Introduction Knee osteoarthritis is a major cause of disability among the middle to senior age groups. Despite being effective, office-based physical therapy (OBPT) needs professional human resources and is both costly and time-consuming. We aimed to compare the efficacy of tele-rehabilitation (tele-rehab) compared with OBPT in patients with knee osteoarthritis. Methods In this randomized clinical trial, patients with symptomatic osteoarthritis of the knee were assigned to participate in either a 6-week home-based tele-rehab or an OBPT program between 2015 and 2016. Our primary outcome was the mean change from the baseline until 1 and 6 month's post-intervention in scores of the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We used analysis of variance for the repeated measure statistical test. Results A total of 54 patients entered the final analysis, with 27 in each group. The mean age of the patients was 58.2 ± 7.41 years and 60.2% were female. In the tele-rehab and OBPT group, KOOS scores increased from baseline to 6 months post-intervention (50.6 to 83.1 and 49.8 to 81.8) respectively. There was no significant difference between tele-rehab and OBPT groups in any of the studied scales. Discussion The tele-rehab program is as effective as OBPT in improving the function of patients with knee osteoarthritis. Considering the much lower time and cost consumed by tele-rehab, it is the recommended program for the older population living in remote sites.

This study aimed to compare the efficacy of four treatments in the management of knee osteoarthritis. We carried out a randomized clinical trial with four study arms in an outpatient Department of Physical Medicine and Rehabilitation at a University Hospital. In total, 120 patients with knee osteoarthritis ≥50 years of age were randomly allocated to four groups. The primary outcome was knee pain in visual analog scale and the secondary outcome was the Knee Injury and Osteoarthritis Outcome Score. The exercise was prescribed daily for all participants throughout the study. For physical therapy (group 1), participants received superficial heat, transcutaneous electrical nerve stimulation and pulsed ultrasound. We administered a single intra-articular injection of botulinum neurotoxin type A (group 2) and three injections of hyaluronic acid (group 3) or 20% dextrose (group 4) to patients in the corresponding groups. Mixed analysis of variance showed that there was statistically significant difference between the groups in pain (P < 0.001), and Knee Injury and Osteoarthritis Outcome Score (P < 0.001). Pairwise between- and within-group comparisons showed that botulinum neurotoxin and dextrose prolotherapy were the most, and hyaluronic acid was the least efficient treatments for controlling pain and recovering function in patients. An intra-articular injection of botulinum toxin type A or dextrose prolotherapy is effective first-line treatments. In the next place stands physical therapy particularly if the patient is not willing to continue regular exercise programs. Our study was not very supportive of intra-articular injection of hyaluronic acid as an effective treatment of knee osteoarthritis.

BackgroundOsteoarthritis (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.ObjectivesTo compare the effect of periarticular versus intra-articular prolotherapy on pain and disability in patients with knee OA.Study designRandomized double-blind controlled clinical trial.SettingSingle center, university hospital (Imam Hossein Hospital, Tehran, Iran).MethodsA 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.ResultsThe 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 standing pain, were all improved in both groups from 1 to 5 months after treatment.LimitationsWOMAC scores are subjective and could be a limitation of the study.ConclusionPeriarticular prolotherapy has comparable effects on pain and disability due to knee OA to intra-articular injections, while avoiding risks of complications.

