Effects Of Kinesiotherapy, Ultrasound And Electrotherapy In Management Of Bilateral Knee Osteoarthritis: Prospective Clinical Trial

Background: Although recent advances in knee osteoarthritis (OA) treatment and evaluation were achieved, to the best of our knowledge, few studies have evaluated the longitudinal effect of therapeutic modalities on the functional exercise capacity of patients with knee OA. The purpose was to investigate the effects of kinesiotherapy and electrotherapy on functional exercise capacity, evaluated using the six-minute walk test (6-MWT) in patients with bilateral knee OA. Secondary measurements included range of motion (ROM), severity of knee pain (VAS), and a measure of perceived health and physical function, evaluated using the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index. Methods. A total of 40 women with bilateral knee OA were assigned to three groups: kinesiotherapy (KIN, n=16), transcutaneous electrical nerve stimulation (TENS, n=12), or ultrasound (US, n=10). The groups underwent 12weeks of intervention twice per week. The participants were subjected to the 6-MWT, ROM, VAS and WOMAC index. These tests were performed before and after the intervention. The study was focused on outpatients and was carried out at Universidade Estadual de Campinas, Brazil. Results: At follow-up, the KIN and US groups had significantly higher 6-MWT distances (19.8 21.7 and 14.1 22.5%, respectively) compared with their respective pre-intervention values. All treatments were effective for reducing pain and improving the WOMAC index. Conclusions: We demonstrated that the 6-MWT is a tool that can be used to evaluate improvements in the functional exercise capacity of patients submitted to a clinical intervention. © 2012 Mascarin et al.; licensee BioMed Central Ltd.13Bennell, K.L., Egerton, T., Wrigley, T.V., Hodges, P.W., Hunt, M., Roos, E.M., Kyriakides, M., Hinman, R.S., Comparison of neuromuscular and quadriceps strengthening exercise in the treatment of varus malaligned knees with medial knee osteoarthritis: A randomised controlled trial protocol (2011) BMC Musculoskelet Disord, 12, p. 276. , 10.1186/1471-2474-12-276 22141334Hunter, D.J., Sharma, L., Skaife, T., Alignment and osteoarthritis of the knee (2009) J Bone Joint Surg Am, 1 (SUPPL. 1), pp. 85-89Cooper, C., The epidemiology of osteoartbritis (1994) Rheumatology, pp. 731-734. , CV Mosby, New York Klippel J, Dieppe POsiri, M., Welch, V., Brosseau, L., Shea, B., McGowan, J., Tugwell, P., Wells, G., Transcutaneous electrical nerve stimulation for knee osteoarthritis (2000) Cochrane Database Syst Rev, 4, pp. 3D002823. , 11034768Rutjes, A.W., Nüesch, E., Sterchi, R., Kalichman, L., Hendriks, E., Osiri, M., Brosseau, L., Jüni, P., Transcutaneous electrostimulation for osteoarthritis of the knee (2009) Cochrane Database Syst Rev, 4, pp. 3D002823. , 19821296Leslie, M., Knee osteoarthritis management therapies (2000) Pain Manag Nurs, 1 (2), pp. 51-57. , 10.1053/jpmn.2000.7782 11706459Bennell, K.L., Hinman, R.S., Metcalf, B.R., Buchbinder, R., McConnell, J., McColl, G., Green, S., Crossley, K.M., Efficacy of physiotherapy management of knee joint osteoarthritis: A randomised, double blind, placebo controlled trial (2005) Annals of the Rheumatic Diseases, 64 (6), pp. 