Journal of Research in Rehabilitation Sciences

Comparing the Effect of continuous and Intermittent Physiotherapy on the Pain and Function in Moderate Knee Osteoarthritis; A Pilot Randomized Clinical Trial Study

Document Type : Original Articles

Authors

1 MSc Student, Musculoskeletal Research Center, Rehabilitation Research Institute AND Student Research Committee AND Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

2 Instructor, Musculoskeletal Research Center, Rehabilitation Research Institute AND Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

3 Assistant Professor, Musculoskeletal Research Center, Rehabilitation Research Institute AND Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

4 Physical Therapy Unite, Alzahra Educational and Treatment Center, Isfahan University of Medical Sciences, Isfahan, Iran

5 Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

10.22122/jrrs.v14i4.3239

Abstract

Introduction: Osteoarthritis is one of the common types of joint disorder. This study compared the effects of continuous and intermittent physiotherapy on the pain and function of the individuals with moderate knee osteoarthritis.Materials and Methods: This randomized clinical trial study included 20 patients with moderate knee osteoarthritis randomly assigned into continuous and intermittent physiotherapy groups. The intervention was exactly the same for both groups including 10 sessions of conventional physical therapy. The treatment frequency was 6 and 3 sessions per week for continuous and intermittent groups, respectively. Using Knee injury and Osteoarthritis Outcome Score (KOOS) and Intermittent and Constant Osteoarthritis Pain (ICOAP) questioners, 6-minute-walking test, timed get up and go test, pain based on visual analogue scale (VAS), and function were assessed before, after 10 sessions, and after one month of follow up. The outcome was analyzed using independent t-test and, repeated measures ANOVA.Results: Prior to the study, there was no significant difference between groups (P > 0.05). At the end of the 10th treatment session (P = 0.048), and after 1 month of follow up (P = 0.030), only the daily activity subscale of the KOOS questionnaire was significantly less in the continuous group. The records of 6-minute-walk test (P = 0.046), timed get up and go test (P = 0.040), continuous pain (P = 0.006), symptoms (P = 0.020), pain (P = 0.003), and quality of life (P = 0.010) subclasses of KOOS improved significantly in continuous group. After one month of follow up, daily activity subclass and pain based on VAS score were significantly better than baseline records (P = 0.002). In intermittent group, pain based on VAS score (P = 0.002) and continuous pain (P = 0.030) improved significantly after 10th session and follow up period).Conclusion: It seems that the frequency of the treatment sessions has no significant effect on the treatment results in short term. Thus, the physiotherapist may take the subject's preference and their time limitations for scheduling the sessions. Continuous intervention may probably be the better choice to reach better results while intermittent protocol may result in more lasting effects.

