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1.
Sports Med Arthrosc Rev ; 30(2): 102-110, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35533062

RESUMO

Osteoarthritis of the knee generally affects individuals from the fifth decade, the typical age of middle-age athletes. In the early stages, management is conservative and multidisciplinary. It is advisable to avoid sports with high risk of trauma, but it is important that patients continue to be physically active. Conservative management offers several options; however, it is unclear which ones are really useful. This narrative review briefly reports the conservative options for which there is no evidence of effectiveness, or there is only evidence of short-term effectiveness.


Assuntos
Osteoartrite do Joelho , Esportes , Atletas , Humanos , Joelho , Articulação do Joelho , Pessoa de Meia-Idade , Osteoartrite do Joelho/terapia
2.
Medicina (Kaunas) ; 58(4)2022 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-35454299

RESUMO

Background and Objectives: Knee osteoarthritis (OA) is a frequent cause of pain, functional limitations, and a common reason for surgical treatment, such as joint replacement. Conservative therapies can reduce pain and improve function; thus, delaying or even preventing surgical intervention. Various individual conservative therapies show benefits, but combination therapies remain underexplored. The aim of this prospective case-study was to assess the effect of a conservative combination therapy in patients with painful varus knee OA. Materials and Methods: With strong inclusion and exclusion criteria, nine patients with painful varus knee OA (mean age 56 years (range 51-63 years) were selected and monitored over six months, using the following clinical outcome scores: pain visual analog scale (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC score), short-form-36 items (SF-36) quality of life score, and the sports frequency score. All patients received a standardized conservative trio-therapy with varus-reducing hindfoot shoe-insoles with a lateral hindfoot wedge, oral viscosupplementation, and physiotherapy for six months. Results: The pain was reduced significantly from initial VAS values of 5.4 points (range, 3-10) to values of 0.6 points (range, 0-3; p < 0.01), at the end of treatment. After six months, seven out of nine patients reported no pain at all (VAS 0). The WOMAC score improved significantly, from initial values of 35 (range, 10-56) to values of 2 (range, 0-9; p < 0.01). The SF-36 score showed significant improvement after six months in all four domains of physical health (p < 0.01) and in two of the four domains of mental health (p < 0.05). The sports frequency score increased by at least one level in six out of nine patients after six months. Conclusions: The conservative trio-therapy in patients with varus knee OA showed positive initial clinical results: less pain, higher function, better quality of life, and higher sport activity. Further studies are required to evaluate the long-term effect.


Assuntos
Osteoartrite do Joelho , Pré-Escolar , Tratamento Conservador , Humanos , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/terapia , Dor/etiologia , Medição da Dor , Qualidade de Vida , Resultado do Tratamento
3.
Medicine (Baltimore) ; 101(15): e29098, 2022 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-35475797

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is one of the leading causes of disability. The effectiveness of auricular point pressing therapy for treating KOA remains controversial. This protocol describes the method of a systematic review and meta-analysis evaluating the effectiveness and safety of auricular point pressing therapy for treating KOA. METHODS: Four English databases (PubMed, Embase, Cochrane Library databases and Web of Science) and 4 Chinese databases (China National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, and Wanfang) will be searched. All randomized controlled trials related to auricular point pressing therapy for KOA will be included. Extracted data will include publication details, basic information, demographic data, intervention details and patient outcomes. The primary outcome will be Western Ontario and McMaster Universities Osteoarthritis Index and visual analogue scale. Risk of bias will be assessed using the Cochrane Collaboration tool for assessing risk of bias. Article selection, data extraction and risk of bias assessment will be performed by 2 independent reviewers. If the meta-analysis is precluded, we will conduct a descriptive synthesis using a best-evidence synthesis approach. The strength of recommendations and quality of evidence will be assessed using the Grading of Recommendations Assessment Development. RESULTS: The systematic review will provide evidence to assess the efficacy and safety of auricular point pressing therapy on KOA. CONCLUSION: The systematic review will provide evidence to assess the efficacy and safety of auricular point pressing therapy for KOA patients. ETHICS AND DISSEMINATION: For this review, ethical approval is not required. Patients will not be involved. The findings will be published in a peer-reviewed journal. INPLASY REGISTRATION NUMBER: INPLASY 202220077.


