The effectiveness of pulsed ultrasound treatment on pain, function, synovial sac thickness and femoral cartilage thickness in patients with knee osteoarthritis: a randomized, double-blind clinical, controlled study

Abstract

Objective: This study aims to investigate the efficacy of therapeutic pulsed ultrasound on pain, function, synovial sac and femoral cartilage in knee osteoarthritis. Design: Randomized, double-blind, controlled study Setting: Dokuz Eylul University, Department of Physical Medicine and Rehabilitation Subjects: A total of 96 patients with knee osteoarthritis Interventions: Participants were randomized into two groups; Group I ( n = 48, pulsed ultrasound) and Group II ( n = 48, sham ultrasound). The sessions were held three times a week for 8 weeks. The study continued for 12 weeks (with 4 weeks follow-up). All participants performed exercises at home for 12 weeks. Main measures: Knee pain (at rest and ADLs) was assessed using the visual analog scale (VAS). Functionality was assessed using the Timed Up and Go test and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaire. Femoral cartilage and synovial sac thickness was measured using ultrasonography. All evaluations were performed at the baseline, at the 8 and 12 weeks after baseline. Results: The study was completed with a total of 75 patients ( n = 39 in group I and n = 36 in group II). The mean (SD) pain at ADLs score at baseline and week 12 was 7.2 (2.1), with 3.6 (2.9) in the group I, and 6.7 (2.0) and 4.3 (2.2) in the group II, respectively. Both groups presented significant improvements in terms of pain and function ( P < 0.001). There was no difference between groups for any parameters. Conclusion: Treatment of pulsed ultrasound has no positive effect on knee pain, function, femoral cartilage and synovial sac thickness in knee osteoarthritis.

Effects of low-intensity pulsed ultrasound on knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials

“…After the whole selection process, 37 articles were included in the systematic review, of which 13 studies with 807 subjects were included in the meta-analysis for statistical comparison. [29][30][31][32][33][34][35][36][37][38][39][40][41] The characteristics of the included studies are shown in Table 1.…”

“…31,32,35 And ten studies used it as a combination therapy. 29,30,33,34,[36][37][38][39][40][41] The outcome indicators of the included studies were: the Visual analog scale score, the Western Ontario and McMaster Universities Osteoarthritis Index score, the Lysholm score, the Lequesne index, Range of motion, 20 meters and 50 meters walking time. The follow-up period ranged from 2 weeks to 1 year.…”

“…As shown in Figure 3. [29][30][31][33][34][35][36][37][38][39][40][41] The synthesized data indicated that the intervention group had significantly alleviated pain as compared with a comparison group (MD = −0.95, 95% CI: −1.43 to −0.48， P < 0.001), and a random-effect model was used because of a substantial heterogeneity for this synthesized outcome (I 2 = 86.6%). For the subgroups of trials with therapeutic periods of ≤ 4 weeks and > 4 weeks, no differences in pain relief were found when comparing the effect between them (P = 0.6443), and all subgroups show heterogeneity (I 2 > 50%).…”

“…Six studies with 341 participants reported the effects of different interventions on the Western Ontario and McMaster Universities Osteoarthritis Index score, as shown in Figure 4A. 31,32,36,37,40,41 The synthesized data indicated that the intervention group had significantly promoted the functional recovery as compared with a comparison group (MD = −4.35, 95% CI: −8.30 to −0.40, P = 0.0309), and a random-effect model was used because of a substantial heterogeneity for this synthesized outcome (I 2 = 56.5%). The comparison between subgroups of trials with therapeutic periods of ≤4 weeks and > 4 weeks showed that the shorter therapeutic period (≤4 weeks) produced a more significant effect on reducing the Western Ontario and McMaster Universities Osteoarthritis Index score ( P = 0.0083).…”

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.…”