Background: Physical modalities have been safely used for decades for pain relief and for reducing physical disability in the conservative treatment of knee osteoarthritis (OA). However, patients’ response to treatment is highly variable, which may be related to certain patient-related factors such as pain catastrophizing and depression. Objectives: This study aimed to evaluate the effects of pain catastrophizing and depression on physical therapy outcomes and to identify the baseline factors predictive of poor outcomes in patients with knee OA. Study Design: This research used a prospective, cohort, observational study design. Setting: The research took place in an outpatient physical therapy unit within a tertiary hospital in Ankara, Turkey. Methods: Eighty-nine patients with knee OA underwent 10 sessions of physical therapy. At baseline, depression and pain catastrophizing were evaluated using the Beck Depression InventoryII (BDI-II) and the Pain Catastrophizing Scale (PCS). The therapeutic efficacy of physical therapy was assessed based on the level of pain and disability using the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Changes in the VAS score and WOMAC were evaluated at 2 and 6 weeks following physical therapy. A multivariate logistic regression analysis was conducted to identify the predictors of poor outcomes. Results: Patients with low pain-catastrophizing and low depression scores tended to demonstrate better improvement at weeks 2 and 6. The results of a multivariate logistic regression analysis showed that the significant outcome predictor for both pain and function at week 6 was the baseline PCS score. The baseline depression score was not an independent predictor of a clinically poor outcome. Limitations: This study is limited owing to the combined use of several physical therapy modalities and short follow-up. Conclusions: This study suggests that the baseline PCS score is a predictive factor of poor response to physical therapy in patients with knee OA. Considering this factor before therapy and taking the necessary precautions may improve the outcomes of physical therapy. Key Words: Catastrophization, central nervous system sensitization, depression, disability evaluation, knee osteoarthritis, pain, physical therapy modalities, transcutaneous electric nerve stimulation.
BackgroundMechanical lumbar traction has been used to treat spinal disorders and low back pain for centuries, since Hippocrates(.2,3Although the supine position is generally preferred, the patient may also be positioned prone during traction treatment(.4,5 However, to the best of our knowledge, no studies have compared the effects of lumbar traction in these two different positions for patients with chronic LBP.ObjectivesTo compare the effects of mechanical lumbar traction either in the supine or prone position with conventional physical therapy(PT) in patients with chronic low back pain(LBP) and lumbosacral nerve root involvement in terms of disability, pain, and mobility.MethodsParticipants(n=125) were randomly assingned to receive 15 sessions of PT with additional mechanical lumbar traction either in the supine position (supine traction group), or in the prone position (prone traction group), or only PT without traction(PT only group). Patients were assessed at baseline and at the end of the PT sessions in terms of disability, pain, and mobility. Disability was assessed using the modified Oswesty Disability Index (ODI); pain was assessed using a visual analogue scale (VAS); and lumbar mobility was assessed using the modified lumbar Schober test (mLST).Results118 patients completed the trial. All groups improved significantly in the ODI, VAS, and mLST (p<0.05) (table 1). In the between-group analysis, improvements of ODI and VAS were found significantly better in the prone traction group compared with the PT only group (adjusted p=0.031 and.006, respectively).ConclusionsAddition of traction in prone position to other modalities resulted in larger immediate improvements in terms of pain and disability, and the results suggest that when using traction, prone traction might be first-choice. Further research is needed to confirm the benefits of lumbar traction in the prone position.References[1] Marketos SG, Skiadas P. Hippocrates. The father of spine surgery. Spine1999;24:1381–7.[2] Krause M, Refshauge KM, Dessen M, et al. Lumbar spine traction: evaluation of effects and recommended application for treatment. Manual therapy2000;5:72–81.[3] Harte AA, Gracey JH, Baxter GD. Current use of lumbar traction in the management of low back pain: results of a survey of physiotherapists in the UK. Archives of physical medicine and rehabilitation2005;86:1164–9.[4] Fritz JM, Lindsay W, Matheson JW, et al. Is there a subgroup of patients with low back pain likely to benefit from mechanical traction? Results of a randomized clinical trial and subgrouping analysis. Spine2007;32:E793–800.Disclosure of InterestNone declaredAbstract THU0539 – Table 1 Supine traction group(n=39) Prone traction group(n=39) Only PT group(n=40) preinterventionpostinterventionPpreinterventionpostinterventionP preinterventionpostinterventionP ODI 50.4±22.5 33.2±15.5 .001 53.8±15.1 35.9±15.9 .001 49.5±15.1 40.9±17.6 .002VAS8.0±1.64.3±2.2.0018.0±1.73.7±2.7.0017.7±1.55.2±2.3.001mLST19.4±1.920.7±1.8.00118.8±1.820.5±1.3.00119.7±1.920.8±1.7.001
It was concluded that especially solid PAFO can be more beneficial in terms of energy consumption in CP patients. In rehabilitation phase, the EEI measurement was seen to be a useful and practical method for choosing the proper orthosis type.
To compare the effectiveness of ultrasound-guided genicular nerve block (GNB) and physical therapy (PT) in patients with chronic knee osteoarthritis. A prospective randomised study with 102 patients (45-70 years) was performed wherein the patients received ultrasound-guided GNB (n = 51) and PT (n = 51) along with a standard home exercise programme. Scores for pain on a Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 6-min walking test (6MWT) were assessed pre-treatment and at 2-and 12-weeks post-treatment. Both groups were comparable for sociodemographic characteristics. VAS scores (in mm) in the ultrasound-guided GNB group at 0, 2 and 12 weeks were 7.01 ± 1.36; 3.71 ± 2.18; 5.08 ± 2.22 (p < 0.001) and 6. 64 ± 1.99; 4.35 ± 1.09; 5.25 ± 1.33, (p < 0.001) in the PT group. While the increase in the 6MWT test in the 2nd week was similar for both groups (p = 0.073), the increase in walking distance was greater in the ultrasound-guided GNB group at 12 weeks (p = 0.046). As compared to PT, ultrasound-guided GNB is beneficial in reducing pain and increasing functional and physical capacity, with greater retention of effects on the physical capacity seen at 12 weeks. Trial registration number: ClinicalTrials.gov (NCT04782401).
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