Assuntos
Terapia por Acupuntura , Osteoartrite do Joelho , Terapia por Acupuntura/métodos , Humanos , Metanálise como Assunto , Osteoartrite do Joelho/terapia , Medição da Dor , Literatura de Revisão como Assunto , Revisões Sistemáticas como Assunto
4.
BMC Musculoskelet Disord ; 23(1): 364, 2022 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-35436874

RESUMO

BACKGROUND: This study aimed to quantify the absenteeism costs of knee and hip osteoarthritis in the Netherlands for the Dutch workforce and specific groups of workers. METHODS: We used a longitudinal, dynamic database from a large occupational health service in which occupational physicians register information about personal information and sick leave of workers with the diagnosis of knee- and/or hip osteoarthritis. We included all employees aged 15 to 75 years performing paid work and diagnosed with knee and/or hip osteoarthritis. Costs were calculated annually and per episode for different subgroups from an employer's perspective using the Human Capital Approach. In the Netherlands, the employer has to pay 70% of the employee's wage out of pocket for the first two years of sick leave and also for the occupational health care. In this way, employers receive information about the costs of workers on sick leave due to knee or hip osteoarthritis. This might stimulate investments in targeted prevention and work-directed care. RESULTS: For the period 2015-2017, 1399 workers fulfilled the inclusion criteria. An average sick leave episode of knee osteoarthritis had a duration of 186 calendar days and was associated with €15,550 in costs. For hip osteoarthritis these data were 159 calendar days and €12,482 in costs. These costs are particularly high among male workers and workers with a higher number of weekly working hours. The average annual costs for the Dutch workforce due to sick leave for knee and hip osteoarthritis were €26.9 million and €13.8 million, respectively. Sick leave costs decreased for hip and not for knee osteoarthritis during 2015-2017. CONCLUSIONS: Annual sick leave costs due to knee and hip osteoarthritis are about €40 million for the Dutch workforce and approximately twice as high for knee compared to hip osteoarthritis. Average costs per sick leave episode are particularly high among male workers and workers with a higher number of weekly working hours.


Assuntos
Osteoartrite do Quadril , Osteoartrite do Joelho , Absenteísmo , Feminino , Estresse Financeiro , Humanos , Masculino , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/epidemiologia , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/epidemiologia , Osteoartrite do Joelho/terapia , Licença Médica , Recursos Humanos
5.
BMC Musculoskelet Disord ; 23(1): 361, 2022 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-35436914

RESUMO

BACKGROUND: Hip osteoarthritis (OA) is a leading cause of musculoskeletal pain. Exercise is a core recommended treatment. Most evidence is based on muscle-strengthening exercise, but aerobic physical activity has potential to enhance clinical benefits. The primary aim of this study is to test the hypothesis that adding aerobic physical activity to a muscle strengthening exercise leads to significantly greater reduction in hip pain and improvements in physical function, compared to a lower-limb muscle strengthening exercise program alone at 3 months. METHODS: This is a superiority, 2-group, parallel randomised controlled trial including 196 people with symptomatic hip OA from the community. Following baseline assessment, participants are randomly allocated to receive either i) aerobic physical activity and muscle strengthening exercise or; ii) muscle strengthening exercise only. Participants in both groups receive 9 consultations with a physiotherapist over 3 months. Both groups receive a progressive muscle strengthening exercise program in addition to advice about OA management. The aerobic physical activity plan includes a prescription of moderate intensity aerobic physical activity with a goal of attaining 150 min per week. Primary outcomes are self-reported hip pain assessed on an 11-point numeric rating scale (0 = 'no pain' and 10 = 'worst pain possible') and self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index physical function subscale) at 3 months. Secondary outcomes include other measures of self-reported pain (assessed at 0, 3, 9 months), self-reported physical function (assessed at 0, 3, 9 months), performance-based physical function (assessed at 0, 3 months), joint stiffness (assessed at 0, 3, 9 months), quality of life (assessed at 0, 3, 9 months), muscle strength (assessed at 0, 3 months), and cardiorespiratory fitness (assessed at 0, 3 months). Other measures include adverse events, co-interventions, and adherence. Measures of body composition, serum inflammatory biomarkers, quantitative sensory measures, anxiety, depression, fear of movement and self-efficacy are included to explore causal mechanisms. DISCUSSION: Findings will assist to provide an evidence-based recommendation regarding the additional effect of aerobic physical activity to lower-limb muscle strengthening on hip OA pain and physical function. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry reference: ACTRN 12619001297112. Registered 20th September 2019.


Assuntos
Osteoartrite do Quadril , Osteoartrite do Joelho , Artralgia/etiologia , Austrália , Exercício Físico , Terapia por Exercício/métodos , Humanos , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/terapia , Dor/complicações , Medição da Dor/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
6.
Trials ; 23(1): 323, 2022 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-35436968

