. Transcutaneous electrical nerve stimulation for knee osteoarthritis. Cochrane Database Syst Rev. 2000;4:CD002823.
    1. Rutjes AW, Nüesch E, Sterchi R, Kalichman L, Hendriks E, Osiri M, Brosseau L, Reichenbach S, Jüni P. Transcutaneous electrostimulation for osteoarthritis of the knee. Cochrane Database Syst Rev. 2009;4:CD002823.
    1. Leslie M. Knee osteoarthritis management therapies. Pain Manag Nurs. 2000;1(2):51–57. doi: 10.1053/jpmn.2000.7782.
    1. Bennell KL, Hinman RS, Metcalf BR, Buchbinder R, McConnell J, McColl G, Green S, Crossley KM. Efficacy of physiotherapy management of knee joint osteoarthritis: a randomised, double blind, placebo controlled trial. Ann Rheum Dis. 2005;64(6):906–912. doi: 10.1136/ard.2004.026526.
    1. Altman RD. Pharmacological therapies for osteoarthritis of the hand: a review of the evidence. Drugs Aging. 2010;27(9):729–745. doi: 10.2165/11539010-000000000-00000.
    1. Conrozier T, Chevalier X. Long-term experience with hylan GF-20 in the treatment of knee osteoarthritis. Expert Opin Pharmacother. 2008;9(10):1797–1804. doi: 10.1517/14656566.9.10.1797.
    1. Hawker GA, Mian S, Bednis K, Stanaitis I. Osteoarthritis year 2010 in review: non pharmacologic therapy. Osteoarthr Cartil. 2011;19(4):366–374. doi: 10.1016/j.joca.2011.01.021.
    1. Suarez-Almazor ME, Looney C, Liu Y, Cox V, Pietz K, Marcus DM, Street RL Jr. A randomized controlled trial of acupuncture for osteoarthritis of the knee: effects of patient-provider communication. Arthritis Care Res (Hoboken) 2010;62(9):1229–1236. doi: 10.1002/acr.20225.
    1. Myers SS, Phillips RS, Davis RB, Cherkin DC, Legedza A, Kaptchuk TJ. Patient expectations as predictors of outcome in patients with acute low back pain. J Gen Intern Med. 2008;23(2):148–153. doi: 10.1007/s11606-007-0460-5.
    1. Linde K, Witt CM, Streng A, Weidenhammer W, Wagenpfeil S, Brinkhaus B, Willich SN, Melchart D. The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain. Pain. 2007;128(3):264–271. doi: 10.1016/j.pain.2006.12.006.
    1. Deyle GD, Allison SC, Matekel RL, Ryder MG, Stang JM, Gohdes DD, Hutton JP, Henderson NE, Garber MB. Physical therapy treatment for osteoarthritis of the knee: a randomised comparison of supervised clinical exercise and manual therapy procedures versus a home exercise programme. Phys Ther. 2005;85(12):1301–1317.
    1. Bunning RD, Materson RS. A rational program of exercise for patients with osteoarthritis. Semin Arthritis Rheum. 1991;21(3 Suppl 2):33–43.
    1. Rutjes AW, Nüesch E, Sterchi R, Jüni P. Therapeutic ultrasound for osteoarthritis of the knee or hip. Cochrane Database Syst Rev. 2010;1:CD003132.
    1. Kozanoglu E, Basaran S, Guzel R, Guler-Uysal F. Short term efficacy of ibuprofen phonophoresis versus continuous ultrasound therapy in knee osteoarthritis. Swiss Med Wkly. 2003;133(23–24):333–338.
    1. Sharma L. Nonpharmacologic management of osteoarthritis. Curr Opin Rheumatol. 2002;14(5):603–607. doi: 10.1097/00002281-200209000-00022.
    1. Lin YC, Davey RC, Cochrane T. Tests for physical function of the elderly with knee and hip osteoarthritis. Scand J Med Sci Sports. 2001;11(5):280–286. doi: 10.1034/j.1600-0838.2001.110505.x.
    1. French HP, Fitzpatrick M, FitzGerald O. Responsiveness of physical function outcomes following physiotherapy intervention for osteoarthritis of the knee: an outcome comparison study. Physiotherapy. 2011;97(4):302–308. doi: 10.1016/j.physio.2010.03.002.
    1. Santana MG, de Lira CA, Passos GS, Santos CA, Silva AH, Yoshida CH, Tufik S, de Mello MT. Is the six-minute walk test appropriate for detecting changes in cardiorespiratory fitness in healthy elderly men? J Sci Med Sport. 2012;15(3):259–265. doi: 10.1016/j.jsams.2011.11.249.
    1. ATS/ACCP. ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003;167(2):211–277.
    1. Kutlay S, Küçükdeveci AA, Elhan AH, Oztuna D, Koç N, Tennant A. Validation of the World Health Organization disability assessment schedule II (WHODAS-II) in patients with osteoarthritis. Rheumatol Int. 2011;31(3):339–346. doi: 10.1007/s00296-009-1306-8.
    1. Goggins J, Baker K, Felson D. What WOMAC pain score should make a patient eligible for a trial in knee osteoarthritis? J Rheumatol. 2005;32(3):540–542.
    1. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M. et al.Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29(8):1039–1049. doi: 10.1002/art.1780290816.
    1. Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. 2. F.A. Davis Company, Philadelphia; 1995.
    1. ATS. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111–117.
    1. Kennedy DM, Stratford PW, Wessel J, Gollish JD, Penney D. Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty. BMC Musculoskelet Disord. 2005;6:3. doi: 10.1186/1471-2474-6-3.
    1. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833–1840.
