Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.551
Filtrar
1.
Med Clin North Am ; 105(1): 117-136, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246514

RESUMO

Knee pain is present in up to 20% of the adult general population and can be significantly debilitating to patients. A thorough history and physical examination can help localize the source of inflammation or injury to further determine if imaging, physical therapy, specialty referral, or surgery is necessary. By following a systematic approach to evaluating knee pain, primary care physicians can make the correct diagnosis and formulate an appropriate therapeutic strategy for patients.


Assuntos
Assistência Ambulatorial , Artralgia/etiologia , Artralgia/terapia , Adulto , Idoso , Artralgia/classificação , Artralgia/diagnóstico , Tratamento Conservador , Diagnóstico Diferencial , Diagnóstico por Imagem , Terapia por Exercício , Feminino , Humanos , Masculino , Anamnese , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/terapia , Exame Físico , Perda de Peso , Adulto Jovem
2.
Medicine (Baltimore) ; 99(50): e23596, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327324

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is a chronic disease, which is also recognized as a common disease affecting the elderly. However, the application of Western medicine is limited in clinical because of its obvious adverse reactions. Warm needle acupuncture (WNA) has a long history in the treatment of KOA and is widely used in Chinese. Here we will submit a protocol to evaluate the efficacy and safety of WNA in the treatment of KOA. METHODS: We will search 5 English databases (PubMed, MEDLINE, Embase, Cochrane Library, Web of Science), 4 Chinese databases [China National Knowledge Infrastructure (CNKI), China Biology Medicine, Chinese Science and Technology Journal Database (VIP), and Wanfang database] and grey literature for randomized controlled trials of WNA in the treatment of KOA. The primary outcome measure is Western Ontario and McMaster Universities Arthritis Index (WOMAC), and the secondary outcome will include degree of knee flexion and adverse events caused by WNA, such as dizziness, nausea, abdominal pain, arrhythmia, etc. The selection of the literatures will be conducted by endnote X7 software, and we will use Review Manger V.5.3 software to conduct the meta-analysis. RESULTS: This study will provide reliable evidence for WNA in the treatment of KAO. CONCLUSION: The conclusion of this study will testify the efficacy and safety of WNA in the treatment of KAO. REGISTRATION: OSF Preregistration. 2020, October 11; osf.io/bu5qw.


Assuntos
Terapia por Acupuntura , Osteoartrite do Joelho/terapia , Humanos
4.
Medicine (Baltimore) ; 99(49): e23343, 2020 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-33285713

RESUMO

OBJECTIVE: To evaluate the effects and safety of intra-articular injection of mesenchymal stem cells on patients with knee osteoarthritis by a systematic review and meta-analysis. METHODS: PubMed, EMBASE, and Cochrane Library were retrieved. An assessment of the risk of bias was done through the Cochrane Collaborative Bias Risk Tool, publication bias was assessed by plotting funnel plots and Egger tests. Pain and functional improvements in patients with knee osteoarthritis were determined by changes in VAS scores and WOMAC scores at baseline and follow-up endpoints. For the evaluation of MRI, the WORMS score and changes in cartilage volume were used. In addition, the number of adverse events in the intervention group and the control group were counted to explore the safety. RESULTS: A total of 10 randomized controlled trials involving 335 patients were included. In the pooled analysis, compared with the control groups, the VAS scores of MSC groups decreased significantly (MD,-19.24; 95% CI: -26.31 to -12.18, P < .00001. All of the WOMAC scores also improved significantly: the total scores (SMD, - 0.66; 95% CI: - 1.09 to -0.23, P = .003), pain scores (SMD, - 0.46; 95% CI: - 0.75 to -0.17, P = .002), stiffness scores (SMD, -0.32; 95% CI: -0.64 to 0.00 P = 0.05), and functional scores (SMD, -0.36; 95% CI: -0.69 to -0.04, P = .03). Two studies with non-double-blind designs were the main source of heterogeneity. In terms of cartilage repair, there was no significant difference in the WORMS score, but there was a significant increase in cartilage volume in the MSC group (SMD, 0.69; 95% CI: 0.25 to 1.13, P = .002). The proportion of patients with adverse events in the MSCs treatment group was significantly higher than that in the control group (OR, 3.20; 95% CI: 1.50 to 6.83, P = .003). CONCLUSIONS: Intra-articular injection of mesenchymal stem cells is effective and safety to relieve pain and improve motor function of patients with knee osteoarthritis in a short term which is different to conclusions of previous study.


