Comparing hot pack, short-wave diathermy, ultrasound, and TENS on isokinetic strength, pain, and functional status of women with osteoarthritic knees: a single-blind, randomized, controlled trial. TENS, electroacupuncture and ice massage: comparison of treatment for osteoarthritis of the knee. The treatment of osteoarthritis of the knee with pulsed electrical stimulation. Use of ultrasound to increase effectiveness of isokinetic exercise for knee osteoarthritis. The effects of electro-acupuncture and transcutaneous electrical nerve stimulation on patients with painful osteoarthritic knees: a randomized controlled trial with follow-up evaluation. A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis. Does transcutaneous electrical nerve stimulation improve the physical performance of people with knee osteoarthritis? [Cryotherapy as analgesic technique in direct, postoperative treatment following elective joint replacement]. Effect of ultrasound on mobility in osteoarthritis of the knee. A randomized clinical trial.
To investigate the therapeutic effects of physical agents administered before isokinetic exercise in women with knee osteoarthritis.
                One hundred patients with bilateral knee osteoarthritis were randomized into five groups of 20 patients each: group 1 received short-wave diathermy + hot packs and isokinetic exercise; group 2 received transcutaneous electrical nerve stimulation + hot packs and isokinetic exercise; group 3 received ultrasound + hot packs and isokinetic exercise; group 4 received hot packs and isokinetic exercise; and group 5 served as controls and received only isokinetic exercise.
                Pain and disability index scores were significantly reduced in each group. Patients in the study groups had significantly greater reductions in their visual analog scale scores and scores on the Lequesne index than did patients in the control group (group 5). They also showed greater increases than did controls in muscular strength at all angular velocities. In most parameters, improvements were greatest in groups 1 and 2 compared with groups 3 and 4.
                Using physical agents before isokinetic exercises in women with knee osteoarthritis leads to augmented exercise performance, reduced pain, and improved function. Hot pack with a transcutaneous electrical nerve stimulator or short-wave diathermy has the best outcome. The purpose of this study was to compare the effectiveness of transcutaneous nerve stimulation (TENS), electroacupuncture (EA), and ice massage with placebo treatment for the treatment of pain. Subjects (n = 100) diagnosed with osteoarthritis (OA) of the knee were treated with these modalities. The parameters for evaluating the effectiveness of treatment include pain at rest, stiffness, 50 foot walking time, quadriceps muscle strength, and knee flexion degree. The results showed (a) that all three methods could be effective in decreasing not only pain but also the objective parameters in a short period of time; and (b) that the treatment results in TENS, EA and ice massage were superior to placebo. The safety and effectiveness of pulsed electrical stimulation was evaluated for the treatment of osteoarthritis (OA) of the knee.
                A multicenter, double blind, randomized, placebo controlled trial that enrolled 78 patients with OA of the knee incorporated 3 primary efficacy variables of patients' pain, patients' function, and physician global evaluation of patients' condition, and 6 secondary variables that included duration of morning stiffness, range of motion, knee tenderness, joint swelling, joint circumference, and walking time. Measurements were recorded at baseline and during the 4 week treatment period.
                Patients treated with the active devices showed significantly greater improvement than the placebo group for all primary efficacy variables in comparisons of mean change from baseline to the end of treatment (p < 0.05). Improvement of > or = 50% from baseline was demonstrated in at least one primary efficacy variable in 50% of the active device group, in 2 variables in 32%, and in all 3 variables in 24%. In the placebo group improvement of > or = 50% occurred in 36% for one, 6% for 2, and 6% for 3 variables. Mean morning stiffness decreased 20 min in the active device group and increased 2 min in the placebo group (p < 0.05). No statistically significant differences were observed for tenderness, swelling, or walking time.
                The improvements in clinical measures for pain and function found in this study suggest that pulsed electrical stimulation is effective for treating OA of the knee. Studies for longterm effects are warranted. To investigate the effects of ultrasound (US) in isokinetic muscle strengthening exercises on functional status of patients with knee osteoarthritis (OA).
                Effectiveness of isokinetic muscle strengthening exercises for treatment of periarticular soft tissue disorders was compared with and without pulsed and continuous US.
                Outpatient exercise program in a Taiwan medical university hospital.
