Efficacy of continuous and pulsed therapeutic ultrasound combined with exercises for knee osteoarthritis: a randomized controlled trial

Abstract

Objectives: To compare the effects of continuous and pulsed therapeutic ultrasound combined with strengthening exercises. Design: This is a double-blind randomized controlled trial. Setting: Pontifical Catholic University. Subjects: One hundred participants with Grade 2–4 knee osteoarthritis and both genders were involved. Intervention: Participants were randomized into five groups: Group I ( n = 20; in the first month, continuous ultrasound was applied), Group II ( n = 20; in the first month, pulsed ultrasound was applied), Group III ( n = 20; in the first and second months, continuous ultrasound was applied), Group IV ( n = 20; in the first and second months, pulsed ultrasound was applied) and Group V ( n = 20; patients received only exercise sessions for eight weeks). All patients in the groups that received ultrasound application performed exercises in the second month of treatment. The sessions occurred three times a week. Main measures: Pain was assessed using the visual analogical scale, functionality was assessed using the Lequesne questionnaire, range of motion was assessed using a universal goniometer, muscular strength was assessed using a dynamometer, mobility was assessed using the Timed Up and Go test and 8-meter walk test and the activity level was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Results: Statistically significant differences ( P < 0.05) were presented by Group III in the variables pain during activities of daily living (ADLs) 5.89 (2.18), mobility assessed by 8-meter test 2.68 (2.56), in pain 10.65 (4.40), function 25.50 (10.87) and total 38.65 (15.29) of WOMAC and functionality 9.10 (5.15). Conclusion: Prolonged applications of continuous ultrasound combined with exercises are effective in providing pain, mobility, functionality and activity in subjects with knee osteoarthritis.

Knee Pain from Osteoarthritis: Pathogenesis, Risk Factors, and Recent Evidence on Physical Therapy Interventions

“…Of the nine trials using continuous ultrasound as a treatment, eight reduced WOMAC scores by 20%. While most studies showed favorable relative risk reductions in WOMAC, only a few studies [ 55 , 56 , 57 ] yielded clinically significant relative risk reductions in stiffness WOMAC score, with −62.5%, the relative risk reduction for pain WOMAC score being the most clinically significant [ 57 ]. Discrepancies in findings can be attributed to the combination of ultrasound application with or without rigorous exercise.…”

“…Discrepancies in findings can be attributed to the combination of ultrasound application with or without rigorous exercise. Of the trials that showed clinically meaningful results, the continuous ultrasound treatments used a 1 MHz frequency with an intensity of 1 W/cm 2 or 1.5 W/cm 2 for 5 to 10 min [ 38 , 57 , 58 ]. The pulsed ultrasound interventions similarly used a 1 MHz frequency with an intensity of 1 W/cm 2 for 10 min at a pulsed mode of 25% [ 57 , 59 ].…”

Review on experimental study and clinical application of low- intensity pulsed ultrasound in inflammation

“…For example, they can both be used to improve endothelial function, alleviate pain, and improve physical disability (84)(85)(86). Continuous ultrasound produces more significant thermal effects than pulsed ultrasound when the parameters are the same (87,88). As far as we know, the therapeutic effect of low-intensity ultrasound is mainly caused by mechanical effects.…”

Efficacy of ultrasound therapy for the treatment of lateral elbow tendinopathy (the UCICLET Trial): study protocol for a three-arm, prospective, multicentre, randomised controlled trial

“…US can reduce muscle spasms and pain, and facilitate tissue repair by increasing local blood flow and stimulating inflammatory mediators 26. US has been widely reported to be treatment beneficial in fracture non-unions,27 28 osteoarthritis,29 30 chronic muscle pain,31 32 soft tissue injury,33 and so on. As for tendinopathy, US is also a potential non-invasive treatment modality for frozen shoulder,34 35 rotator cuff,36 achilles37 38 and patellar39 tendinopathy.…”