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Objective: To assess the effects of aqua-cycling on pain, physical function, and muscle strength among elderly people with knee osteoarthritis. Methods: We performed a randomized controlled trial from November 2016 through July 2017 in an outpatient clinic of the Department of Physical Medicine and Rehabilitation at the University Hospital. Patients were 60 years and older and had knee osteoarthritis. Among 32 patients who were randomly allocated to the groups aqua-cycling and control, 30 completed the study. We used the Knee injury and Osteoarthritis Outcome Score to assess the patients' opinion about their knees and associated problems. The measurements were performed at the baseline, and after 4, 8, and 12 sessions of aqua-cycling. Participants in the intervention group performed aqua-cycling, 3 sessions per week for 4 weeks. Each session lasted 50 minutes including 10 minutes of warm-up, 30 minutes of cycling, and 10 minutes of cool-down exercises. Both groups used acetaminophen, if needed, and followed lifestyle recommendations for 4 weeks. Results: There were significant improvements in pain reduction, physical function, and muscle strength in favor of aqua-cycling (all P < .001). Within-group analyses showed that participants in the aqua-cycling group experienced significant pain reduction (P < .001), and improved in physical function (P < .001), quadriceps (P < .001), and hamstring muscle strength (P < .001). Within-group comparisons for the group control were not significant (all P > .05). Conclusion: Aqua-cycling is effective, and can be used alone or combined with other treatments in the management of osteoarthritis.

Aim The aim of this study is to assess the efficacy of aquatic exercise on pain, gait, and balance among elderly patients with knee osteoarthritis. Methods We performed a randomized controlled trial at a university hospital. Overall, 32 men with knee osteoarthritis, aged ≥ 60 years, were included. Pain, balance, and gait were evaluated before and 2 months after interventions. The group control used acetaminophen and followed lifestyle recommendations. The intervention group performed the aquatic exercise three sessions per week for 8 weeks. Results At the end of the study, mean pain scores were significantly different between the groups (p = 0.010). Within-group analyses showed that group intervention experienced significant pain relief (p = 0.019), whereas group control did not show the significant change (p = 0.493). There was significant improvement in favor of aquatic exercise with regard to static (p = 0.001) and dynamic (p = 0.001) balance, step length (p = 0.038), stride length (p < 0.001), and cadence (p < 0.001). However, we did not find a significant difference in step time and width between the two groups. Conclusions Aquatic exercise would be beneficial in decreasing subjective pain of osteoarthritis. There are some recognizable improvements in patients’ gait and balance as well.

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Background: Knee osteoarthritis (KOA) is the most common cause of chronic knee pain, and disability and different modalities have been used to improve pain and function. Botulinum toxin intra-articular injection is proposed to manage resistant joint pains. Objectives: This study was carried out to compare therapeutic effects of intra-articular botulinum neurotoxin (BTX) versus physical therapy (PT) in KOA. Methods: In this single-blind randomized clinical trial, patients with KOA attending to Imam-Reza Hospital, Tehran, Iran, from June 2018 to March 2019 were enrolled. Patients who met the inclusion criteria were randomly divided into BTX receiving a single intra-articular dose of 100 units (250 units from disport brand) and PT groups. The study was described for patients, and informed consent forms were received. For assessment of the pain and related severity, the VAS score and KOOS scales were used. Post-intervention assessment was done 1, 3, and 6 months after the intervention. The level of significance was set at α = 0.05. All data analyses were performed with SPSS version 26 for windows. Results: In this study, 50 patients were randomly divided into BTX and PT groups. All patients completed the study, and there was no loss to follow-up. There was no significant difference between demographic data of the two groups, including age and BMI. The VAS score was similar in the two groups at the beginning. KOOS subscales were not significantly different, but the quality of life was better in the BTX than the PT group (86.2 ± 15 vs. 72.1 ± 11.5, P < 0.001). One month after the intervention, all KOOS subscales were improved in the BTX group in comparison to the PT group (P < 0.001). This difference was statistically significant in the 3rd (P < 0.001 in all comparisons except Sport/Rec subscale in which P = 0.02) and 6th months (P < 0.001) after the intervention, and the improvement in all KOOS subscales and VAS score were higher in the BTX group than the PT group. The trend of KOOS subscales and VAS score was improved over time in the BTX (P < 0.001 in all tests), but the PT group showed no improvement (P > 0.05) except for Sport/Rec and VAS score (P < 0.001). Conclusions: Totally, it is concluded that the use of BTX can reduce pain and improve the function and quality of life in patients with KOA.