RESUMO

BACKGROUND: Knee osteoarthritis (OA) is a leading cause of global disability. According to current guidelines, exercise is the most recommended and important non-surgical treatment for knee OA. However, the best type of exercise for this condition remains unclear. Evidence has shown that traditional Chinese exercises may be more effective. Therefore, the current prospective, two-armed, single-center randomized controlled trial (RCT) aimed to identify an effective physiotherapy for knee OA. METHODS/DESIGN: In total, 114 patients with painful knee OA will be recruited from the orthopedic outpatient department of Shanghai Jiao Tong University Affiliated Sixth People's Hospital. To compare the therapeutic effect of two different home-based exercise programs, the participants will be randomly assigned into the experimental group (leg swing exercise) or the control group (quadriceps strengthening exercise). Each participant in both groups will be required to attend five individual sessions with a physiotherapist who will teach the exercise program and monitor progress. Participants will be instructed to perform the exercises at home every day for 12 weeks. Clinical outcomes will be assessed at baseline and 12 and 24 weeks after starting the intervention. The primary outcomes are average overall knee pain and physical function in daily life. The secondary outcomes include other measures of knee pain, physical function, patient-perceived satisfactory improvement, health-related quality of life, physical activity and performance, muscle strength of the lower limb, and adherence. DISCUSSION: This study will provide more evidence on the effects of traditional Chinese exercise on improving physical function and relieving joint pain among patients with knee OA. If proven effective, leg swing exercise can be used as a non-surgical treatment for knee OA in the future. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2000039005 . Registered on 13 October 2020.


Assuntos
Osteoartrite do Joelho , China , Exercício Físico , Terapia por Exercício/métodos , Humanos , Perna (Membro) , Extremidade Inferior , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/terapia , Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
7.
Int J Yoga Therap ; 32(2022)2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-35405738

RESUMO

Hatha yoga (HY) and aerobic and strengthening exercise (ASE) programs are recommended for optimal management of osteoarthritis. However, evidence on long-term adherence to these programs and factors that influence it is lacking in older adults. The purposes of this study were to (1) describe and compare long-term HY and ASE adherence in community-dwelling older women with knee osteoarthritis 12 months post-HY/ASE intervention programs; (2) identify benefits and facilitators of, and barriers to, long-term adherence; and (3) examine other self-care interventions used after completing HY or ASE programs. Adherence was defined as following the prescribed HY/ASE program or incorporating the practice into daily habits. Five semistructured focus group interviews and 12 months of exercise diaries were obtained from 28 women (mean age 71.2 years). Long-term adherence to the prescribed HY or ASE regimen was relatively high, albeit adapted to individual needs, priorities, and preferences. Over the 12-month follow-up period, participants spent on average 3.5 days/3.1 hours per week on exercise. Most participants remained physically active by modifying their prescribed programs and integrating elements of the interventions into their own exercise regimens. Facilitators to long-term adherence were perceived benefits, having an exercise routine/habit, and program structure/instruction. Poor health status, lack of time, and exercise preferences were identified as barriers. Participants used a variety of self-care interventions including oral supplements and alternative diets for managing their osteoarthritis. This work suggests that exercise programs for osteoarthritis that incorporate individual preferences, flexible hours, and easy-to-follow instructions are most likely to result in long-term adherence.


Assuntos
Osteoartrite do Joelho , Ioga , Idoso , Exercício Físico , Terapia por Exercício/métodos , Feminino , Humanos , Vida Independente , Osteoartrite do Joelho/terapia
8.
Clin Geriatr Med ; 38(2): 345-360, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35410684

RESUMO

Adherence has been proposed as a major barrier to implementing and maintaining the benefits of osteoarthritis (OA) core treatments and is influenced by many factors. Although there are reasonable data to support factors influencing adherence to exercise/physical activity in knee/hip OA populations, there is less research examining alternative interventions, or in the hand OA population. This problem is complicated by the lack of gold-standard measurement of adherence for core osteoarthritis treatments. The predictors of treatment adherence are not well understood, and findings are contradictory. Strategies incorporating behavior change techniques should be implemented to improve and maintain long-term adherence.


Assuntos
Terapia por Exercício , Osteoartrite do Joelho , Exercício Físico , Terapia por Exercício/métodos , Humanos , Articulação do Joelho , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/terapia , Manejo da Dor
9.
J Am Acad Orthop Surg ; 30(9): e721-e729, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35383651

RESUMO

Management of Osteoarthritis of the Knee (nonarthroplasty) Evidence-Based Clinical Practice Guideline is based on a systematic review of published studies for the nonarthroplasty treatment of osteoarthritis of the knee in adults (ages 17 years and older). The purpose of this clinical practice guideline is to evaluate current best evidence associated with treatment. The scope of this guideline contains nonpharmacologic and pharmacologic interventions for symptomatic osteoarthritis of the knee, including surgical procedures less invasive than knee arthroplasty. It does not provide recommendations for patients with rheumatoid arthritis, arthritis of other joints, or other imflammatory athropathies. This guideline contains 29 recommendations to assist all qualified and appropriately trained healthcare professionals involved in the nonarthroplasty management of osteoarthritis of the knee and provide information for patients. In addition, the work group highlighted the need for better research into intra-articular corticosteroid, hyaluronic acid, and platelet-rich plasma detailing osteoarthritis characterization, including subgroup analyses and osteoarthrosis severity stratification, and clinically relevant outcomes with control subjects for bias and cost-effectiveness analysis. Studies comparing outcomes in patients with mild-to-moderate knee osteoarthritis and an MRI confirmed meniscal tear who have undergone partial meniscectomy after failing to improve with a course of conservative treatment (nonsteroidal anti-inflammatory drugs, steroid injection, and physical therapy) versus those who have undergone partial meniscectomy without a dedicated course of conservative treatment. Prospective randomized trials or prospective cohort studies are still needed to establish efficacy of individual oral nonsteroidal anti-inflammatory drugs within specific subgroups and populations to tailor systemic medications to help increase efficacy and decrease the risk of adverse effects.