Assuntos
Transplante de Células-Tronco Mesenquimais/métodos , Osteoartrite do Joelho/terapia , Humanos , Injeções Intra-Articulares , Transplante de Células-Tronco Mesenquimais/efeitos adversos , Manejo da Dor/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Recuperação de Função Fisiológica
5.
J Vasc Interv Radiol ; 31(12): 2043-2050, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33132027

RESUMO

PURPOSE: To determine the value of preprocedural MR imaging in genicular artery embolization (GAE) for patients with osteoarthritic knee pain. MATERIALS AND METHODS: This single-center study retrospectively analyzed 28 knees in 18 patients who underwent GAE for intractable knee pain < 1 month after MR imaging. The pain experienced in each knee was evaluated on a 100-mm visual analog scale (VAS) at baseline and 1- and 3-month after GAE. "GAE responders" were defined as knees that exhibited greater than 30% reduction of VAS pain scores from baseline at both follow-up visits. Musculoskeletal radiologists evaluated MR images of the affected knee compartment regarding cartilage defects, osteophytes, subchondral cysts, bone marrow lesions (BMLs), meniscal injury, and joint effusion. The performances of Kellgren-Lawrence (KL) grading and MR findings in predicting GAE responders was estimated based on receiver operating characteristic curves. RESULTS: The mean VAS pain score was 84.3 mm. BML (area under the curve [AUC], 0.860; P < .001), meniscal injury (AUC, 0.811; P = .003), and KL grading (AUC, 0.898; P < .001) were significantly associated with GAE outcome. To predict GAE responders, KL grade ≤ 2 yielded a sensitivity of 87.5% and a specificity of 60.9%, BML grade ≤ 1 yielded a sensitivity of 75.0% and a specificity of 69.6%, and meniscal injury grade ≤ 2 yielded a sensitivity of 83.3% and a specificity of 72.7%. CONCLUSIONS: Large BMLs and severe meniscal injuries on MR imaging, as well as high KL grades, indicated poor responses to GAE.


Assuntos
Artérias/diagnóstico por imagem , Artralgia/terapia , Embolização Terapêutica , Articulação do Joelho/irrigação sanguínea , Angiografia por Ressonância Magnética , Osteoartrite do Joelho/terapia , Idoso , Idoso de 80 Anos ou mais , Artralgia/diagnóstico por imagem , Tomada de Decisão Clínica , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Medição da Dor , Seleção de Pacientes , Valor Preditivo dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
6.
Complement Ther Clin Pract ; 41: 101254, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33190009

RESUMO

BACKGROUND: Electromoxibustion devices are commercially available and can be self-administered by patients. Nevertheless, little is known about the effectiveness and potential burn injury of these devices as this topic is under-investigated. OBJECTIVE: To assess the preliminary effects and safety of an electromoxibustion (EM) device for improving knee pain and joint functions in older adults with knee osteoarthritis (KOA). DESIGN, SETTING, PARTICIPANTS AND INTERVENTION: This was a pilot two-armed assessor-blinded randomized controlled trial to assess the effects of electromoxibustion (EM) on older adults with KOA. A total of 38 subjects aged 60 or above, with KOA for 3 months or above were recruited. Participants were randomized to the EM group or the knee health education group. The intervention group (n = 21) received 12 sessions of EM spanning across four weeks, while the control group (n = 17) received two sessions of knee health education. MAIN OUTCOME MEASURES: Primary outcome included the pain severity Numerical Rating Scale (NRS) at baseline and week 4. Secondary outcomes included the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Short-Form Six-Dimension (SF6D), Timed Up & Go Test (TUG) and Fast Speed Gait (FSG). RESULTS: Both groups showed a decreasing trend in knee pain intensity by NRS at post-intervention. There were also trends of improvement in the WOMAC score, TUG score, FGS test score and SF-6D score at week 4. Only a small between-group effect size (d = 0.13) was found, but medium between-group effects sizes were found in the WOMAC total score (d = 0.40) and WOMAC functional sub-score (d = 0.51). However, the differences were not statistically significant. CONCLUSION: This study suggested that EM may be beneficial for KOA in older adults, particularly in terms of improving knee function. Replication of similar studies in larger RCTs is warranted to confirm the effectiveness of EM on reducing pain and knee function of older adults with KOA. TRAIL REGISTRATION NUMBER: NCT04034394.