                One hundred twenty subjects with bilateral knee OA (Altman grade II).
                Subjects were randomized sequentially into 1 of 4 groups. Group I received isokinetic muscular strengthening exercises, group II received isokinetic exercise and continuous US, group III received isokinetic exercise and pulsed US treatment, and group IV was the control group.
                Therapeutic effects of isokinetic exercise were evaluated by changes in ambulation speed and the Lequesne index. In addition, changes in knee range of motion (ROM), visual analog scale for pain, and muscle peak torques during knee flexion and extension were compared. Compliance in each group was recorded.
                Each treated group had increased muscle peak torques and significantly reduced pain and disability after treatment and at follow-up. However, only patients in groups II and III had significant improvement in ROM and ambulation speed after treatment. Fewer participants in group III discontinued treatment due to knee pain during exercise. Patients in group III also showed the greatest increase in walking speed and decrease in disability after treatment and at follow-up. Gains in muscular strength in 60 degrees /s angular velocity peak torques were also noted in groups II and III. However, group III showed the greatest muscular strength gains with 180 degrees /s angular velocity peak torques after treatment and follow-up.
                US treatment could increase the effectiveness of isokinetic exercise for functional improvement of knee OA, and pulsed ultrasound has a greater effect than continuous US. To examine the relative effectiveness of electro-acupuncture (EA) and transcutaneous electrical nerve stimulation (TENS) in alleviating osteoarthritic (OA)-induced knee pain.
                Single-blinded, randomized controlled study.
                Twenty-four (24) subjects (23 women and 1 man), mean age 85, were recruited from eight subsidized Care & Attention Homes for the elderly.
                Subjects were randomly assigned to the EA, TENS, or control groups. Subjects in the EA group (n = 8) received low-frequency EA (2 Hz) on two acupuncture points (ST-35, Dubi and EX-LE-4, Neixiyan) of the painful knee for 20 minutes. Subjects in the TENS group (n = 8) received low-frequency TENS of 2 Hz and pulse width of 200 micros on the same acupuncture points for 20 minutes. In both treatment groups, electrical treatment was carried out for a total of eight sessions in 2 weeks. Eight subjects received osteoarthritic knee care and education only in a control group. All subjects were evaluated before the first treatment, after the last treatment, and at 2-week follow-up periods.
                After eight sessions of treatment, there was significant reduction of knee pain in both EA group and TENS group, as measured by the Numeric Rating Scale (NRS) of pain (p < 0.01). Prolonged analgesic effect was maintained in the EA and the TENS groups at a 2-week follow-up evaluation. The Timed Up-and-Go Test (TUGT) score of the EA group was significantly lower than that of the control group (p < 0.05), but such change was not observed in the TENS group.
                Both EA and TENS treatments were effective in reducing OA-induced knee pain. EA had the additional advantage of enhancing the TUGT results as opposed to TENS treatment or no treatment, which did not produce such corollary effect. To investigate the therapeutic effects of different muscle-strengthening exercises on the functional status of patients with knee osteoarthritis (OA).
                One hundred thirty-two patients with bilateral knee OA (Altman Grade II) were sequentially divided into 4 random groups (GI to GIV). The patients in group I received isokinetic muscle-strengthening exercise, group II received isotonic muscle-strengthening exercise, group III received isometric muscle-strengthening exercise, and group IV acted as controls. The changes of muscle power of leg flexion and extension were measured with a Kinetic Communicator dynamometer, and patients' functional status was evaluated by visual analogue scale, ambulation speed, and Lequesne index before and after treatment, and at the follow-up 1 year later.
                The results showed that the patients with OA in each treated group had significant improvement in pain reduction, disability reduction, and in walking speed after treatment and at follow-up when compared with their initial status. Isotonic exercise had the greatest effect on pain reduction after treatment, and fewer participants discontinued the treatment because of exercise knee pain. Isokinetic exercise caused the greatest increase of walking speed and decrease of disability after treatment and at follow-up. The greatest muscle-strength gain in 60 degrees /second angular velocity peak torques was found in the isokinetic and isotonic exercise groups. A significant muscle-strength gain in 180 degrees /second angular velocity peak torques was found only in the isokinetic group after treatment.