Assuntos
Osteoartrite do Joelho , Adolescente , Adulto , Anti-Inflamatórios/uso terapêutico , Humanos , Injeções Intra-Articulares , Articulação do Joelho , Meniscectomia , Osteoartrite do Joelho/tratamento farmacológico , Osteoartrite do Joelho/terapia , Estudos Prospectivos
10.
Sci Prog ; 105(2): 368504221088375, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35379041

RESUMO

The clinical relevance of Tai Chi on pain, stiffness, and physical function in adults with knee osteoarthritis (KOA) has not been established. Therefore, the purpose of the current study was to address this gap. Eight randomized controlled trials from a recent meta-analysis representing 407 participants (216 Tai Chi, 191 control) in adults ≥18 years of age with KOA and included the assessment of pain, stiffness, and physical function using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were assessed. The inverse variance heterogeneity model (IVhet) was first used to pool standardized mean difference effect sizes (ES) for each outcome. Clinical relevance, i.e., number-needed-to treat (NNT) ≤10 and relative risk reduction (RRR) ≥25% was calculated across assumed controlled risks (ACR) ranging from 0.01 to 0.99. Statistically significant improvements were found for pain (ES, -0.75, 95% CI, -0.99, -0.51; Q = 8.9, p = 0.26; I2 = 21%), stiffness (ES, -0.70, 95% CI, -0.95, -0.46; Q = 9.6, p = 0.21; I2 = 27%), and physical function (ES, -0.91, 95% CI, -1.12, -0.70; Q = 7.2, p = 0.40; I2 = 3%). The intersection of results for a NNT ≤10 and RRR ≥25% yielded high evidence and clinically relevant improvements across a wide range of ACR for pain (0.15 to 0.88), stiffness (0.15 to 0.87), and physical function (0.13 to 0.97). These findings suggest that Tai Chi results in statistically significant as well as clinically important improvements in pain, stiffness, and physical function across a wide range of ACR in adults with KOA.


Assuntos
Osteoartrite do Joelho , Tai Ji , Humanos , Ontário , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/terapia , Dor , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Zhen Ci Yan Jiu ; 47(4): 321-8, 2022 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-35486011

RESUMO

OBJECTIVE: To observe the effect of warm needling on the expression of oxidative stress related factors and pro-inflammatory factors in cartilage of mono sodium iodoacetate (MIA) induced knee osteoarthritis (KOA) model rats, so as to explore its mechanisms underlying improvement of KOA. METHODS: Sixty male Sprague Dawley rats were randomly divided into 5 groups: control, model, acupuncture, moxibustion,warm needling, with 12 rats in each group. Rats of the acupuncture, moxibustion,warm needling groups received manual acupuncture or moxibustion or both stimulation of "Zusanli" (ST36) for 15 minutes, once a day for 21 days beginning from the third day after modeling. The foot volume was measured by drainage method, and the plantar mechanical contraction reflex threshold (mechanical pain threshold, MPT) measured by using an electronic pain meter. After 21 days of treatment, the histopathological changes of knee joint were observed by HE staining, and Mankin score was calculated to evaluate the degree of cartilage destruction. The malondialdehyde (MDA) level was measured by colorimetry, and immunofluorescence staining was used to observe the expression of NOX2, SOD2 or IL-1ß. RESULTS: Compared with the control group, the knee joint swelling volume from the 3rd day after modeling, Mankin score, MDA level, and the number of NOX2 and IL-1ß positive cells were significantly increased (P<0.01, P<0.05), while the MPT from the 3rd day after modeling, and the number of SOD2 positive cells were considerably decreased (P<0.01) in the model group. After the interventions, the increased levels of the knee joint swelling volume from the 12th day after modeling, and the Mankin score, MDA level, NOX2 and IL-1ß positive cells, and the levels of decreased MPT from the 9th day after modeling and SOD2 positive cell number were reversed in the acupuncture, moxibustion,warm needling groups (P<0.05, P<0.01), and the effects of warm needling were significantly superior to those of simple manual acupuncture and simple moxibustion in down-regulating knee joint volume, Mainkin score, MDA le-vel, and NOX2 and IL-1ß positive cells, and in up-regulating MPT from the 12th day after modeling, and the number of SOD2 positive cells (P<0.05). No significant differences were found between the acupuncture and moxibustion groups in the levels of all the indexes mentioned above (P>0.05). HE staining showed rough and damaged articular surface, with subchondral neovascularization and moderate connective tissue hyperplasia, and abundant lymphocyte and monocyte infiltration in the model group, which was milder in the acupuncture, moxibustion groups particularly in the warm needling group after 21 days' interventions. CONCLUSION: Warm needling can relieve knee joint pain, swelling and inflammatory damage in KOA rats, which may be associated with its function in inhibiting oxidative stress and inflammation in the cartilage of KOA. The therapeutic effect of warm needling is better than that of manual acupuncture and moxibustion alone.