Assuntos
Osteoartrite do Joelho , Idoso , Pré-Escolar , Humanos , Articulação do Joelho , Ontário , Osteoartrite do Joelho/terapia , Medição da Dor , Projetos Piloto , Resultado do Tratamento
7.
Zhongguo Zhong Yao Za Zhi ; 45(17): 4065-4070, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33164390

RESUMO

Osteoarthritis(OA) is a kind of osteoarticular degenerative disease. The most common joint involvement of OA is knee and hip joint. The incidence rate of OA increases with age. Meta analysis shows that moxibustion is superior to other therapies in treating knee osteoarthritis(KOA). In this study, the effects of moxibustion materials from different places of origin(Hubei Qichun, Henan Nanyang, Hunan) and storage periods(5, 3, 1 years) on knee osteoarthritis in rats were compared. The swelling degree of knee joint and the histopathology of knee joint cartilage were measured. The mechanism of moxibustion in the treatment of knee osteoarthritis was discussed from the perspective of Wnt/ß-catenin signaling pathway. The results showed that the swelling degree of knee joint in the moxibustion material group of Hubei Qichun and Henan Nanyang was significantly lower than that in the model group, the diffe-rence was statistically significant(P<0.05), and it was better than that in the moxibustion material group of Hunan Province; compared with the model group, the degeneration and pathological change of knee joint cartilage tissue in the moxibustion material group of different origins were alleviated to different degrees, the Mankin's score was significantly reduced, and that in the moxibustion material group of Qichun in Hubei Province and Nanyang in Henan Province was significantly reduced and better than Hunan moxibustion material group. The effect of moxibustion materials with different storage years on the swelling degree of osteoarthritis in rats was the earliest in Qichun 5-year group, and there was significant difference between Qichun 5-year group and model group after 3 days of treatment; the improvement of histopathological changes in Qichun 5-year and 3-year moxibustion materials group was better than that in Qichun 1-year moxibustion materials group. The study on the mechanism of action showed that moxibustion materials from different places could reduce the mRNA expression of ß-catenin, BMP-2, MMP-3, MMP-9 and MMP-13 genes in knee cartilage, suggesting that moxibustion could inhibit cartilage base by regulating Wnt/ß-catenin signal pathway. It may be one of the mechanisms of moxibustion in the treatment of OA.


Assuntos
Cartilagem Articular , Moxibustão , Osteoartrite do Joelho , Animais , Articulação do Joelho , Osteoartrite do Joelho/terapia , Ratos , Via de Sinalização Wnt
8.
PLoS One ; 15(10): e0241175, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33095777

RESUMO

AIM: Clinical guidelines recommend non-surgical treatment before surgery is considered in patients eligible for knee replacement. Surgical treatment is provided by orthopedic surgeons and exercise therapy is provided by physical therapists. The aim of this study was to identify perceived facilitators and barriers-among orthopedic surgeons and physical therapists-towards coordinated non-surgical and surgical treatment of patients eligible for knee replacement using pre-operative home-based exercise therapy with one exercise. METHODS: This qualitative study is embedded within the QUADX-1 randomized trial that investigates a model of coordinated non-surgical and surgical treatment for patients eligible for knee replacement. Physical therapists and orthopedic surgeons working with patients with knee osteoarthritis in their daily clinical work were interviewed (one focus group and four single interviews) to explore their perceived facilitators and barriers related to pre-operative home-based exercise therapy with one exercise-only in patients eligible for knee replacement. Interviews were analyzed using thematic analysis. RESULTS: From the thematic analysis three main themes emerged: 1) Physical therapists' dilemma with one home-based exercise, 2) Orthopedic surgeons' dilemma with exercise, and 3) Coordinated non-surgical and surgical care. CONCLUSION: We found that the pre-operative exercise intervention created ambivalence in the professional role of both the physical therapists and orthopedic surgeons. The physical therapists were skeptical towards over-simplified exercise therapy. The orthopedic surgeons were skeptical towards the potential lack of (long-term) effect of exercise therapy in patients eligible for knee replacement. The consequence of these barriers and ambivalence in the professional role is important to consider when planning implementation of the model of coordinated non-surgical and surgical treatment. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02931058.