Keywords

  1. Paton JF, Rogers WT, Schwaber JS. Tonically rhythmic neurons within a cardiorespiratory region of the nucleus tractus solitarii of the rat. J Neurophysiol 1991; 66(3): 824-38.
  2. Haq SA, Davatchi F. Osteoarthritis of the knees in the COPCORD world. Int J Rheum Dis 2011; 14(2): 122-9.
  3. Hadian M R, Jahangard T, Pourkazemi F, Mazaheri H, Khosh Akhlagh A, Zohorian M, et al. Comparison of the effects of heat, exercise therapy and combination of low level laser therapy on the side effects of knee osteoarthritis (women 40-65 years). J Mod Rehabil 2008; 2(1): 15-23. [In Persian].
  4. Chhabr HK, Sathya P. Effect of conventional exercises with balance training &only conventional exercises in patients with osteoarthritis of knee. Int J Innov Res Sci Eng 2015; 4(7): 5048-56.
  5. Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian J Intern Med 2011; 2(2): 205-12.
  6. Luyten FP, Denti M, Filardo G, Kon E, Engebretsen L. Definition and classification of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 2012; 20(3): 401-6.
  7. Abbasi E, Kahrizi S, Razi M, Faghihzadeh S. The effect of whole-body vibration training on the lower extremity muscles' electromyographic activities in patients with knee osteoarthritis. Med J Islam Repub Iran 2017; 31: 107.
  8. Brandt KD. Nonsurgical management of osteoarthritis, with an emphasis on nonpharmacologic measures. Arch Fam Med 1995; 4(12): 1057-64.
  9. Toopchizadeh V, Babaei-Ghazani A, Eftekhar Sadat B. Comparison of therapeutic effects of action potential simulation (APS) and transcutaneous electrical nerve stimulation (TENS) in knee osteoarthritis. Med J Tabriz Univ Med Sci 2013; 35(3): 32-9. [In Persian].
  10. Osiri M, Welch V, Brosseau L, Shea B, McGowan J, Tugwell P, et al. Transcutaneous electrical nerve stimulation for knee osteoarthritis. Cochrane Database Syst Rev 2000; (4): CD002823.
  11. Jamtvedt G, Dahm KT, Christie A, Moe RH, Haavardsholm E, Holm I, et al. Physical therapy interventions for patients with osteoarthritis of the knee: An overview of systematic reviews. Phys Ther 2008; 88(1): 123-36.
  12. Tascioglu F, Kuzgun S, Armagan O, Ogutler G. Short-term effectiveness of ultrasound therapy in knee osteoarthritis. J Int Med Res 2010; 38(4): 1233-42.
  13. Zhang C, Shi J, Zhu C, Xiang T, Yi Z, Kong Y. Effect of ultrasound therapy for knee osteoarthritis: A meta-analysis of randomized, double-blind, placebo-controlled clinical trials. Int J Clin Exp Me 2016; 9(11): 20552-61.
  14. Ahadi T, Saleki M, Razi M, Raeisi G, Forough B. Comparison of physical modality and knee isometric exercise training on symptom of knee osteoarthritis. J Gorgan Univ Med Sci 2011; 12(4): 12-7. [In Persian].
  15. Cetin N, Aytar A, Atalay A, Akman MN. 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. Am J Phys Med Rehabil 2008; 87(6): 443-51.
  16. Palmieri-Smith RM, Thomas AC, Karvonen-Gutierrez C, Sowers MF. Isometric quadriceps strength in women with mild, moderate, and severe knee osteoarthritis. Am J Phys Med Rehabil 2010; 89(7): 541-8.
  17. Anwer S, Alghadir A. Effect of isometric quadriceps exercise on muscle strength, pain, and function in patients with knee osteoarthritis: a randomized controlled study. J Phys Ther Sci 2014; 26(5): 745-8.
  18. Carter R, Lubinsky J. Rehabilitation research: Principles and applications. Elsevier Health Sciences; 2015.
  19. Fattahi L, Rezaeian ZS. The immediate effects of conventional physical therapy on the knee joint load in subjects with moderate knee osteoarthritis; a preliminary single blinded randomized control trial. Journal of Rehabilitation Sciences and Research 2015; 2(4): 71-9.
  20. Mangione KK, Axen K, Haas F. Mechanical unweighting effects on treadmill exercise and pain in elderly people with osteoarthritis of the knee. Phys Ther 1996; 76(4): 387-94.
  21. Altman RD, Gold GE. Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthritis Cartilage 2007; 15(Suppl A): A1-56.
  22. Mehrabian H, Shojaedin SS, Baratii AH, Ghasemi M. Effects of aquatic exercise on the pain, symptoms, motor performance and quality of life of elderly women with knee osteoarthritis. J Res Rehab Sci 2012; 8(2): 337-45. [In Persian].
  23. Heiden TL, Lloyd DG, Ackland TR. Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarthritis patient gait. Clin Biomech (Bristol, Avon) 2009; 24(10): 833-41.
  24. Pietrosimone BG, Saliba SA, Hart JM, Hertel J, Kerrigan DC, Ingersoll CD. Effects of disinhibitory transcutaneous electrical nerve stimulation and therapeutic exercise on sagittal plane peak knee kinematics and kinetics in people with knee osteoarthritis during gait: a randomized controlled trial. Clin Rehabil 2010; 24(12): 1091-101.
  25. van der Esch M, Steultjens M, Harlaar J, Knol D, Lems W, Dekker J. Joint proprioception, muscle strength, and functional ability in patients with osteoarthritis of the knee. Arthritis Rheum 2007; 57(5): 787-93.
  26. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16(4): 494-502.
  27. Melyanian B, Niki Z, Rezaeian ZS. The effect of symmetrical involvement of the knee joints in moderate osteoarthritis on individuals' report of pain and function (part one of a preliminary study): Intermittent and Constant Osteoarthritis Pain Measure. J Res Rehabil Sci 2016; 11(6): 375-83. [In Persian].
  28. Rikli R, Jones J. The reliability and validity of a 6-minute walk test as a measure of physical endurance in older adults. J Aging Phys Act 1998; 6(4): 363-75.
  29. Piva SR, Fitzgerald GK, Irrgang JJ, Bouzubar F, Starz TW. Get up and go test in patients with knee osteoarthritis 1,2. Arch Phys Med Rehabil 2004; 85(2): 284-9.
  30. Salavati M, Mazaheri M, Negahban H, Sohani SM, Ebrahimian MR, Ebrahimi I, et al. Validation of a Persian-version of Knee injury and Osteoarthritis Outcome Score (KOOS) in Iranians with knee injuries. Osteoarthritis Cartilage 2008; 16(10): 1178-82.
  31. Panah SH, Baharlouie H, Rezaeian ZS, Hawker G. Cross-cultural adaptation and validation of the Persian version of the Intermittent and Constant Osteoarthritis Pain Measure for the knee. Iran J Nurs Midwifery Res 2016; 21(4): 417-23.
  32. Moreton BJ, Wheeler M, Walsh DA, Lincoln NB. Rasch analysis of the intermittent and Constant Osteoarthritis Pain (ICOAP) scale. Osteoarthritis Cartilage 2012; 20(10): 1109-15.
  33. Melyanian B. Immediate effect of supplementary treadmill walking exercise with conventional physical therapy on the pain and function in patients with moderate knee osteoarthritis [MSc Thesis]. Isfahan, Iran: Isfahan University of Medical Sciences; 2016. [In Persian].
  34. Eftekharsadat B, Shakouri SK, Mahmoudian B. Analgesic Effects of Low Energy Laser in Patients with Knee Osteorathritis. Journal of Advances in Medical and Biomedical Research 2004; 12(49): 16-21. [In Persian].
  35. Mahmoodi Aghdam S, Khademi Kalantari K, Akbarzadeh Baghban A R, Rezayi M, Rahimi A, Naimee S S. Effect of sustained traction on physical improvements of patients with severe knee osteoarthritis. J Mod Rehabil 2013; 7(3): 24-31. [In Persian].
  36. Khademi Kalantari K, Zahedi A, Rahmani S, Bozari S, Rezaei M. A Comparison Between The Immediate Effects of Two. J Mod Rehabil 2009; 2 (3-4): 1-5. [In Persian].
Journal of Research in Rehabilitation Sciences
Volume 14, Issue 4 - Serial Number 4
September 2018
Pages 189-198