Assuntos
Osteoartrite do Joelho , Pontos de Acupuntura , Animais , Cartilagem , Inflamação , Masculino , Osteoartrite do Joelho/genética , Osteoartrite do Joelho/terapia , Estresse Oxidativo , Ratos , Ratos Sprague-Dawley , Resultado do Tratamento
12.
Value Health ; 25(4): 614-621, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35365305

RESUMO

OBJECTIVES: This study aimed to evaluate the cost-effectiveness of the randomized clinical trial STEP-KOA (STepped Exercise Program for patients with Knee OsteoArthritis). METHODS: The trial included 230 intervention and 115 control participants from 2 Veterans Affairs (VA) medical centers. A decision tree simulated outcomes for cohorts of patients receiving arthritis education (control) or STEP-KOA (intervention), which consisted of an internet-based exercise training program (step 1), phone counseling (step 2), and physical therapy (step 3) according to patient's response. Intervention costs were assessed from the VA perspective. Quality of life (QOL) was measured using 5-level EQ-5D US utility weights. Incremental cost-effectiveness ratios (ICERs) were calculated as the difference in costs divided by the difference in quality-adjusted life-years (QALYs) between arms at 9 months. A Monte Carlo probabilistic sensitivity analysis was used to generate a cost-effectiveness acceptability curve. RESULTS: The adjusted model found differential improvement in QOL utility weights of 0.042 (95% confidence interval 0.003-0.080; P=.03) for STEP-KOA versus control at 9 months. In the base case, STEP-KOA resulted in an incremental gain of 0.028 QALYs and an incremental cost of $279 per patient for an ICER of $10 076. One-way sensitivity analyses found the largest sources of variation in the ICER were the impact on QOL and the need for a VA-owned tablet. The probabilistic sensitivity analysis found a 98% probability of cost-effectiveness at $50 000 willingness-to-pay per QALY. CONCLUSIONS: STEP-KOA improves QOL and has a high probability of cost-effectiveness. Resources needed to implement the program will decline as ownership of mobile health devices increases.


Assuntos
Osteoartrite do Joelho , Qualidade de Vida , Exercício Físico , Terapia por Exercício , Humanos , Osteoartrite do Joelho/terapia , Anos de Vida Ajustados por Qualidade de Vida
13.
J Healthc Eng ; 2022: 9167956, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35399845

RESUMO

Objective: To observe the effect of warm acupuncture combined with meloxicam and comprehensive nursing on pain improvement and joint function in patients with knee osteoarthritis. Method: Eighty-one patients with KOA were randomly divided into control group (CG), traditional Chinese medicine group (TCMG), and combined group (JG). The CG was treated with meloxicam. The TCMG received warm acupuncture treatment. The JG was treated with meloxicam combined with warm acupuncture. Three groups were given comprehensive nursing intervention, and the course of treatment was 4 weeks. Knee function was assessed by knee pain, activity, stability, walking ability, and ability to walk up and down stairs. Improvement time of clinical symptoms of patients was assessed from knee pain, swelling, and movement limitation. Pain mediators (prostaglandin E2 (PGE2), substance P (SP), dopamine (DA), 5-hydroxytryptamine (5-HT)) were detected by enzyme-linked immunosorbent assay (ELISA). Oxidative stress indicators (superoxide dismutase (SOD) and malondialdehyde (MDA)) of the enrolled patients were detected by water-soluble tetrazolium-1 (WST-1) and the thiobarbituric acid (TBA) method. The clinical efficacy was assessed by the visual analog scale (VAS) score. Results: After treatment, the pain scores of the three groups decreased, and the scores of mobility, stability, walking ability, and the ability to walk up and down stairs increased. Compared with the CG and the TCMG, the JG had a greater range of changes in pain, mobility, stability, walking ability, and ability to walk up and down stairs after treatment. After 7 d, 14 d, and 28 d treatment, PGE2, SP, DA, 5-HT, and MDA in the three groups were decreased compared with before treatment, and the decrease in the JG was more obvious than that in the CG and the TCMG. SOD levels in the three groups were increased, and the increase in the JG was more obvious than that in the CG and the TCMG. The total effective rate of the JG (96.30%) was significantly different from that of the CG (77.78%) and the TCMG (81.48%). The improvement time of knee pain, swelling, and movement limitation in the JG was shorter than that in the CG and the TCMG, and the difference in the improvement time of movement limitation in the TCMG was statistically significant. Conclusion: Warm acupuncture combined with meloxicam and comprehensive nursing can effectively improve knee swelling and pain in patients with KOA, and the mechanism may be related to reducing the content of inflammatory mediators.