Assuntos
Artroplastia do Joelho , Atitude do Pessoal de Saúde , Terapia por Exercício/psicologia , Osteoartrite do Joelho/terapia , Cuidados Pré-Operatórios/psicologia , Adulto , Terapia por Exercício/métodos , Terapia por Exercício/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgiões Ortopédicos/psicologia , Fisioterapeutas/psicologia , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Pesquisa Qualitativa , Resultado do Tratamento
9.
Am Fam Physician ; 102(8): 465-477, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-33064421

RESUMO

Chronic low back pain, neck pain, hip and knee osteoarthritis, and fibromyalgia are the most common types of chronic musculoskeletal pain. Because no individual therapy has consistent benefit, a multimodal treatment approach to chronic musculoskeletal pain is recommended. Many nonpharmacologic, noninvasive treatment approaches yield small to moderate improvement and can be used with pharmacologic or more invasive modalities. Systematic reviews and guidelines support the effectiveness of various forms of exercise in improving pain and function in patients with chronic pain. Cognitive behavior therapy and mindfulness techniques appear to be effective for small to moderate short- and long-term improvement of chronic low back pain. Cognitive behavior therapy may also be effective for small short- and intermediate-term improvement of fibromyalgia. Spinal manipulation leads to a small benefit for chronic neck and low back pain. Acupuncture has a small to moderate benefit for low back pain and small benefit for nonpain fibromyalgia symptoms. Massage or myofascial release yields a small improvement in low back pain, hip and knee osteoarthritis, and fibromyalgia. Low reactive level laser therapy may provide short-term relief of chronic neck and low back pain, and ultrasound may provide short-term pain relief for knee osteoarthritis. Multidisciplinary rehabilitation may be effective for short- and at least intermediate-term improvement in pain and function for chronic low back pain and fibromyalgia. Patients should be encouraged to engage in a variety of therapies aligned with their preferences and motivation.


Assuntos
Dor Crônica/terapia , Dor Musculoesquelética/terapia , Terapia por Acupuntura , Terapia Cognitivo-Comportamental , Exercício Físico , Fibromialgia/terapia , Humanos , Dor Lombar/terapia , Terapia com Luz de Baixa Intensidade , Manipulação da Coluna , Massagem , Atenção Plena , Relaxamento Muscular , Cervicalgia/terapia , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/terapia , Clínicas de Dor , Educação de Pacientes como Assunto , Terapia por Ultrassom
10.
Medicine (Baltimore) ; 99(44): e22853, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126326

RESUMO

BACKGROUND: Knee osteoarthritis (KOA), a concerning public health problem, seriously threatens well being of human beings. At present, studies have shown that massage therapy is effective in relieving related symptoms of KOA. However, the evidence of massage for KOA has not been systematically evaluated. Therefore, the study is conducted to systematically assess the reliability of patients with KOA treated by massage. METHODS: We will retrieve the relevant literature of massage for KOA from PubMed, Cochrane Library, EMBASE, Web of Science, Wanfang, Chongqing VIP, CNKI, and Chinese Biomedical Literature Database from the establishment of the databases to August 1, 2020. Two researchers will independently perform the screening of literature and extract the basic information of the data. In addition, RevMan V.5.3 software will be used for data analysis. RESULTS: The study will comprehensively assess the effect of massage for KOA. CONCLUSION: The study will provide comprehensive evidence for evaluating whether massage therapy is useful in treating patients with KOA. INPLASY REGISTRATION NUMBER: INPLASY202080115.


Assuntos
Massagem/normas , Metanálise como Assunto , Osteoartrite do Joelho/terapia , Protocolos Clínicos , Humanos , Massagem/métodos , Massagem/estatística & dados numéricos , Osteoartrite do Joelho/fisiopatologia , Revisões Sistemáticas como Assunto , Resultado do Tratamento
11.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4502-4505, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018994

RESUMO

A dynamic and low-profile unloader tibiofemoral knee brace is designed and prototyped by synergizing concepts from the fields of microfluidics and soft robotics. Microfluidics provides strategies for miniaturization and multiplexing while soft robotics afford the tools to create soft fluidic actuators and allow compliant and inherently safe robotic assistance as part of clothing. The unloader knee brace provides dynamic response during the gait cycle, where a three-point leverage torque is provided only during the stance phase to contribute to joint stability when required and enhance comfort and compliance.Clinical Relevance- This novel soft robotic brace has the potential to reduce device abandonment due to aesthetics, user non-compliance and discomfort due to a constant three-point leverage torque during the gait cycle. Also, this air microfluidics enabled soft robotic knee brace could be expanded upon to improve the efficacy of braces in general and augment the effects of physical therapy, rehabilitation and treatment of musculoskeletal conditions.