    1. Soderman P, Malchau H. Validity and reliability of Swedish WOMAC osteoarthritis index: a self-administered disease-specific questionnaire (WOMAC) versus generic instruments (SF-36 and NHP) Acta Orthop Scand. 2000;71(1):39–46. doi: 10.1080/00016470052943874.
    1. Tok F, Aydemir K, Peker F, Safaz I, Taşkaynatan MA, Ozgül A. The effects of electrical stimulation combined with continuous passive motion versus isometric exercise on symptoms, functional capacity, quality of life and balance in knee osteoarthritis: randomized clinical trial. Rheumatol Int. 2011;31(2):177–181. doi: 10.1007/s00296-009-1263-2.
    1. Thorlund JB, Aagaard P, Roos EM. Muscle strength and functional performance in patients at high risk of knee osteoarthritis: a follow-up study. Knee Surg Sports Traumatol Arthrosc. 2011;20(6):1110–1117.
    1. Escalante Y, García-Hermoso A, Saavedra JM. Effects of exercise on functional aerobic capacity in lower limb osteoarthritis: a systematic review. J Sci Med Sport. 2011;14(3):190–198. doi: 10.1016/j.jsams.2010.10.004.
    1. Rosemffet MG, Schneeberger EE, Citera G, Sgobba ME, Laiz C, Schmulevich H, Artçanuturry P, Gagliardi S, Maldonado Cocco JA. Effects of functional electrostimulation on pain, muscular strength, and functional capacity in patients with osteoarthritis of the knee. J Clin Rheumatol. 2004;10(5):246–249. doi: 10.1097/01.rhu.0000141831.40350.91.
    1. Cammarata ML, Dhaher YY. Associations between frontal plane joint stiffness and proprioceptive acuity in knee osteoarthritis. Arthritis Care Res (Hoboken) 2012;64(5):735–743. doi: 10.1002/acr.21589.
    1. Holla JF, van der Leeden M, Roorda LD, Bierma-Zeinstra SM, Damen J, Dekker J, Steultjens MP. Diagnostic accuracy of range of motion measurements in early symptomatic hip and/or knee osteoarthritis. Arthritis Care Res (Hoboken) 2012;64(1):59–65. doi: 10.1002/acr.20645.
    1. Elbaz A, Debbi EM, Segal G, Haim A, Halperin N, Agar G, Mor A, Debi R. Sex and body mass index correlate with Western Ontario and McMaster Universities Osteoarthritis Index and quality of life scores in knee osteoarthritis. Arch Phys Med Rehabil. 2011;92(10):1618–1623. doi: 10.1016/j.apmr.2011.05.009.
    1. Fransen M, McConnell S, Bell M. Exercise for osteoarthritis of the hip or knee. Cochrane Database Syst Rev. 2003;3:CD004286.
    1. Roddy E, Zhang W, Doherty M. Aerobic walking or strengthening exercise for osteoarthritis of the knee? A systematic review. Ann Rheum Dis. 2005;64(4):544–548. doi: 10.1136/ard.2004.028746.
    1. Ng MM, Leung MC, Poon DM. The effects of electro-acupuncture and transcutaneous electrical nerve stimulation on patients with painful osteoarthritic knees: a randomized controlled trial with follow-up evaluation. J Altern Complement Med. 2003;9(5):641–649. doi: 10.1089/107555303322524490.
    1. Cheing GL, Hui-Chan CW, Chan KM. Does four weeks of TENS and/or isometric exercise produce cumulative reduction of osteoarthritic knee pain? Clin Rehabil. 2002;16(7):749–760. doi: 10.1191/0269215502cr549oa.
    1. Loyola-Sánchez A, Richardson J, MacIntyre NJ. Efficacy of ultrasound therapy for the management of knee osteoarthritis: a systematic review with meta-analysis. Osteoarthr Cartil. 2010;18(9):1117–1126. doi: 10.1016/j.joca.2010.06.010.
    1. Tascioglu F, Kuzgun S, Armagan O, Ogutler G. Short-term effectiveness of ultrasound therapy in knee osteoarthritis. J Int Med Res. 2010;38(4):1233–1242.
    1. Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med. 1998;158(5 Pt 1):1384–1387.
    1. Wang TJ, Belza B, Elaine Thompson F, Whitney JD, Bennett K. Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee. J Adv Nurs. 2007;57(2):141–152. doi: 10.1111/j.1365-2648.2006.04102.x.
    1. Bautmans I, Lambert M, Mets T. The six-minute walk test in community dwelling elderly: influence of health status. BMC Geriatr. 2004;4:6. doi: 10.1186/1471-2318-4-6.
    1. Zugck C, Kruger C, Durr S, Gerber SH, Haunstetter A, Hornig K, Kübler W, Haass M. Is the 6-minute walk test a reliable substitute for peak oxygen uptake in patients with dilated cardiomyopathy? Eur Heart J. 2000;21(7):540–549. doi: 10.1053/euhj.1999.1861.
    1. Wyatt FB, Milam S, Manske RC, Deere R. The effects of aquatic and traditional exercise programs on persons with knee osteoarthritis. J Strength Cond Res. 2001;15(3):337–340.
    1. Bent NP, Wright CC, Rushton AB, Batt ME. Selecting outcome measures in sports medicine: a guide for practitioners using the example of anterior cruciate ligament rehabilitation. Br J Sports Med. 2009;43(13):1006–1012. doi: 10.1136/bjsm.2009.057356.
    1. Ries MD, Philbin EF, Groff GD. Relationship between severity of gonarthrosis and cardiovascular fitness. Clin Orthop Relat Res. 1995;313:169–176.

Source: PubMed

3
Suscribir