Assuntos
Terapia por Acupuntura , Osteoartrite do Joelho , Dinoprostona , Humanos , Articulação do Joelho , Meloxicam/uso terapêutico , Osteoartrite do Joelho/terapia , Dor , Serotonina , Superóxido Dismutase , Resultado do Tratamento
14.
Rheum Dis Clin North Am ; 48(2): 549-567, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35400378

RESUMO

Knee osteoarthritis (OA) is a common and morbid condition. No disease-modifying therapies exist; hence the goals of current treatment are to palliate pain and to retain function. OA pain is significantly influenced by the placebo effect. Nonpharmacologic interventions are essential and have been shown to improve outcomes. Canes, unloading braces, and therapeutic heating/cooling may be valuable. Pharmacotherapy options include topical and oral nonsteroidal anti-inflammatory drugs, duloxetine, and periodic intra-articular glucocorticoids and hyaluronans. Opioids, intra-articular stem cells, and platelet-rich plasma are not recommended. Novel targets such as nerve growth factor are under investigation and may be approved soon for OA pain.


Assuntos
Osteoartrite do Joelho , Plasma Rico em Plaquetas , Humanos , Ácido Hialurônico , Injeções Intra-Articulares , Osteoartrite do Joelho/terapia , Dor , Resultado do Tratamento
15.
Pain Res Manag ; 2022: 2856457, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35371366

RESUMO

Purpose: This study aimed to investigate the effect of knee taping in addition to a supervised exercise protocol on the pain intensity and functional status of individuals with patellofemoral osteoarthritis (PF OA). Methods: The study was based on a randomized, controlled pretest-posttest experimental group design. Following an initial screening, forty people with PF OA (mean age 55, range 40-60) were randomly assigned to one of two groups, Group A or Group B (n = 20 each). Group A underwent knee taping and participated in a supervised exercise program, whereas Group B only participated in a supervised exercise program. For four weeks, both groups received their prescribed treatment five consecutive days each week. At baseline (day 1 preintervention) and 4 weeks postintervention, the visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were obtained. To compare the effect of stipulated interventions within and between groups, paired and unpaired t tests were performed, with the level of significance set at p < 0.05. Results: When comparing the outcome scores at 4 weeks postintervention with baseline scores, the within-group analysis revealed significant mean differences for the outcomes within groups A (VAS: MD = -3.08-0.76; T = 9.70; p < 0.05 and WOMAC: MD = -7.05-0.81; T = 11.11; p < 0.05) and B (WOMAC: MD = -1.6-0.17; T = 2.35; p < 0.05), but a nonsignificant mean difference for the outcomes of VAS within group B (∆MD = 0.08 ± 0.03; T = -0.56; p > 0.05). Similarly, when the score of VAS (MD = -2.73-1.29; T = -9.17; p < 0.05) and WOMAC (MD = -5.95-1.63; T = -5.86; p < 0.05) were compared at 4 weeks postintervention, there was a significant mean difference between groups A and B. Conclusions: In people with patellofemoral osteoarthritis, combining knee taping with a supervised exercise protocol was more effective than the supervised exercise protocol alone in relieving pain and enhancing functional status.


Assuntos
Estado Funcional , Osteoartrite do Joelho , Adulto , Artralgia/etiologia , Artralgia/terapia , Fita Atlética , Exercício Físico , Terapia por Exercício , Humanos , Articulação do Joelho , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/terapia , Dor/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
Trials ; 23(1): 315, 2022 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-35428274

RESUMO

BACKGROUND: Clinical recommendations suggest exercises as the main treatment modality for patients with knee osteoarthritis (OA). This study aimed to compare the effects of two different exercise interventions, i.e., open kinetic chain (OKC) and closed kinetic chain (CKC) exercises, on the pain and lower limb biomechanics of patients with mild knee OA. METHOD: A total of 66 individuals with painful early knee OA, aged 50 years and above, with body mass index (BMI) between 18.9kg/m2 and 29.9 kg/m2 in Kelantan, Malaysia, will be recruited in this study. Participants will be randomly allocated into three different groups, either the OKC, CKC, or control groups. All three groups will attend an individual session with a physiotherapist. The participants in the OKC and CKC groups will perform the exercises three times weekly for 8 weeks at their home. The control group will receive education about clinical manifestations, risk factors, diagnosis, treatment, and nursing care for knee via printed materials. The primary outcomes include self-reported pain scores (visual analog scale), disability scores (Western Ontario and McMaster Universities Arthritis Index), and quality of life scores (Osteoarthritis Knee and Hip Quality of Life). Secondary outcomes include lower limb biomechanics during gait and sit-to-stand as well as isokinetic knee strength. The outcomes will be measured before and after the intervention. DISCUSSION: The present study will compare the effects of two different home-based exercise intervention programs among patients with mild knee OA. The study findings will provide vital information that can be used to design an effective exercise program that aims at delaying the OA progression. TRIAL REGISTRATION: The protocol was registered on 22 December 2020 at ClinicalTrials.gov (registration number: NCT04678609 ).


