Exercise program combined with electrophysical modalities in subjects with knee osteoarthritis: a randomised, placebo-controlled clinical trial

Abstract

Background: It is not yet clear which of the various electrophysical modalities used in clinical practice is the one that contributes most positively when added to an exercise program in patients with knee osteoarthritis (OA). The aim of the present study was to analyze the clinical effects of the inclusion of interferential current therapy (ICT), shortwave diathermy therapy (SDT) and photobiomodulation (PHOTO) into an exercise program in patients with knee OA. Methods: This prospective, five-arm, randomised, placebo-controlled trial was carried out with blinded participants and examiners. We recruited 100 volunteers aged 40 to 80 years with knee OA. Participants were allocated into five groups: exercise, exercise + placebo, exercise + ICT, exercise + SDT, and exercise + PHOTO. The outcome measures included Western Ontario and McMaster Universities (WOMAC), numerical rating pain scale (NRPS), pressure pain threshold (PPT), self-perceived fatigue and sit-to-stand test (STST), which were evaluated before and after 24 treatment sessions at a frequency of three sessions per week. Results: In all groups, there was a significant improvement (p < 0.05) in all variables over time, except pressure pain threshold. We observed significant differences (p < 0.05) between the groups for WOMAC function (exercise vs. exercise + placebo, mean difference [MD] = 5.55, 95% confidence interval [CI] = 3.63 to 7.46; exercise vs. exercise + ICT, MD = 3.40, 95% CI = 1.46 to 5.33; exercise vs. exercise + SDT, MD = 4.75, 95% CI = 1.85 to 7.64; exercise vs. exercise + PHOTO, MD = 5.45, 95% CI = 3.12 to 7.77) and WOMAC pain, with better scores achieved by the exercise group. However, these differences were not clinically relevant when considering the minimum clinically important difference.

Photobiomodulation therapy and the clinical reality in Brazil: response to the letter to the editor

“…In terms of the disputes concerning the dose used in our research [ 1 ] and the study used as reference, we have used the study by Hegedus et al [ 2 ] as the basis for defining the location and points for irradiation since the establishment of our first intervention protocol [ 3 ], as well as in another randomized clinical trial with a similar theme [ 2 ], which is already published.…”

“…Photobiomodulation therapy and the clinical reality in Brazil: response to the letter to the editor Cid André Fidelis de Paula Gomes 1* , Almir Vieira Dibai-Filho 2 , Fabiano Politti 1 , Adriano Rodrigues de Oliveira 1 , Cheila de Souza Bacelar Pereira 1 , Aron Charles Barbosa da Silva 1 and Daniela Aparecida Biasotto-Gonzalez 1 We are extremely honored to know that our work has a wide reach within the area of photobiomodulation therapy. We understand the questions and conflicting points raised by the authors of the Letter to the Editor and consider them important.…”

Neglect of relevant treatment recommendations in the conduct and reporting of a laser therapy knee osteoarthritis trial: letter to the editor

“…We read with interest the article by Gomes et al entitled: “ Exercise program combined with electrophysical modalities in subjects with knee osteoarthritis: A randomised, placebo-controlled clinical trial ”. Gomes et al concluded that the addition of low-level laser therapy (LLLT) “… did not increase the clinical benefit after 8 weeks of treatment (primary and secondary variables) when combined with an exercise protocol for knee osteoarthritis .” [ 1 ].…”

“…However, this dose parameter can be calculated from other LLLT information in the report. Gomes et al stated that a 904 nm wavelength laser device with a probe (spot) size of 0.1309 cm 2 was utilized in skin contact mode and that the energy density was 6 J/cm 2 [ 1 ]. This means that the dose per treatment spot applied was 0.78 J (6 J/cm 2 *0.1309 cm 2 = 0.78 J).…”

“…The dose applied by Gomes et al does not satisfy the WALT recommendations and our LLLT dose-response meta-analysis can explain the negative findings. However, neither the WALT recommendations [ 5 ], nor our systematic review [ 3 ] is mentioned by Gomes et al [ 1 ]. Gomes et al claimed that they used a similar dose to that applied by Hegedus et al However, Hegedus et al stated that they applied 6 J per treatment spot, not 6 J/cm 2 [ 6 ].…”