The efficacy of balneotherapy and mud-pack therapy in patients with knee osteoarthritis. Efficacy of balneotherapy on pain, function and quality of life in patients with osteoarthritis of the knee Balneotherapy in elderly patients: effect on pain from degenerative knee and spine conditions and on quality of life. Evaluation of the effect of Lake Hévíz thermal mineral water in patients with osteoarthritis of the knee: a randomized, controlled, single-blind, follow-up study. A 10-day course of SPA therapy is beneficial for people with severe knee osteoarthritis The association between radiographic knee osteoarthritis and knee symptoms, function and quality of life 10–15 years after anterior cruciate ligament reconstruction Intra‐articular injection of autologous adipose‐derived mesenchymal stem cells in the treatment of knee osteoarthritis Balneotherapy and tap water therapy in the treatment of knee osteoarthritis Does short-wave diathermy increase the effectiveness of isokinetic exercise on pain, function, knee muscle strength, quality of life, and depression in the patients with knee osteoarthritis? A randomized controlled clinical study. Effect of guided imagery with relaxation on health-related quality of life in older women with osteoarthritis. Assessing the comparative effectiveness of Tai Chi versus physical therapy for knee osteoarthritis: design and rationale for a randomized trial The effects of injecting intra-articular platelet-rich plasma or prolotherapy on pain score and function in knee osteoarthritis The effectiveness of self‐management educational interventions for osteoarthritis of the knee Periarticular dextrose prolotherapy instead of intra-articular injection for pain and functional improvement in knee osteoarthritis Therapeutic effects of short-term monochromatic infrared energy therapy on patients with knee osteoarthritis: a double-blind, randomized, placebo-controlled study. Factors affecting the prevalence of osteoarthritis in healthy middle-aged women: data from the longitudinal Melbourne Women's Midlife Health Project. Is Home-Based, High-Intensity Interval Training Cycling Feasible and Safe for Patients With Knee Osteoarthritis? Effect of Laser Therapy on Chronic Osteoarthritis of the Knee in Older Subjects. Anti-inflammatory effect as a mechanism of effectiveness underlying the clinical benefits of pelotherapy in osteoarthritis patients: regulation of the altered inflammatory and stress feedback response Musculoskeletal Atrophy in an Experimental Model of Knee Osteoarthritis: The Effects of Exercise Training and Low-Level Laser Therapy Yoga for managing knee osteoarthritis in older women: a pilot randomized controlled trial The Effects of Various Kinds of Lateral Wedge Insoles on Performance of Individuals with Knee Joint Osteoarthritis The Arthritis, Diet and Activity Promotion Trial (ADAPT): design, rationale, and baseline results.
OBJECTIVES Knee osteoarthritis ( OA ) is a common chronic degenerative disorder . There are various treatment modalities . This study was planned to investigate the efficacy of balneotherapy , mud-pack therapy in patients with knee OA . METHODS A total of 80 patients with knee OA were included . Their ages ranged between 39 - 78 . The patients were separated in to three groups . Group I ( n=25 ) received balneotherapy , group II ( n=29 ) received mud-pack therapy and group III ( n=26 ) was hot-pack therapy group . The therapies were applied for 20 min duration , once a day , five times per week and a total of 10 session . Patients were assessed according to pain , functional capacity and quality of life parameters . Pain was assessed by using Visual Analogue Scale ( VAS ) and Western Ontario McMaster Osteoarthritis Index ( WOMAC ) pain scale ( 0 - 4 likert scale ) . Functional capacity was assessed by using WOMAC functional capacity and WOMAC global index . Quality of life was evaluated by Nottingham Health Profile ( NHP ) self-administered question naire . Also physician 's global assessment and the maximum distance that patient can walk without pain , were evaluated . The assessment parameters were evaluated before and after three months . RESULTS There were statistically significant improvement in VAS and WOMAC pain scores in group I ( p<0.001 ) , group II and III ( p<0.05 ) . The WOMAC functional and global index also decreased in group I ( p<0.05 ) , group II ( p<0.001 ) and hot-pack group ( p<0.05 ) . Quality of life results were significantly improved in balneotherapy and mud-pack therapy groups ( p<0.05 ) . No difference was observed in hot-pack therapy group ( p>0.05 ) . The maximum distance was improved both in group I and II ( p<0.05 ) but not in group III . Also physician 's global assessment was found to be improved in all groups ( p<0.05 ) . CONCLUSIONS Balneotherapy and mud-pack therapy were effective in treating patients with knee OA The aims of this study were to evaluate whether balneotherapy with mineral sulphate – bicarbonate – calcium water could determine substantial symptomatic improvement , and to detect any changes in the quality of life ( QoL ) of patients with symptomatic knee osteoarthritis ( OA ) . This was a prospect i ve r and omized , single blind controlled trial . Sixty out patients with primary bilateral knee OA , according to ACR criteria , were included in the study and r and omized to one of two groups : group I ( 30 patients ) was treated with a daily sulphate – bicarbonate – calcium mineral water bath ; group II ( 30 patients ) , the control group , continued their regular outpatient care routine . At baseline , after 15 days and after 12 weeks , patients were evaluated by Visual Analogue Scale ( VAS ) for spontaneous pain , Lequesne and Womac Index for gonarthrosis , SF-36 , Arthritis Impact Measurement Scale ( AIMS ) and symptomatic drugs consumption . We observed a significant improvement of all parameters at the end of the cycle of balneotherapy which persisted throughout the follow-up period , whereas in the control group no significant differences were noted . This symptomatic effect was confirmed by the significant reduction of symptomatic drugs consumption . The differences between the two groups were significant for all considered parameters already from the 15th day and persisted during follow-up . Tolerability of balneotherapy  seemed to be good , with light and transitory side effects . Our results confirm that the beneficial effects of balneotherapy in patients with knee OA last over time , with positive effects on the painful symptomatology , a significant improvement on functional capacities and QoL.  