Assuntos
Osteoartrite do Joelho , Fenômenos Biomecânicos , Terapia por Exercício/métodos , Humanos , Extremidade Inferior , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/terapia , Dor/diagnóstico , Dor/etiologia , Percepção da Dor , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
17.
Cartilage ; 13(2): 19476035221093060, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35438034

RESUMO

OBJECTIVE: The present study explored whether low-intensity pulsed ultrasound (LIPUS) enhances the therapeutic efficacy of mesenchymal stem cells (MSCs) in osteoarthritis (OA) cartilage repair by regulating autophagy-mediated exosome release. DESIGN: MSCs were isolated from the rat bone marrow and treated with rapamycin, 3-methyladenine, or LIPUS. The mechanism of the LIPUS-stimulated exosome release by MSCs was analyzed by inhibiting autophagy. In addition, the MSCs were co-cultured with OA chondrocytes and stimulated by LIPUS, with or without exosome release inhibitor intervention. The exosome release was detected through transmission electron microscopy (TEM), nanoparticle tracking analysis, and biomarker expression analysis. Autophagy was analyzed through TEM, autophagy-related gene expression analysis, and immunofluorescence analysis in vitro. Furthermore, a rat knee OA model was constructed and treated with MSCs, GW4869, and LIPUS. The cartilage repair was assessed through histopathological analysis and extracellular matrix protein expression analysis. RESULTS: The in vitro results indicated that LIPUS promoted MSC exosome release by activating autophagy. The in vivo results demonstrated that LIPUS significantly enhanced the positive effects of MSCs on OA cartilage. These effects were significantly blocked by GW4869, an inhibitor of exosome release. CONCLUSIONS: LIPUS can enhance the therapeutic efficacy of MSCs in OA cartilage repair, and the underlying mechanism is related to the increase in autophagy-mediated exosome release.


Assuntos
Células-Tronco Mesenquimais , Osteoartrite do Joelho , Animais , Autofagia , Medula Óssea , Osteoartrite do Joelho/terapia , Ratos , Ondas Ultrassônicas
18.
BMC Musculoskelet Disord ; 23(1): 274, 2022 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-35317764

RESUMO

BACKGROUND: Osteoarthritis is a common and disabling condition that places heavy burden to individuals and healthcare systems. Patient education is a facilitator in the treatment decision making process, aiming to develop a treatment plan for the disease management. Electronic health (eHealth) is an alternative forum for the delivery of patient education and given the prevailing of eHealth in healthcare, introducing patient education programs using the technology has the potential to improve patient engagement, self-management and outcomes in patients with osteoarthritis. The study will evaluate the efficacy of eHealth patient education tool on patients' perception of knee osteoarthritis and treatment options, satisfaction and compliance to treatments. METHODS: This study is a prospective randomized controlled trial with a 1:1 allocation in two groups. We will recruit 216 patients diagnosed with knee osteoarthritis from the outpatient physiatry/physiotherapy clinic at West China Hospital, Sichuan University in Southwest China. Both groups will receive usual care and additionally, the intervention group will use eHealth patient education tool during the process. Measurements will be taken at baseline, post-intervention, 1 month, 3- and 6-months follow-up. Primary outcome will be patients' knowledge about disease and treatment options, measured by the validated osteoarthritis patient knowledge questionnaire. Secondary outcomes include patients' satisfaction with the consultation, the eHealth patient education tool, and their trust of the physiotherapist. DISCUSSION: The eHealth patient education tool is designed to provide participants with an innovative model of care delivery and this trial will assess the efficacy of the tool and whether this new model of patient education will have the potential to increase patient knowledge and empower self-management. Results collected from this study will further inform future research employing eHealth tool as interventions for the management of a range of other chronic conditions and help participants in communities or rural areas having the equal access to health care services. TRIAL REGISTRATION: This study was prospectively registered on the Chinese Clinical Trials Registry ( ChiCTR2100051083 ) registered 12.09.2021.