Assuntos
Osteoartrite do Joelho , Robótica , Fenômenos Biomecânicos , Braquetes , Humanos , Microfluídica , Osteoartrite do Joelho/terapia
12.
Medicine (Baltimore) ; 99(44): e22963, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126367

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is a common chronic degenerative disorder with an increasingly prevalence among the older individuals and the leading cause of pain in the elderly. Baduanjin, one of the ancient traditional Chinese mind-body exercise routine, has been recognized to have clinical benefits for KOA. We aim to evaluate the efficacy and safety of Baduanjin for patients with KOA through this systematic review and meta-analysis. METHODS: Four English databases (Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and Web of Science), and 4 Chinese databases (China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, and Wanfang Database), will be searched from establishment of the database until October 2020. The reference lists and the citation lists of studies meeting the inclusion criteria will also be searched to identify further studies for inclusion. The search languages are English and Chinese. The randomized controlled trials of Baduanjin training for patients with KOA will be included. The primary outcome will be assessed according to the Western Ontario and McMaster Universities Osteoarthritis Index. Meta-analysis will be conducted with the use of RevMan 5.3. RESULTS: The results of this research will be submitted to a peer-reviewed publications. CONCLUSION: This systematic review aims to present evidence for whether Baduanjin training is an effective intervention which can improve both physical condition and life quality in patients suffering KOA. INPLASY REGISTRATION NUMBER: INPLASY202090051.


Assuntos
Terapia por Exercício/métodos , Medicina Tradicional Chinesa/métodos , Terapias Mente-Corpo/métodos , Osteoartrite do Joelho/terapia , Humanos
13.
Medicine (Baltimore) ; 99(44): e23035, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126393

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is a degenerative disease, making a unique contribution to chronic pain, edema, and limited mobility of knee joint. This disease is an important factor affecting the quality of life of middle-aged and elderly people. Complementary and alternative medicine (CAM) therapies have been used clinically to treat KOA; however, the selection strategies of different CAM interventions in clinical practice are still uncertain, and the purpose of this study is to evaluate the efficacy and acceptability of different CAM therapies using systematic review and network meta-analysis. METHODS: According to the strategy, the authors will retrieve a total of 7 electronic databases by October 2020, including PubMed, the Cochrane Library, EMbase, China National Knowledge Infrastructure, China Biological Medicine, Chongqing VIP, and Wan-fang databases After a series of screening, 2 researchers will use Aggregate Data Drug Information System and Stata software to analyze the data extracted from the randomized controlled trials of CAM therapies for the KOA. Finally, the evidence grade of the results will be evaluated. RESULTS: This study will provide a reliable evidence for the selection of CAM therapies for KOA. CONCLUSION: The results of this study will provide references for evaluating the influence of different CAM therapies for KOA, and provide decision-making references for clinical research. ETHICS AND DISSEMINATION: This study does not require ethical approval. The results will be disseminated through a peer-reviewed publication. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/GJMF4.


Assuntos
Terapias Complementares , Osteoartrite do Joelho/terapia , Humanos , Metanálise em Rede , Projetos de Pesquisa
14.
Medicine (Baltimore) ; 99(42): e22599, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080693

RESUMO

INTRODUCTION: Whether there is the long-term effect of acupuncture on patients with knee osteoarthritis (KOA) or not is controversial. According to the basic theory of traditional acupuncture, deqi is the key to the efficacy of acupuncture. This randomized controlled trial aims to evaluate the existence of long-term effects caused by deqi in patients with KOA. METHODS AND ANALYSIS: A three-armed, parallel-design, randomized controlled trial is underway in China.108 KOA patients recruited by the rehabilitation center of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine will be randomly assigned to the acupuncture with deqi group (A group), the acupuncture without deqi group (B group) and the waiting-list group (C group). Each patient will receive 5 30-minute sessions per week for 4 consecutive weeks and rest for 2 days between treatments, and undergo a 20-week follow-up. The primary outcome is the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC score). The secondary outcomes include Western Ontario and McMaster Universities Osteoarthritis index (WOMAC score), Knee Injury and Osteoarthritis Outcome Score (KOOS), arthritis quality of life measurement scale simplified scale (AIMS2-SF), emotional monitoring and expectation scale. The pain visual analogue scale (VAS) and the Chinese version of modified Massachusetts General Hospital Acupuncture Sensation Scale (C-MMASS) will be used to evaluate the deqi sensation after each acupuncture treatment. At the same time, adverse events (AEs) occurred in the whole process will be recorded and analyzed. We will perform an intention-to-treat analysis and protocol (PP) analysis to statistically analyze the results of the trial. DISCUSSION: This trial will be useful to study the long-term effect of acupuncture and the influence of the deqi sensation on the long-term in the treatment of KOA, and to provide a clinical basis for treatment of patients with mild to moderate knee osteoarthritis in clinic. TRIAL REGISTRATION: Chinese Clinical Trial Registry, IDF: ChiCTR2000029291. Registered on January 21, 2020.