906-912. , DOI 10.1136/ard.2004.026526Altman, R.D., Pharmacological therapies for osteoarthritis of the hand: A review of the evidence (2010) Drugs Aging, 27 (9), pp. 729-745. , 10.2165/11539010-000000000-00000 20809663Conrozier, T., Chevalier, X., Long-term experience with hylan GF-20 in the treatment of knee osteoarthritis (2008) Expert Opin Pharmacother, 9 (10), pp. 1797-1804. , 10.1517/14656566.9.10.1797 18570611Hawker, G.A., Mian, S., Bednis, K., Stanaitis, I., Osteoarthritis year 2010 in review: Non pharmacologic therapy (2011) Osteoarthr Cartil, 19 (4), pp. 366-374. , 10.1016/j.joca.2011.01.021 21324369Suarez-Almazor, M.E., Looney, C., Liu, Y., Cox, V., Pietz, K., Marcus, D.M., Street Jr., R.L., A randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient-provider communication (2010) Arthritis Care Res (Hoboken), 62 (9), pp. 1229-1236. , 10.1002/acr.20225Myers, S.S., Phillips, R.S., Davis, R.B., Cherkin, D.C., Legedza, A., Kaptchuk, T.J., Patient expectations as predictors of outcome in patients with acute low back pain (2008) J Gen Intern Med, 23 (2), pp. 148-153. , 10.1007/s11606-007-0460-5 18066631Linde, K., Witt, C.M., Streng, A., Weidenhammer, W., Wagenpfeil, S., Brinkhaus, B., Willich, S.N., Melchart, D., The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain (2007) Pain, 128 (3), pp. 264-271. , DOI 10.1016/j.pain.2006.12.006, PII S0304395906006713Deyle, G.D., Allison, S.C., Matekel, R.L., Ryder, M.G., Stang, J.M., Gohdes, D.D., Hutton, J.P., Garber, M.B., Physical therapy treatment effectiveness for osteoarthritis of the knee: A randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program (2005) Physical Therapy, 85 (12), pp. 1301-1317Bunning, R.D., Materson, R.S., A rational program of exercise for patients with osteoarthritis (1991) Semin Arthritis Rheum, 21 (3 SUPPL. 2), pp. 33-43. , 1796304Rutjes, A.W., Nüesch, E., Sterchi, R., Jüni, P., Therapeutic ultrasound for osteoarthritis of the knee or hip (2010) Cochrane Database Syst Rev, 1, pp. 3D003132. , 20091539Kozanoglu, E., Basaran, S., Guzel, R., Guler-Uysal, F., Short term efficacy of ibuprofen phonophoresis versus continuous ultrasound therapy in knee osteoarthritis (2003) Swiss Medical Weekly, 133 (23-24), pp. 333-338Sharma, L., Nonpharmacologic management of osteoarthritis (2002) Current Opinion in Rheumatology, 14 (5), pp. 603-607. , DOI 10.1097/00002281-200209000-00022Lin, Y.-C., Davey, R.C., Cochrane, T., Tests for physical function of the elderly with knee and hip osteoarthritis (2001) Scandinavian Journal of Medicine and Science in Sports, 11 (5), pp. 280-286French, H.P., Fitzpatrick, M., Fitzgerald, O., Responsiveness of physical function outcomes following physiotherapy intervention for osteoarthritis of the knee: An outcome comparison study (2011) Physiotherapy, 97 (4), pp. 302-308. , 10.1016/j.physio.2010.03.002 22051586Santana, M.G., De Lira, C.A., Passos, G.S., Santos, C.A., Silva, A.H., Yoshida, C.H., Tufik, S., De Mello, M.T., Is the six-minute walk test appropriate for detecting changes in cardiorespiratory fitness in healthy elderly men? (2012) J Sci Med Sport, 15 (3), pp. 259-265. , 10.1016/j.jsams.2011.11.249 22154397ATS/ACCP Statement on cardiopulmonary exercise testing (2003) Am J Respir Crit Care Med, 167 (2), pp. 211-277. , ATS/ACCP 12524257Kutlay, S., Küçükdeveci, A.A., Elhan, A.H., Oztuna, D., Koç, N., Tennant, A., Validation of the World Health Organization disability assessment schedule II (WHODAS-II) in patients with osteoarthritis (2011) Rheumatol Int, 31 (3), pp. 339-346. , 10.1007/s00296-009-1306-8 20020133Goggins, J., Baker, K., Felson, D., What WOMAC pain score should make a patient eligible for a trial in knee osteoarthritis? (2005) Journal of Rheumatology, 32 (3), pp. 540-542Altman, R., Asch, E., Bloch, D., Bole, G., Borenstein, D., Brandt, K., Christy, W., Hochberg, M., Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association (1986) Arthritis Rheum, 29 (8), pp. 1039-1049. , 10.1002/art.1780290816 3741515Norkin, C.C., White, D.J., (1995) Measurement of Joint Motion: A Guide to Goniometry, , F.A. Davis Company, Philadelphia 2ATS statement: Guidelines for the six-minute walk test (2002) Am J Respir Crit Care Med, 166 (1), pp. 111-117. , ATS 12091180Kennedy, D.M., Stratford, P.W., Wessel, J., Gollish, J.D., Penney, D., Assessing stability and change of four performance measures: A longitudinal study evaluating outcome following total hip and knee arthroplasty (2005) BMC Musculoskeletal Disorders, 6, p. 3. , http://www.biomedcentral.com/1471-2474/6/3, DOI 10.1186/1471-2474-6-3Bellamy, N., Buchanan, W.W., Goldsmith, C.H., Campbell, J., Stitt, L.W., Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee (1988) Journal of Rheumatology, 15 (12), pp. 1833-1840Soderman, P., Malchau, H., Validity and reliability of Swedish WOMAC osteoarthritis index: A self-administered disease-specific questionnaire (WOMAC) versus generic instruments (SF-36 and NHP) (2000) Acta Orthopaedica Scandinavica, 71 (1), pp. 39-46Tok, F., Aydemir, K., Peker, F., Safaz, I., Takaynatan, M.A., Ozgül, A., The effects of electrical stimulation combined with continuous passive motion versus isometric exercise on symptoms, functional capacity, quality of life and balance in knee osteoarthritis: Randomized clinical trial (2011) Rheumatol Int, 31 (2), pp. 177-181. , 10.1007/s00296-009-1263-2 20012051Thorlund, J.B., Aagaard, P., Roos, E.M., Muscle strength and functional performance in patients at high risk of knee osteoarthritis: A follow-up study (2011) Knee Surg Sports Traumatol Arthrosc, 20 (6), pp. 1110-1117. , 22037811Escalante, Y., García-Hermoso, A., Saavedra, J.M., Effects of exercise on functional aerobic capacity in lower limb osteoarthritis: A systematic review (2011) J Sci Med Sport, 14 (3), pp. 190-198. , 10.1016/j.jsams.2010.10.004 21111676Rosemffet, M.G., Schneeberger, E.E., Citera, G., Sgobba, M.E., Laiz, C., Schmulevich, H., Artcanuturry, P., Maldonado Cocco, J.A., Effects of functional electrostimulation on pain, muscular strength, and functional capacity in patients with osteoarthritis of the knee (2004) Journal of Clinical Rheumatology, 10 (5), pp. 246-249. , DOI 10.1097/01.rhu.0000141831.40350.91Cammarata, M.L., Dhaher, Y.Y., Associations between frontal plane joint stiffness and proprioceptive acuity in knee osteoarthritis (2012) Arthritis Care Res (Hoboken), 64 (5), pp. 735-743. , 10.1002/acr.21589Holla, J.F., Van Der Leeden, M., Roorda, L.D., Bierma-Zeinstra, S.M., Damen, J., Dekker, J., Steultjens, M.P., Diagnostic accuracy of range of motion measurements in early symptomatic hip and/or knee osteoarthritis (2012) Arthritis Care Res (Hoboken), 64 (1), pp. 59-65. , 10.1002/acr.20645Elbaz, A., Debbi, E.M., Segal, G., Haim, A., Halperin, N., Agar, G., Mor, A., Debi, R., Sex and body mass index correlate with Western Ontario and McMaster Universities Osteoarthritis Index and quality of life scores in knee osteoarthritis (2011) Arch Phys Med Rehabil, 92 (10), pp. 1618-1623. , 10.1016/j.apmr.2011.05.009 21839981Fransen, M., McConnell, S., Bell, M., Exercise for osteoarthritis of the hip or knee (2003) Cochrane Database Syst Rev, 3, pp. 3D004286. , 12918008Roddy, E., Zhang, W., Doherty, M., Aerobic walking or strengthening exercise for osteoarthritis of the knee? A systematic review (2005) Annals of the Rheumatic Diseases, 64 (4), pp. 544-548. , DOI 10.1136/ard.2004.028746Ng, M.M.L., Leung, M.C.P., Poon, D.M.Y., The Effects of Electro-Acupuncture and Transcutaneous Electrical Nerve Stimulation on Patients with Painful Osteoarthritic Knees: A Randomized Controlled Trial with Follow-Up Evaluation (2003) Journal of Alternative and Complementary Medicine, 9 (5), pp. 641-649Cheing, G.L.Y., Hui-Chan, C.W.Y., Chan, K.M., Does four weeks of TENS and/or isometric exercise produce cumulative reduction of osteoarthritic knee pain? (2002) Clinical Rehabilitation, 16 (7), pp. 749-760. , DOI 10.1191/0269215502cr549oaLoyola-Sánchez, A., Richardson, J., MacIntyre, N.J., Efficacy of ultrasound therapy for the management of knee osteoarthritis: A systematic review with meta-analysis (2010) Osteoarthr Cartil, 18 (9), pp. 1117-1126. , 10.1016/j.joca.2010.06.010 20637297Tascioglu, F., Kuzgun, S., Armagan, O., Ogutler, G., Short-term effectiveness of ultrasound therapy in knee osteoarthritis (2010) J Int Med Res, 38 (4), pp. 1233-1242. , 20925995Enright, P.L., Sherrill, D.L., Reference equations for the six-minute walk in healthy adults (1998) Am J Respir Crit Care Med, 158 (5 PART 1), pp. 1384-1387. , 9817683Wang, T.J., Belza, B., Elaine Thompson, F., Whitney, J.D., Bennett, K., Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee (2007) J Adv Nurs, 57 (2), pp. 141-152. , 10.1111/j.1365-2648.2006.04102.x 17214750Bautmans, I., Lambert, M., Mets, T., The six-minute walk test in community dwelling elderly: Influence of health status (2004) BMC Geriatr, 4, p. 6. , 10.1186/1471-2318-4-6 15272934Kruger, C., Durr, S., Gerber, S.H., Haunstetter, A., Hornig, K., Kubler, W., Haass, M., Is the 6-minute walk test a reliable substitute for peak oxygen uptake in patients with dilated cardiomyopathy? (2000) European Heart Journal, 21 (7), pp. 540-549. , DOI 10.1053/euhj.1999.1861Wyatt, F.B., Milam, S., Manske, R.C., Deere, R., The Effects of Aquatic and Traditional Exercise Programs on Persons with Knee Osteoarthritis (2001) Journal of Strength and Conditioning Research, 15 (3), pp. 337-340. , DOI 10.1519/1533-4287(2001)0152.0.CO;2Bent, N.P., Wright, C.C., Rushton, A.B., Batt, M.E., Selecting outcome measures in sports medicine: A guide for practitioners using the example of anterior cruciate ligament rehabilitation (2009) Br J Sports Med, 43 (13), pp. 1006-1012. , 10.1136/bjsm.2009.057356 19224908Ries, M.D., Philbin, E.F., Groff, G.D., Relationship between severity of gonarthrosis and cardiovascular fitness (1995) Clin Orthop Relat Res, 313, pp. 169-176. , 764147