Assuntos
Osteoartrite do Joelho , Telemedicina , Eletrônica , Humanos , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/terapia , Educação de Pacientes como Assunto , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Telemedicina/métodos
19.
Zhen Ci Yan Jiu ; 47(3): 262-7, 2022 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-35319845

RESUMO

OBJECTIVE: To observe the effect of acupuncture combined with moxibustion on serum bone metabolism indexes in patients with knee osteoarthritis (KOA), so as to evaluate its clinical efficacy on KOA. METHODS: Ninety-six patients with KOA were randomly divided into control and observation groups, with 48 cases in each group. The patients in the control group were treated with acupuncture at Zusanli(ST36), Neixiyan(EX-LE4), Heding(EX-LE2) and Xuanzhong(GB39) etc. on the affected side for 30 min once daily. Patients in the observation group were given moxibustion on the above-mentioned acupoints on the basis of treatment in the control group. The course of treatment for both groups was 4 weeks. The Western Ontario and MacMaster University Osteoarthritis Index (WOMAC) scores were compared before and after treatment and the clinical efficacy of the two groups were calculated according to the WOMAC scores after treatment. Ultrasound examination of the knee joint was used to analyze the thickness of joint effusion and synovial membrane thickness of the patients. Enzyme-linked immunoassay was used to detect the serum type Ⅰ collagen C-terminal foreign body peptide (CTX-Ⅰ), insulin-like growth factor (IGF), bone gla protein (BGP), matrix metalloproteinase-9 (MMP-9), matrix metalloproteinase inhibitor-1 (TIMP-1) levels. RESULTS: Compared with those before treatment, WOMAC score, knee joint synovial thickness and joint effusion thickness, serum CTX-Ⅰ, MMP-9, TIMP-1 levels, and MMP-9/TIMP-1 ratio were all down-regulated (P<0.05), while the levels of serum IGF and BGP up-regulated (P<0.05) in the two groups after treatment. The improvements of the above indexes in the observation group were superior to those in the control group (P<0.05). The total effective rate in the observation group was 95.83% (46/48), which was higher than 81.25% (39/48) in the control group(P<0.05). CONCLUSION: Acupuncture combined with moxibustion can regulate bone metabolism and effectively improve the symptoms of KOA patients, which may be related to its effect in regulating the dynamic balance of MMP-9 and TIMP-1 in serum.


Assuntos
Terapia por Acupuntura , Moxibustão , Osteoartrite do Joelho , Humanos , Metaloproteinase 9 da Matriz/genética , Inibidores de Metaloproteinases de Matriz , Osteoartrite do Joelho/terapia
20.
Zhonghua Yi Xue Za Zhi ; 102(11): 795-800, 2022 Mar 22.
Artigo em Chinês | MEDLINE | ID: mdl-35325959

RESUMO

Objective: To evaluate the efficacy and safety of selective genicular artery embolization for the treatment of the knee pain secondary to osteoarthritis. Methods: From October 2020 to July 2021, 17 patients (23 knees) aged (68±7) years with moderate to severe knee pain secondary to knee osteoarthritis were prospectively included in the General Hospital of Ningxia Medical University. There were 6 males and 11 females included in this research. Patients were assessed with knee pain, stiffness, and function with the Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, using the Kellgren-Lawrence (K-L) grading to evaluate the severity of KOA, and using the Magnetic Resonance Knee Osteoarthritis Score (MOAKS) to evaluate the MR imaging characteristics of the affected knee. Selective genicular artery embolization (GAE) was performed in all patients. The patients were followed up for 6 months after the procedure. Patients were assessed with the VAS score and WOMAC scale at 1 d, 1 week and 1, 3 and 6 months after the procedure to evaluate the clinical outcomes, including the improvement of knee joint pain, stiffness and function, as well as the occurrence of adverse reactions. Results: Three to seven genicular artery branches were superselected and embolized in 23 knees, and 4 to 7 genicular artery branches were embolized in 7 patients with K-L grade 4. The clinical improvement was 95.6% (22/23) at 1 month, 86.9% (20/23) at 3 months, and 91.3% (21/23) at 6 months. Twenty-three knees completed the 6-month follow-up, and the VAS score, WOMAC pain score, and total WOMAC score at 1, 3, and 6 months after surgery were (2.5±1.3), (3.4±2.4), and (19.7±9.8) points, (3.0±1.8), (4.5±3.4), and (22.3±11.3) points, (2.8±1.5), (4.1±3.0), and (20.5±11.0) points, which were lower than the (6.6±0.9), (11.4±2.6) and (47.0±12.0) points at baseline (all P<0.001). During the follow-up period, 7 patients had adverse reactions: 3 cases had skin ecchymosis in the femoral artery puncture area, 4 cases had knee joint stiffness and pain within 1 day after operation, which were relieved spontaneously in 1 week, 6 patients had joint clicking during extension and flexion activities after operation, of which 3 cases subsided spontaneously within 3 months after operation. None of the patients had major procedure-related adverse events. Conclusion: GAE has a high clinical improvement rate and a low incidence of adverse reactions in the treatment of the pain secondary to knee osteoarthritis, which provides a new treatment option for patients who fail to respond to conservative treatment.


Assuntos
Articulação do Joelho , Osteoartrite do Joelho , Idoso , Artérias , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/terapia , Dor/etiologia , Resultado do Tratamento
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