Assuntos
Terapia por Acupuntura , Osteoartrite do Joelho/terapia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Medicine (Baltimore) ; 99(35): e21749, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871895

RESUMO

BACKGROUND: Osteoarthritis is the most common form of arthritis, and is a major cause of disability and chronic pain in adults. However, there is very limited evidence in the scientific literature to support the effectiveness of extracorporeal shockwave therapy (ESWT) in human knee osteoarthritis. This retrospective study aimed to compare the efficacy of ESWT treatment with sham-ESWT on pain, walking speed, physical function, and adverse effects in knee osteoarthritis. METHODS: This study will be performed and reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist. We reviewed patients diagnosed with knee osteoarthritis at our academic center from 2016 to 2017. This retrospective cohort study was approved by the institutional review board in Ruijin Hospital. The primary outcome measure was pain on movement measured by a 100-cm visual analog scale. The secondary outcome measures included the Western Ontario and McMaster University Osteoarthritis Index, range of motion, and adverse effects. Statistical analysis was performed using Statistical Package for Social Sciences version 20.0 (IBM Corporation, Armonk, NY). A P-value of <.05 was defined as statistical significance. RESULTS: The hypothesis was that ESWT would be an effective treatment for improving pain and physical function in knee osteoarthritis to control symptoms. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5801).


Assuntos
Tratamento por Ondas de Choque Extracorpóreas , Osteoartrite do Joelho/terapia , Terapia por Exercício , Humanos , Articulação do Joelho/fisiopatologia , Estudos Observacionais como Assunto , Osteoartrite do Joelho/fisiopatologia , Medição da Dor , Amplitude de Movimento Articular , Projetos de Pesquisa , Estudos Retrospectivos
16.
Pain Physician ; 23(5): E549-E558, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32967406

RESUMO

BACKGROUND: Intraarticular pulsed radiofrequency (IAPRF) for the treatment of painful knee osteoarthritis (KOA) is a less invasive treatment method. It has fewer adverse effects and can quickly reduce KOA-related pain and improve knee joint dysfunction. OBJECTIVES: We compared the effectiveness of high- and low-voltage IAPRF for the treatment of chronic knee pain. STUDY DESIGN: Retrospective comparative study design. SETTING: This study took place at Shengjing Hospital of China Medical University. METHODS: A total of 57 patients with KOA who were hospitalized between July 2018 and July 2019 were randomly allocated into the high-voltage (n = 29) and low-voltage (n = 28) IAPRF groups. IAPRF was performed under the guidance of computed tomography (CT). Numeric Rating Scale (NRS-11), Oxford Knee Score (OKS), degree of pain relief, global perceived effect, and side effects at baseline and 1 week, 2 weeks, 1 month, 3 months, and 6 months after the procedure were recorded and analyzed. RESULTS: NRS-11 scores decreased significantly in both groups after the procedure, but gradually increased after the 6-month follow-up period. There was a significant difference in NRS-11 scores between the 2 groups at all follow-up periods postprocedure. OKS were similar between the 2 groups. Patients with pain relief rate 50% or greater at 1, 3, and 6 months after the procedure accounted for 72.41%, 72.41%, and 55.17% in the high-voltage group, and 46.43%, 46.43%, and 28.57% in the low-voltage group, respectively. The difference between the 2 groups was statistically significant. No significant adverse reactions were observed in the 2 groups, however, patient satisfaction in the high-voltage group was significantly higher compared with patients in the low-voltage group. LIMITATIONS: This study was a single-center retrospective study with a relatively small sample cohort and short follow-up period. CONCLUSIONS: CT-guided high-voltage IAPRF is more beneficial in reducing knee pain and improving knee function compared with low-voltage IAPRF. In addition, patients who received high-voltage IAPRF were more satisfied with their treatment.