                Isotonic exercise is suggested for initial strengthening in patients with OA with exercise knee pain, and isokinetic exercise is suggested for improving joint stability or walking endurance at a later time.
                Copyright 2003 Elsevier Inc. All rights reserved. : According to a recent metaanalysis study, there is strong evidence to support the view that transcutaneous electrical nerve stimulation (TENS) is an effective treatment for managing osteoarthritis (OA) knee pain. However, there is limited evidence showing its effectiveness in improving physical function. This study examined whether TENS alone can improve physical function in terms of range of knee motion and the Timed-Up-and-Go Test.
                : Subjects were randomly allocated into 2 groups receiving TENS at 100 Hz or a placebo TENS. Outcome measures included: 1) visual analog scale for measuring the intensity of the present pain, 2) Timed-Up-and-Go Test, and 3) range of knee motion (ROM). Repeated-measures analysis of variance and Pearson correlation were used for data analyses.
                : By day 10, TENS produced a significantly greater increase in maximum knee ROM than the placebo group (P = 0.033). TENS also significantly increased the pain-limited knee ROM across sessions, but the between-group difference was short of significance (P = 0.067). The decrease in time in performing the Timed-Up-and-Go Test was also not significantly different between the 2 groups. A moderate correlation was observed between the reduction in pain scores and the improvement in the Timed-Up-and-Go Test.
                : Our findings suggested that TENS did improve some of the physical parameters but over 10 days was unable to produce significant improvement in functional performance among people with knee OA. A larger-scale study with the assessment of other functional outcomes may be required to clarify if TENS could improve function in people with knee OA. Also, exercise can be considered to be an important adjunct treatment to TENS to improve function significantly. The application of crushed ice or hydrogenated silicate, a micro-crystalline substitute has been used as a method to treat posttraumatic and postoperative irritations of the locomotor system for a long time. Closed systems using pumps can be viewed as further development as they enable continuous, water-free cooling of operating areas. The analgetic effect of postoperative cold therapy was evaluated in a prospective clinical trial, including 312 patients after total knee or hip arthroplasty. Conventional cold packs, consisting of microcrystalline silicate were compared to a continuous applicable closed system. Continuous cryotherapy resulted in a depression of skin temperature to 12 degrees C, whereas intermittent cooling only caused a mean temperature decrease of 1 degree C. Clinically continuous cold application leads to a more than 50% decrease of analgetic demands in both, systemic and regional application (p < 0.001). This observation was found in a significant correlation with patient's pain sensation as well as primary range of motion. Intermittent cryotherapy was found to be ineffective in postoperative pain relieve in hip- and adequate in knee arthroplasty patients. We could not report an influence on postoperative blood loss, as discussed in previous reports. Ultrasound increases soft tissue extensibility and may be an effective adjunct in the treatment of knee contractures secondary to connective tissue shortening. A randomized clinical trial was conducted to determine the effectiveness of ultrasound in relieving stiffness and pain in patients (age mean = 67.5 years, SD = 13.0) who had osteoarthritis (OA) and a chronic knee contracture. Subjects received 12 treatments of exercise preceded by either ultrasound (n = 34) or sham ultrasound (n = 35) and a blinded evaluation at baseline, after treatment, and 2 months after treatment. MANCOVA controlling for baseline scores showed that there were no significant differences in knee active range of motion (ROM) (goniometry) or pain (visual analogue scale) between experimental and control groups. Possible explanations for the no difference finding involve dosage issues, muscle shortening, transiency of effects, and the effects of exercise. Paired t-tests revealed that both groups significantly improved (p less than 0.05) in active ROM, pain, and gait velocity, and maintained improvement for at least 2 months. Although ultrasound may not contribute to the management of patients with chronic knee stiffness and OA, benefits of the exercise program and increased activity secondary to program participation probably influenced the overall improvement.
Ice massage compared to control had a statistically beneficial effect on ROM, function and knee strength. Cold packs decreased swelling. Hot packs had no beneficial effect on edema compared with placebo or cold application. Ice packs did not affect pain significantly, compared to control, in patients with OA. More well designed studies with a standardized protocol and adequate number of participants are needed to evaluate the effects of thermotherapy in the treatment of OA of the knee.