Balneotherapy can represent a useful backup to pharmacological treatment of knee OA or a valid alternative for patients who do not tolerate pharmacological treatments BACKGROUND Balneotherapy is an established treatment modality for musculoskeletal disease , but few studies have examined the efficacy of spa therapy in elderly patients with degenerative spine and joint diseases . OBJECTIVES To assess the effects of balneotherapy on chronic musculoskeletal pain , functional capacity , and quality of life in elderly patients with osteoarthritis of the knee or with chronic low back pain . METHODS The 81 patients in the study group underwent a 1 day course of 30 minute daily baths in mineral water . Changes were evaluated in the following parameters : pain intensity , functional capacity , quality of life , use of non-steroidal anti-inflammatory or analgesic drugs , subjective disease severity perceived by the patients , investigator-rated disease severity , and severity of pain perceived by the patients . We analyzed the results of 76 subjects as 5 did not complete the study . RESULTS Compared to baseline , all monitored parameters were significantly improved by balneotherapy in both investigated groups . Moreover , the favorable effect was prolonged for 3 months after treatment . CONCLUSIONS This study showed that balneotherapy is an effective treatment modality in elderly patients with osteoarthritis of the knee or with chronic low back pain , and its benefits last for at least 3 months after treatment BACKGROUND Osteoarthritis is the most frequent joint disease and is a leading cause of pain and locomotor disability in elderly people . The treatment of osteoarthritis includes non-pharmacological , pharmacological , and surgical therapies . Silver level evidence has been found concerning balneotherapy in osteoarthritis . AIM OF THE STUDY The aim of this study was to evaluate how Lake Hévíz thermal mineral water therapy influences pain , knee function , and quality of life in patients with knee osteoarthritis , compared to the control group . STUDY DESIGN r and omized , controlled , single-blind , follow-up study . SETTING Spa Hévíz and St. And rew Hospital for Rheumatic Diseases POPULATION This study included 77 out patients between 45 and 75 years of age with mild to moderate osteoarthritis of the knee meeting the American College of Rheumatology classification criteria . METHODS Patients were r and omized into two groups . In group I ( n = 38 ) , subjects bathed in Lake Hévíz and in group II ( N.=39 ) , patients were treated in a pool full of tap water . Water temperature was 34 ° C for both groups . Participants underwent 30-minute therapy sessions , five times a week for three weeks . Outcome measures were pain visual analogue scale scores , active flexion degree , knee circumference , stair-climb time , Western Ontario and McMaster Universities osteoarthritis index ( WOMAC ) , and EuroQoL Group 5-Dimension Self-Report Question naire score ( EQ-5D ) . Study parameters were recorded at baseline , immediately after treatment , and after 15 weeks . RESULTS Comparison of the two groups revealed a statistically significant difference in pain visual analogue scale scores ( P<0.01 ) , active flexion degree ( P<0.01 ) , physical function components of WOMAC ( P<0.05 ) , and EQ-5D scores ( P<0.05 ) even after 15 weeks . CONCLUSIONS Balneotherapy  improved pain , function as well as the quality of life in patients with knee osteoarthritis . CLINICAL REHABILITATION IMPACT Balneotherapy is a potentially useful treatment modality for patients with knee osteoarthritis The objective of this study was to test if spa therapy can play a role in the management of severe knee osteoarthritis ( OA ) . Twenty patients with radiologically and clinical ly severe knee OA were r and omly assigned into spa and drug therapy groups . Spa group ( n = 10 ) traveled to a spa town and stayed at a hotel for a 10-day spa therapy course . They followed a balneotherapy regimen including thermal pool baths at 37 ° C for 20 min two times daily . Drug therapy group ( n = 10 ) stayed at home and followed their individually prescribed drug therapy ( NSAIDs and paracetamol ) . Patients were assessed at baseline ( week 0 ) , after spa therapy at 2 weeks ( week 2 ) and during follow-up period at 12 ( week 12 ) and 24 ( week 24 ) weeks by a blinded investigator . Patients assessed with Lequesne algofunctional index ( LAFI ) , pain ( visual analogue scale , VAS ) , patient ’s and investigator ’s global evaluation ( VAS ) , ten-stairs stepping up and down time , 15 m walking time and three times squatting up and down time . Significant improvement in pain and LAFI scores were found at week 2 , week 12 and week 24 in the spa therapy group compared to baseline . Comparing the two group differences , spa therapy was superior to drug therapy in pain reduction and in physician ’s global assessment at all time points . This superiority was also found in LAFI scores and patients ’ global assessment s at week 12 and week 24 . A 10-day course of spa therapy may be beneficial in short- and medium-term up to 24 weeks by reducing pain and improving functional status and overall well-being in patients with severe knee OA and may be considered as an effective therapeutic tool for such patients in countries like Turkey where it is widely available and ( at least partly ) reimbursed Background There are conflicting results in the literature regarding the association between radiographic knee osteoarthritis ( OA ) and symptoms and function in subjects with previous anterior cruciate ligament ( ACL ) reconstruction . Aim To investigate the associations between radiographic tibiofemoral knee OA and knee pain , symptoms , function and knee-related quality of life ( QOL ) 10–15 years after ACL reconstruction . Study design Cross-sectional study . Material and methods 258 subjects were consecutively included at the time of ACL reconstruction and followed up prospect ively . The authors included the Knee Injury and Osteoarthritis Outcome Score to evaluate knee pain , other symptoms ( symptoms ) , activities of daily living and sport and recreation ( Sport/Rec ) and QOL . The subjects underwent st and ing radiographs 10–15 years after the ACL reconstruction . The radiographs were grade d with the Kellgren and Lawrence ( K&L ) classification ( grade 0–4 ) . Results 210 subjects ( 81 % ) consented to participate in the 10–15-year follow-up . Radiographic knee OA ( K&L ≥ grade 2 ) was detected in 71 % , and 24 % showed moderate or severe radiographic knee OA ( K&L grade s 3 and 4 ) . No significant associations were detected between radiographic knee OA ( K&L grade ≥2 ) and pain , function or QOL , respectively , but subjects with radiographic knee OA showed significantly increased symptoms . Severe radiographic knee OA ( K&L grade 4 ) was significantly associated with more pain , symptoms , impaired Sport/Rec and reduced QOL . Conclusion Subjects with radiographic knee OA showed significantly more symptoms than those without OA , and subjects with severe radiographic knee OA had significantly more pain , impaired function and reduced quality of life than those without radiographic knee OA 10–15 years after ACL reconstruction BACKGROUND Osteoarthritis ( OA ) is a chronic degenerative joint disease and is considered to be the fourth leading cause of disability and the second cause of inability to work in men . Recently , adipose-derived mesenchymal stem cells ( AD-MSCs ) came into focus for regenerative medicine as a promising tool for the treatment of OA . The administration of stem cells into impaired joints results in pain relief and improves quality of life , accompanied by restoration of hyaline articular cartilage . METHODS In the present study , nine patients ( including two patients with bilateral symptoms ) diagnosed with osteoarthritis ( International Knee Documentation grade B in 5 and grade D in six knees ) were treated using a single injection of AD-MSCs at a concentration of 0.5 - 1.0 × 107 cells and were followed up for 18 months . During follow-up , all the cases were evaluated clinical ly by Knee Society score ( KSS ) , Hospital for Special Surgery knee score ( HSS-KS ) , Tegner-Lysholm ( T-L ) score and visual analogue scale ( VAS ) of pain , as well as by plain radiography and by magnetic resonance imaging visualization with 2D Magnetic Resonance Observation of Cartilage Repair Tissue ( MOCART ) score assessment . RESULTS Significant improvement of all four clinical scores was observed within the first 6 months ( KSS for 41.4 points , HSS-KS for 33.9 points , T-L score for 44.8 points , VAS of pain from 54.5 to 9.3 ) and improvement persisted throughout the rest of the follow-up . MOCART score showed significant cartilage restoration ( from 43 ± 7.2 to 63 ± 17.1 ) , whereas radiography showed neither improvement , nor further joint degeneration . CONCLUSIONS The results obtained in the present study provide good basis for prospect i ve r and omized controlled clinical trials with respect to the use of AD-MSCs in the treatment of osteoarthritis To investigate if spa water is superior to tap water ( TW ) in relieving the symptoms of pain , joint motion , life quality in knee osteoarthritis ( KOA ) patients . In this r and omized placebo-controlled trial , 52 patients with KOA were followed in two groups . In group I ( n = 27 ) , patients were treated in the pool full of spa water at 37 ° C for 20 min a day , 5 days a week , for a period of 2 weeks . In group II ( n = 25 ) , the same protocol was used but spa water was replaced by TW heated to 37 ° C . Patients in both groups were given a home-based st and ardized exercise program . Evaluation parameters were pain ( pVAS ) , tenderness score ( TS ) , 50-ft walking duration , quadriceps muscle strength ( QMS ) , active flexion degree ( AFD ) , WOMAC OA index , and Nottingham Health Profile ( NHP ) . The first evaluation was done after the informed consent was obtained . Second and third evaluations were done at the 2nd and 12th week . PVAS , 50-ft walking duration , AFD , TS , WOMAC , and NHP variables improved in group I. Same variables except QMS improved also in group II . Comparison of the groups just after treatment showed that only pVAS ( P = 0.015 ) , NHP pain score ( P = 0.020 ) , and TS ( P = 0.002 ) differed significantly in favor of group I at the 2nd or 12th week . Both of the thermal treatment modalities were found to be effective in the management of the clinical symptoms and quality of life in KOA patients . However , pain and tenderness improved statistically better with balneotherapy . There were no significant differences between the groups for the other variables BACKGROUND Knee osteoarthritis ( OA ) is a painful condition causing disability and muscle weakness . Shortwave diathermy ( SWD ) is one of several physical therapy modalities and used predominantly as a pain reduction modality in the clinical practice . However , the efficacy of SWD in knee OA is still inconclusive . AIM The aim of this study was to determine if SWD increase the effectiveness of isokinetic exercise on pain , function , muscle strength , quality of life and depression in patients with OA . DESIGN This was a r and omised , controlled clinical trial . SETTING Inpatient Physiotherapy Department . POPULATION Forty women aged between 42 and 74 years , with a diagnosis of bilateral primary knee OA . METHODS Patients were sequentially r and omized into two groups . Group 1 ( N.=20 ) received SWD and isokinetic muscular strengthening exercises . Group 2 ( N.=20 ) served as control group and they received isokinetic exercises only . Both of the programs were performed three days a week , for a duration of four weeks , and a total of 12 sessions . Patients were assessed before treatment ( BT ) , after treatment ( AT ) , and at a three-month follow-up ( F ) . Outcome measures included visual analogue scale , Western Ontario and McMaster University Osteoarthritis Index , six minute walking distance , isokinetic muscle testing , Short Form 36 and Beck depression index . RESULTS The patients with OA in each group had significant improvements in pain , disability , depression , walking distance , muscle strength , and quality of life AT and F when compared with their initial status ( P<0.05 ) . There was no statistically significant difference between the groups according to all the parameters regarding the change scores between AT-BT test and F-BT test ( P>0.05 ) except some isokinetic peak torque measurements ( F-BT scores of extension right 60 ° , 120 ° and flexion right 60 ° ) . CONCLUSION Use of SWD in addition to isokinetic exercise program seems to have no further significant effect in terms of pain , disability , walking distance , muscle strength , quality of life and depression in patients with knee OA . CLINICAL REHABILITATION IMPACT Considering the time and cost of combination therapy is now , the isokinetic exercise program , as it is efficient , may be preferable for the treatment of knee OA , alone Osteoarthritis ( OA ) is the most common cause of disability in older adults , which , in turn , leads to poor quality of life ( QOL ) . Disability is caused primarily by the joint degeneration and pain associated with OA . A r and omized pilot study was conducted to test the effectiveness of guided imagery with relaxation ( GIR ) to improve health-related QOL ( HRQOL ) in women with OA . A two-group ( intervention versus control ) longitudinal design was used to determine whether GIR leads to better HRQOL in these individuals and whether improvement in HRQOL could be attributed to intervention-associated improvements in pain and mobility .  Twenty-eight women were r and omized to either the GIR intervention or the control intervention group . Using GIR for 12 weeks significantly increased women 's HRQOL in comparison to the women who used the control intervention , even after statistically adjusting for changes in pain and mobility . These findings suggest that the effects of GIR on HRQOL are not limited to improvements in pain and mobility .  GIR may be an easy-to-use self-management intervention to improve the QOL of older adults with OA Background Knee osteoarthritis ( OA ) causes pain and long-term disability with annual healthcare costs exceeding $ 185 billion in the United States . Few medical remedies effectively influence the course of the disease . Finding effective treatments to maintain function and quality of life in patients with knee OA is one of the national priorities identified by the Institute of Medicine . We are currently conducting the first comparative effectiveness and cost-effectiveness r and omized trial of Tai Chi versus a physical-therapy regimen in a sample of patients with symptomatic and radiographically confirmed knee OA . This article describes the design and conduct of this trial . Methods / Design A single-center , 52-week , comparative effectiveness r and omized controlled trial of Tai Chi versus a st and ardized physical-therapy regimen is being conducted at an urban tertiary medical center in Boston , Massachusetts . The study population consists of adults ≥ 40 years of age with symptomatic and radiographic knee OA ( American College of Rheumatology criteria ) . Participants are r and omly allocated to either 12 weeks of Tai Chi ( 2x/week ) or Physical Therapy ( 2x/week for 6 weeks , followed by 6 weeks of rigorously monitored home exercise ) . The primary outcome measure is pain ( Western Ontario and McMaster Universities WOMAC ) subscale at 12 weeks . Secondary outcomes include WOMAC stkiffness and function domain scores , lower extremity strength and power , functional balance , physical performance tests , psychological and psychosocial functioning , durability effects , health related quality of life , and healthcare utilization at 12 , 24 and 52 weeks . Discussion This study will be the first r and omized comparative-effectiveness and cost-effectiveness trial of Tai Chi versus Physical Therapy in a large symptomatic knee OA population with long-term follow up . We present here a robust and well- design ed r and omized comparative-effectiveness trial that also explores multiple outcomes to eluci date the potential mechanisms of mind-body effect for a major disabling disease with substantial health burdens and economic costs . Results of this study are expected to have important public health implication s for the large and growing population with knee OA.Trial registration Clinical Trials.gov identifier : Introduction Osteoarthritis ( OA ) is a chronic joint disease that usually occurs in older people and leads to pain and disabilities . OA treatment ranges from drug therapy to surgery . Drug and rehabilitation therapy are preferred over surgery , and , especially , there is a tendency toward compounds causing regenerative changes in the knee joint . In the present study , the effects of platelet-rich plasma ( PRP ) injection and prolotherapy ( PRL ) were examined on the level of pain and function of the knee joint in patients with OA . Methodology After fulfilling the inclusion criteria and signing the informed consent form , 42 patients with knee OA were scheduled for intra-articular injection in the present r and omized , double-blind , clinical trial . Following admission to the operating pain room , the condition of the patient ’s knee was evaluated first via the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) and , then , ultrasound-guided knee injection was done . Accordingly , patients in the PRP therapy group received 7 mL PRP solution and those in the PRL group received 7 mL 25 % dextrose . Using the WOMAC , levels of pain and knee function were evaluated and recorded for each patient immediately prior to the first injection as well as at 1 month ( immediately prior to the second injection ) , 2 months ( a month after the second injection ) , and 6 months later . Data collected were analyzed using the SPSS v.20 . Results During the first and second months , a rapid decrease in the overall WOMAC score was observed in both groups . The overall WOMAC score increased at the sixth month , but was lower than the overall WOMAC score in the first month . Statistical analysis indicated that the overall WOMAC score significantly decreased in both groups of patients over 6 months . Conclusion Results of the present study suggested a significant decrease in the overall WOMAC score of patients who undergo either PRP therapy or PRL . This positive change in the overall WOMAC score led to an improvement in the quality of life of patients with knee OA shortly after the first injection . PRP injection is more effective than PRL in the treatment of knee OA Background Osteoarthritis ( OA ) is a common cause of pain and disability , and is the most common form of arthritis in the Western world . The most common joint to be affected is the knee . Pain and functional disability are common symptoms , which can lead to reduced quality of life and increase the risk of further morbidity . Current treatment aims to educate patients about the management of OA , reduce pain , improve function , decrease disability and reduce the progression of the disease . Education with clients has been described as a set of planned educational activities design ed to improve patients ' health behaviours and /or health status . The purpose of self‐education is to maintain or improve health , or , in some cases , to slow deterioration by increasing participant 's perception of self efficacy defined as an ability to control or manage various aspects of OA . To date , there is no systematic review of the literature undertaken to identify the effectiveness of self‐management educational activities for osteoarthritis of the knee . Objective The objective of this systematic review is to evaluate the effectiveness of  self‐management educational interventions on function and quality of life for adult subjects with OA of the knee . Search strategy A comprehensive search strategy was undertaken on data bases available from University of South Australia from their inception to January 2007 . Selection criteria R and omised controlled trials or clinical controlled trials were sought which evaluated any self management interventions for osteoarthritis knee . Critical appraisal of study quality was undertaken using Joanna Briggs Institute critical appraisal instruments . Data extraction was via the Joanna Briggs Institute st and ard data extraction form for evidence of effectiveness , and Review Manager Software was used to calculate comparative statistics . Results Thirteen trials were included in the review . Trials were clinical ly and method ologically heterogeneous . Pooled results indicate evidence of a beneficial effect from  self management strategies with reducing pain ( SMD ‐0.25 , 95%CI ‐0.36 to ‐0.13 , 11 trials 1379 participants ) . There was no effect on physical function ( SMD 0.13 , 95%CI ‐0.33 to ‐0.08 , eight trials , 1156 subjects ) . No beneficial effects were found from self management interventions with improving quality of life . We also found the exercise component of self management ( four trials ) demonstrated a benefit with reducing pain , improving function and quality of life . Exercise also offered a benefit over no exercise  . Overall method ological quality was moderate . Discussion Pooled results indicate evidence of a beneficial effect from self management strategies with reducing pain and improving function . Significant heterogeneity was found between trials . This was controlled for in the analysis but may be explained by heterogeneity in both the intervention and control group . The exercise component of self management programmes appears to contribute a significant benefit . Conclusion There is encouraging evidence of a small benefit from exercise in self management programs . Clear guidelines can not be provided for practice regarding the exercise content due to heterogeneity but overall benefit suggests this component should be emphasized and implemented in primary care self management programmes Background Osteoarthritis ( OA ) is a degenerative disease that can lead to painful and dysfunctional joints . Prolotherapy involves using injections to produce functional restoration of the soft tissues of the joint . Intra-articular injections are controversial because of the introduction of needles into the articular capsule . Objectives To compare the effect of periarticular versus intra-articular prolotherapy on pain and disability in patients with knee OA . Study design R and omized double-blind controlled clinical trial . Setting Single center , university hospital ( Imam Hossein Hospital , Tehran , Iran ) . Methods A total of 104 patients with chronic knee OA were enrolled . In the intra-articular group , 8 mL of 10 % dextrose and 2 mL of 2 % lidocaine were injected . Injections were repeated at 1 and 2 weeks after the first injection . In the periarticular group , 5 mL of 20 % dextrose and 5 mL of 1 % lidocaine were injected subcutaneously at 4 points in the periarticular area . Pain and disability , as assessed using the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , were recorded at each follow-up visit at 1 , 2 , 3 , 4 , and 5 months post-injection . Results The visual analog scale score was significantly lower in the periarticular compared with the intra-articular group at the 2- , 3- , 4- , and 5-month visits but not at 1 month . Morning stiffness and difficulty in rising from sitting were improved in both groups and were not signifi-cantly different in the peri- and intra-articular groups . Pain , joint locking , and limitation scores were all improved in both groups . Difficulty in walking on flat surfaces or climbing stairs , and sitting and st and ing pain , were all improved in both groups from 1 to 5 months after treatment . Limitations WOMAC scores are subjective and could be a limitation of the study . Conclusion Periarticular prolotherapy has comparable effects on pain and disability due to knee OA to intra-articular injections , while avoiding risks of complications STUDY DESIGN R and omized , double-blind , placebo-controlled study . OBJECTIVES To examine the short-term therapeutic effects of monochromatic infrared energy ( MIRE ) on participants with knee osteoarthritis ( OA ) . Patients were assessed according to the International Classification of Functioning , Disability and Health . BACKGROUND MIRE is commonly used in therapy for patients with peripheral neuropathies . However , research has not focused intensively on the therapeutic effects of MIRE in patients with knee OA . METHODS This study enrolled 73 participants with knee OA . Participants received six 40-minute sessions of active or placebo MIRE treatment ( 890-nm wavelength ; power , 6.24 W ; energy density , 2.08 J/cm2/min ; total energy , 83.2 J/cm2 ) over the knee joints for 2 weeks . International Classification of Functioning , Disability and Health-related outcomes were collected weekly over 4 weeks using the Knee injury and Osteoarthritis Outcome Score , Lysholm Knee Scale , Hospital Anxiety and Depression Scale , Multidimensional Fatigue Inventory , Chronic Pain Grade question naire , World Health Organization Quality of Life-brief version , and OA Quality of Life Question naire . Data were analyzed by repeated- measures analysis of variance . RESULTS No statistically significant differences were found for the interaction of group by time for Knee injury and Osteoarthritis Outcome Score scores , including pain , other symptoms , function in daily living , function in sport and recreation , and knee-related quality of life . Scores on the Lysholm Knee Scale , Hospital Anxiety and Depression Scale , Multidimensional Fatigue Inventory , Chronic Pain Grade question naire , World Health Organization Quality of Life-brief version , and OA Quality of Life Question naire also showed no significant differences between the 2 groups at any of the 4 follow-up assessment s. CONCLUSION Short-term MIRE therapy provided no beneficial effects to body functions , activities , participation , and quality of life in patients with knee OA The prevalence of  osteoarthritis ( OA )  is greater in women then men . Weight , a factor strongly associated with osteoarthritis , is significantly increased over the menopausal transition . Despite the high prevalence of osteoarthritis , a disabling disease with limited treatment options , there is a paucity of studies in women . The longitudinal phase of the Melbourne Women 's Midlife Health Project , is a population -based prospect i ve study of 438 Australian born women who have been followed annually over 11 years . 257 ( 59 % ) of these women remained in longitudinal assessment at 11th year of follow-up and 224 of these women agreed to undergo X-rays of their knees and h and s. In this study , X-rays were scored for evidence of osteoarthritis using a vali date d scale , by two investigators who were blinded to question naire results . Information on hormone therapy use , physical activity , smoking , BMI and age were obtained by both self-administered and face-to-face question naires . Results showed that one hundred and twenty-eight women ( 56 % ) had evidence of radiological OA . Forty-nine ( 21.6 % ) had evidence of radiological knee OA . One hundred and one ( 44.5 % ) had evidence of radiological h and OA . Compared to baseline , at 11th year of follow-up participants had put on weight ( 4 kg range -14 to 25 kg ) and a larger proportion ( 25 % vs. 40 % ) reported exercising frequently ( P = 0.005 ) . Physical activity and BMI were associated with higher prevalence of osteoarthritis in the final year of follow-up . Smoking was associated with a lower prevalence of radiological knee OA . The prevalence was 61 % among never smokers compared to only 39 % among those who smoked ( P < 0.05 ) . Total OA was associated with never having used hormone therapy ( odds ratio 2.7 ; CI 1.1 - 6.9 ) . There was a trend for increasing level of physical activity at ages 20 - 29 to be associated with an increased risk of knee OA ( P value 0.03 for trend ) . In conclusion increasing age , BMI and history of more frequent physical activity in younger years were risk factors for radiological knee OA . In contrast , smoking appeared to be associated with less knee OA . Never having used hormone therapy was a risk factor for radiological h and and knee OA . Further work will be needed to determine whether modification of these factors can prevent the development of OA Background : Osteoarthritis ( OA ) is a degenerative joint disease affecting the knee joint of many middle-aged and older adults . As OA symptoms typically involve knee pain and stiffness , individuals with knee OA are often insufficiently physically active , have low levels of physical function , and are at increased risk of other comorbidities and reduced quality of life . While moderate-intensity continuous training ( MICT ) cycling is often recommended , little is known about the feasibility , safety , and benefits of high-intensity interval training ( HIIT ) cycling for this population , even though the feasibility , safety , and benefits of HIIT have been demonstrated in other chronic disease groups . Purpose : The primary objective of this pilot study was to examine the feasibility and safety of home-based HIIT and MICT cycling in middle-aged and older adults with knee OA . A secondary objective was to gain some insight into the relative efficacy of HIIT and MICT for improving health status ( pain , stiffness , and disability ) , muscle function , and body composition in this population . This study protocol is being published separately to allow a detailed description of the research methods , explain the rationale for choosing the method ological details , and to stimulate consideration of the best means to simulate a research protocol that is relevant to a real-life treatment environment . Study Design : R and omized pilot study protocol . Methods : This trial sought to recruit 40 middle-aged and older adults with knee OA . Participants were r and omly allocated to either continuous ( MICT ) or HIIT home-based cycle training programs , with both programs requiring the performance of 4 cycling sessions ( approximately 25 minutes per session ) each week . Participants were measured at baseline and postintervention ( 8 weeks ) . Feasibility and safety were assessed by adherence rate , dropout rate , and number of adverse events . The relative efficacy of the cycling programs was investigated by 2 knee OA health status question naires ( Western Ontario and McMaster Universities Osteoarthritis Index scale[WOMAC ] and the Lequesne Index ) as well as the timed up and go , sit to st and , preferred gait speed , and body composition . Discussion : This pilot study appears to be the first study assessing the feasibility and safety of a home-based HIIT training program for middle-aged and older adults with knee OA . As HIIT has been demonstrated to be more effective than MICT for improving aspects of health status , body composition , and /or muscular function in other chronic disease groups , the current study has the potential to improve patient outcomes and inform the design of future r and omized controlled trials INTRODUCTION Osteoarthritis ( OA ) is a common degenerative joint disease particularly in older subjects . It is usually associated with pain , restricted range of motion , muscle weakness , difficulties in daily living activities and impaired quality of life . To determine the effects of adding two different intensities of low-level laser therapy ( LLLT ) to exercise training program on pain severity , joint stiffness , physical function , isometric muscle strength , range of motion of the knee , and quality of life in older subjects with knee OA . METHODS Patients were r and omly assigned into three groups . They received 16 sessions , 2 sessions/week for 8 weeks . Group-I : 18 patients were treated with a laser dose of 6 J/cm(2 ) with a total dose of 48 J. Group-II : 18 patients were treated with a laser dose of 3 J/cm(2 ) with a total dose of 27 J. Group-III : 15 patients were treated with laser without emission as a placebo . All patients received same exercise training program including stretching and strengthening exercises . Patients were evaluated before and after intervention by visual analogue scale ( VAS ) , the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) index for quality of life , h and held dynamometer and universal goniometer . RESULTS T test revealed that there was a significant reduction in VAS and pain intensity , an increase in isometric muscle strength and range of motion of the knee as well as increase in physical functional ability in three treatment groups . Also analysis of variance ( ANOVA ) proved significant differences among them and the post hoc tests ( LSD ) test showed the best improvements for patients of the first group . CONCLUSION It can be concluded that addition of LLLT to exercise training program is more effective than exercise training alone in the treatment of older patients with chronic knee OA and the rate of improvement may be dose dependent , as with 6 J/cm(2 ) or 3 J/cm(2 ) The purpose of the present investigation was to evaluate whether an anti-inflammatory effect together with an improvement of the regulation of the interaction between the inflammatory and stress responses underlies the clinical benefits of pelotherapy in osteoarthritis ( OA ) patients . This study evaluated the effects of a 10-day cycle of pelotherapy at the spa centre ‘ El Raposo ’ ( Spain ) in a group of 21 OA patients diagnosed with primary knee OA . Clinical assessment s included pain intensity using a visual analog scale ; pain , stiffness and physical function using the Western Ontario and McMaster Universities Arthritis Index ; and health-related quality of life using the EuroQol-5D question naire . Serum inflammatory cytokine levels ( IL-1β , TNF-α , IL-8 , IL-6 , IL-10 and TGF-β ) were evaluated using the Bio-Plex ® Luminex ® system . Circulating neuroendocrine-stress biomarkers , such as cortisol and extracellular 72 kDa heat shock protein ( eHsp72 ) , were measured by ELISA . After the cycle of mud therapy , OA patients improved the knee flexion angle and OA-related pain , stiffness and physical function , and they reported a better health-related quality of life . Serum concentrations of IL-1β , TNF-α , IL-8 , IL-6 and TGF-β , as well as eHsp72 , were markedly decreased . Besides , systemic levels of cortisol increased significantly . These results confirm that the clinical benefits of mud therapy may well be mediated , at least in part , by its systemic anti-inflammatory effects and neuroendocrine-immune regulation in OA patients . Thus , mud therapy could be an effective alternative treatment in the management of OA Objective The aim of this study was to evaluate the effects of an exercise training protocol and low-level laser therapy ( and the association of both treatments ) on musculoskeletal atrophy using an experimental model of knee osteoarthritis ( OA ) . Design Fifty male Wistar rats were r and omly divided into five groups : control group , knee OA control group , OA plus exercise training group , OA plus low-level laser therapy group , and OA plus exercise training associated with low-level laser therapy group . The exercise training and the laser irradiation started 4 wks after the surgery , 3 days per week for 8 wks . The exercise was performed at a speed of 16 m/min , 3 days per week , 50 mins per day , for 8 wks . Laser irradiation was applied at two points of the left knee joint ( medial and lateral ) , for 24 sessions . Results The results showed that both trained groups ( irradiated or not ) presented a significant increase in the muscle cross-sectional area and a decrease in muscle fiber density compared with the knee OA control group . Moreover , both trained and laser-irradiated groups demonstrated decreased muscle-specific ring-finger protein 1 and atrogin-1 immunoexpression . Conclusions These results suggest that exercise training and low-level laser therapy were effective in preventing musculoskeletal alterations related to atrophy caused by the degenerative process induced by knee OA Background Osteoarthritis ( OA ) is a common problem in older women that is associated with pain and disabilities . Although yoga is recommended as an exercise intervention to manage arthritis , there is limited evidence documenting its effectiveness , with little known about its long term benefits . This study ’s aims were to assess the feasibility and potential efficacy of a Hatha yoga exercise program in managing OA-related symptoms in older women with knee OA . Methods Eligible participants ( N = 36 ; mean age 72 years ) were r and omly assigned to 8-week yoga program involving group and home-based sessions or wait-list control . The yoga intervention program was developed by a group of yoga experts ( N = 5 ) . The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) total score that measures knee OA pain , stiffness , and function at 8 weeks . The secondary outcomes , physical function of the lower extremities , body mass index ( BMI ) , quality of sleep ( QOS ) , and quality of life ( QOL ) , were measured using weight , height , the short physical performance battery ( SPPB ) , the Pittsburgh Sleep Quality Index ( PSQI ) , the Cantril Self-Anchoring Ladder , and the SF12v2 Health Survey . Data were collected at baseline , 4 weeks and 8 weeks , and 20 weeks . Results The recruitment target was met , with study retention at 95 % . Based on ANCOVAs , participants in the treatment group exhibited significantly greater improvement in WOMAC pain ( adjusted means [ SE ] ) ( 8.3 [ .67 ] , 5.8 [ .67 ] ; p = .01 ) , stiffness ( 4.7 [ .28 ] , 3.4 [ .28 ] ; p = .002 ) and SPPB ( repeated chair st and s ) ( 2.0 [ .23 ] , 2.8 [ .23 ] ; p = .03 ) at 8 weeks . Significant treatment and time effects were seen in WOMAC pain ( 7.0 [ .46 ] , 5.4 [ .54 ] ; p = .03 ) , function ( 24.5 [ 1.8 ] , 19.9 [ 1.6 ] ; p = .01 ) and total scores ( 35.4 [ 2.3 ] , 28.6 [ 2.1 ] ; p = .01 ) from 4 to 20 weeks . Sleep disturbance was improved but the PSQI total score declined significantly at 20 weeks . Changes in BMI and QOL were not significant . No yoga related adverse events were observed . Conclusions A weekly yoga program with home practice is feasible , acceptable , and safe for older women with knee OA , and shows therapeutic benefits .Trial registration Clinical Trials.gov : Background : Knee joint osteoarthritis ( OA ) is one of the most incapacitating diseases affecting older population , which is associated with pain and functional limitation . Various kinds of conservative treatment have been used to decrease knee pain and to improve the quality of life of the subjects suffering from this disease . There are discrepancies in the clinical effects reported for the use of lateral wedge insole in spite of being used as one of the first conservative mechanical treatments for patients with medial compartments of knee OA . Methods : A total of 36 subjects with medial knee compartment OA were recruited in this research project . Subjects were r and omized into two groups to receive 3- and 7-mm lateral wedge insoles based on the date of birth of the participants . Some parameters such as severity of knee pain , Tibiofemoral angle ( TFA ) , severity of OA , and quality of life were selected in this research project . Results : The use of both 3-mm and 7-mm lateral wedge insole improves the quality of life and decreases knee joint pain . However , the effect of 7 mm lateral wedge insole was more than that of 3 mm . Conclusion : Using lateral wedge insole is a simple , inexpensive therapy for decreasing pain and improving quality of life ; however , most research must be carried out to find the effects of lateral wedge on severity of knee joint OA and aligning TFA Osteoarthritis ( OA ) of the knee leads to restrictions of physical activity and ability to perform activities of daily living . Obesity is a risk factor for knee OA and it appears to exacerbate knee pain and disability . The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was developed to test the efficacy of lifestyle behavioral changes on physical function , pain , and disability in obese , sedentary older adults with knee OA . This controlled trial r and omized 316 sedentary overweight and obese older adults in a two-by-two factorial design into one of four 18-month duration intervention groups : Healthy Lifestyle Control ; Dietary Weight Loss ; Structured Exercise ; or Combined Exercise and Dietary Weight Loss . The weight-loss goal for the diet groups was a 5 % loss at 18 months . The intervention was modeled from principles derived from the group dynamics literature and social cognitive theory . Exercise training consisted of aerobic and strength training for 60 minutes , three times per week in a group and home-based setting . The primary outcome measure was self-report of physical function using the Western Ontario and McMaster University Osteoarthritis Index . Other measurements included timed stair climb , distance walked in 6 minutes , strength , gait , knee pain , health-related quality of life , knee radiographs , body weight , dietary intake , and cost-effectiveness of the interventions . We report baseline data stratified by level of overweight and obesity focusing on self-reported physical function and physical performance tasks . The results from ADAPT will provide approaches clinicians should recommend for behavioral therapies that effectively reduce the incidence of disability associated with knee OA
In conclusion , even though limitations must be considered , evidence shows that BT and spa therapy can significantly improve QoL of patients with knee OA .
Moreover , reduction of drug consumption and improvement of algofunctional indexes may be other beneficial effects .
Knee osteoarthritis ( OA ) is a degenerative disease which is expected to become one of the leading causes of disability by the next years .
This work aims to assess if balneotherapy and spa therapy can significantly improve Quality of Life ( QoL ) of patients with knee OA .