Assuntos
Artralgia/etiologia , Artralgia/terapia , Osteoartrite do Joelho/complicações , Manejo da Dor/métodos , Tratamento por Radiofrequência Pulsada/métodos , Idoso , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/terapia , Estudos Retrospectivos , Resultado do Tratamento
17.
Pain Physician ; 23(4S): S295-S304, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32942789

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is characterized by the clinical symptoms of chronic knee pain and knee dysfunction, leading to disability and influencing the quality of life in severe cases. Radiofrequency treatment is a new method to reduce KOA-related pain and partially improve knee joint dysfunction without adverse effect. OBJECTIVE: The present study aimed to assess the treatment efficacy of radiofrequency thermocoagulation on the genicular nerve (RFTGN) and intraarticular pulsed radiofrequency (IAPRF) for KOA. STUDY DESIGN: Retrospective comparative study design. SETTING: This study took place at Shengjing Hospital of China Medical University. METHOD: KOA patients were randomly assigned to the RFTGN, IAPRF, and intraarticular steroid injection (IAS) groups. All procedures were performed under the guidance of computed tomography (CT). The observation indicators of this study were the numeric rating scale (NRS), Oxford knee scale (OKS), and perceived global effect (GPE). The time points for the assessment were 1-week, 1-month, 3-months, and 6-months after the treatment. RESULTS: The postoperative NRS scores in the 3 groups decreased significantly at all the observation time points as compared to the pretreatment scores (P < 0.05). For the patients in the IAS group, the analgesic effect was in a rebound trend, which was the best at 1-week posttreatment, and was close to the preoperative level at 6-months posttreatment. The short-term (1 week or 1 month) analgesic effect of the RFTGN group was better than that of the IAPRF group, and was similar in the long-term (3 or 6 months). The long-term analgesic effect of RFTGN and IAPRF groups was better than that of IAS group. The results of the OKS score were similar to the NRS score. The RFTGN group showed markedly improved knee function in the long-term than the IAPRF and IAS groups. The short-term treatment satisfaction was similar in each group, and some differences were detected between the groups with respect to long-term treatment satisfaction. LIMITATION: This study was a single-center retrospective study with a relatively small sample cohort and short follow-up periodCONCLUSION: Both RFTGN and IAPRF could alleviate the knee joint pain and improve the knee joint dysfunction; however, the treatment efficacy of RFTGN was better than that of IAPRF.


Assuntos
Betametasona/uso terapêutico , Eletrocoagulação/métodos , Osteoartrite do Joelho/terapia , Tratamento por Radiofrequência Pulsada/métodos , Terapia por Radiofrequência/métodos , Corticosteroides/uso terapêutico , Idoso , China , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
18.
Clin Orthop Surg ; 12(3): 304-311, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32904116

RESUMO

Backgroud: To determine patient factors that lead to treatment of meniscal tears with osteoarthritis (OA) with knee arthroscopy (KA) or physical therapy only (PT-only); and to assess differences in clinical outcomes including the time to knee arthroplasty. Methods: Patients aged ≥ 45 years with OA at meniscal tear diagnosis were followed up from the date of surgery (KA) or first PT visit (PT-only) until partial/total knee replacement surgery, death, disenrollment, or end of study. Demographic and clinical characteristics were compared and used to derive propensity scores. A Cox proportional hazards model was used to estimate the risk of knee replacement surgery and greater healthcare utilization associated with KA vs. PT-only. Results: Among 7,026 patients (KA, 69%; PT-only, 31%), 27% had partial or total knee replacement surgery during follow-up. PT-only patients were older and more likely to be women and had more comorbidities. After accounting for differences between groups, the cumulative incidence of knee replacement was modestly but significantly higher for those who received KA than those who underwent PT-only (hazard ratio, 1.30; 95% confidence interval, 1.17-1.44; p < 0.001), although there was no significant difference in health service utilization, narcotic medication dispenses, or knee injections after initiating treatment. Conclusions: For patients with meniscal damage complicated by OA, those who underwent KA were 30% more likely to have partial or total knee replacement surgery at any given time than those who had PT alone.


Assuntos
Artroplastia do Joelho , Artroscopia , Osteoartrite do Joelho/terapia , Modalidades de Fisioterapia , Lesões do Menisco Tibial/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
J Fam Pract ; 69(7): 327-334, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32936842
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA