Laser Therapy on Chronic Knee Joint Osteoarthritis Patients PATIENTS
Condition: Knee Osteoarthritis
MeSH terms: Osteoarthritis
Study type: Interventional

Summary: 
      Knee osteoarthritis is the most common condition presented in physiotherapy OPD.LASER therapy
      is new treatment option and to find out its effects in knee osteoarthritis is need of the
      hour. With this research one can find out best treatment program for knee osteoarthritis
      patients which can be shared with other community members. If there will be added effect of
      LASER treatment in reducing the visits or stays it will be a cost effective option. this
      study will help to find better management option for patients with knee osteoarthritis.

      This study will address the scarcity of research on this topic in Pakistan and will help to
      raise awareness among patients about the effects of LASER THERAY.
    

Detailed description: 
      Osteoarthritis (OA) is a degenerative joint disease characterized by the loss of articular
      cartilage, subchondral bone remodeling, joint space narrowing and the formation of bone
      spurs. The initiation of cartilage breakdown is stimulated by mechanical stress or injury and
      the degenerative process progresses slowly over many years. In the advanced stage of OA, the
      abnormal remodeling of cartilage and subchondral bone results in the formation of osteophytes
      at the joint surface and margins, which irreversibly destroys the affected joint. Obesity,
      previous trauma, female gender and older age are considered the most common risk factors for
      knee OA. The prevalence of radiographic KOA for all age groups and found a value of 27.3 %
      for women and 21.0 % for men.Clinical manifestations include joint pain, stiffness, decreased
      range of motion (ROM), muscle weakness, proprioceptive changes, difficulties in activities of
      daily living (ADL) such as walking, climbing / descending stairs and housekeeping[5]Many
      physical therapy agents such as ultrasound[6], electrical stimulation, strengthening
      exercise[8]and thermal therapy[9] have been introduced.

      Because of the non-invasiveness and advantage of inciting nearly no adverse side effects,
      low-level laser therapy (LLLT) has been widely used to relieve pain in different
      musculoskeletal disorder. It also promotes fibroblasts, collagen synthesis, cell oxygen
      recovery, and bone remodeling. Laser efficacy depends on 4 factors of wavelength, duration of
      treatment, dose, and areas of the application.Low level laser therapy induces photochemical
      physiological actions in living tissues at the cellular level. Some of these effects include
      cellular oxygenation, release of neurotransmitters associated with pain modulation and
      release of anti-inflammatory, endogenous mediators. LLLT consists of a monochromatic light
      source without any thermal effect that stimulates reparative properties in human cartilage.
      Moreover, it has an analgesic effect, although the mechanisms through which this occurs
      remain uncertain. The suggested mechanisms include: increased mitochondrial ATP and tissue
      oxygenation, increased levels of neurotransmitters implicated in pain modulation (such as
      serotonin) and anti-inflammatory effects. Study stated that the reduction in pain through
      using LLLT might be due to mechanisms such as physiological effects mediated by photochemical
      actions at cellular level in animal or human tissue, and through increased levels of the
      neurotransmitters implicated in pain modulation, such as serotonin. Some researchers have
      also concluded that LLLT has an effect on joint cartilage regeneration, achieved through
      proliferation of chondrocytes and synthesis and secretion of extracellular matrix.

      A study on "Effect of laser therapy on chronic osteoarthritis of the knee in older subjects"
      showed 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.

      A study on "Efficacy of low-level laser therapy on pain and disability in knee
      osteoarthritis: systematic review and meta-analysis of randomized placebo-controlled trials"
      showed that LLLT reduces pain and disability in KOA at 4-8 J with 785-860 nm wavelength and
      at 1-3 J with 904 nm wavelength per treatment spot.

      A study on "effectiveness of low-level laser therapy in patients with knee osteoarthritis: a
      systematic review and meta-analysis" this study indicated that low level laser therapy has
      neither early nor later benefits in reducing pain or improving function in patients with KOA.

      A study on "The Effect of Low Level Laser Therapy on Pain and Range of Motion of Patients
      With Knee Osteoarthritis" showed that the effectiveness of low-power laser in reducing pain
      and improving the range of motion in patients with knee osteoarthritis is similar to the
      effectiveness of the placebo laser. Low-power laser is recognized as an appropriate medical
      modality to treat knee osteoarthritis in animals and humans and can be used along with
      acupuncture or exercise.

      A study on Effect of low level laser therapy (904nm) and static stretching in patients with
      knee osteoarthritis: a protocol of randomized controlled trial showed that the The European
      League Against Rheumatism (EULAR) recommendations indicate stretching exercises as an
      adjunctive treatment.
    

Intervention name(s): Group A (Experimental; Group B (Control)
Intervention type(s): Other; Diagnostic Test
Intervention description(s): Laser therapy is performed on patients in supine lying position. Treatments will be delivered with a diode laser (wavelength 830 nm, continuous wave, power 50 mW) in skin contact at a dose of 6 J/point. Treatment times per point are in the range of 30 seconds to 1 minute. eight points were irradiated per session.
Conventional therapy will include:
TENS for 15 minutes
Hot pack for 15 minutes
Hamstrings muscle stretching and calf muscle stretching. Strengthening exercises ,straight leg raising exercise in crook lying position
Joint mobilizations; 1. Participants of this group will receive only conventional therapy which will include;
TENS for 15 minutes
Hot pack for 15 minutes
Hamstrings muscle stretching and calf muscle stretching.Each stretch was sustained for 30 seconds, with 10-second rest intervals.
Strengthening exercises include quadricep drills(full knee extension maintained for 5 seconds, followed by a 5-second rest) 20 repetitions per session,straight leg raising exercise in crook lying position(the patients were asked to tense the quadriceps muscle, elevate the limb to 45° and maintain it for 6 seconds, and lower the limb slowly and then relax for 6 seconds; the exercise was performed for three sets of 10 repetitions per session).
Joint mobilizations (tibiofemoral extension and flexion; patellofemoral medial-lateral and inferior glide).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: WOMAC; ROM; NPRS; OA