Objective: Current treatments for osteoarthritis do not resolve the underlying cause. Dextrose prolotherapy is an alternative method that has been proposed for treatment of osteoarthritis, due to its ability to aid tissue regeneration, improve clinical manifestations, and repair damaged tissue structures, which are pathological conditions in osteoarthritis. The aim of this systematic review was to evaluate the efficacy of dextrose prolotherapy compared with other interventions in the management of osteoarthritis.Methods: Electronic databases PubMed, Google Scholar, Cochrane, and BioMed Central were searched from inception to October 2021. Search terms included [(prolotherapy) OR (prolotherapies) OR (dextrose prolotherapy)] AND [(osteoarthritis) OR (osteoarthritides) OR (knee osteoarthritis) OR (hip osteoarthritis) OR (hand osteoarthritis) OR (shoulder osteoarthritis)]. Randomized controlled trials that compared the use of dextrose prolotherapy with other interventions (injection, placebo, therapy, or conservative treatment) in the treatment of osteoarthritis were included. Potential articles were screened for eligibility, and data were extracted by all authors. Risk of bias was assessed using the Cochrane Risk of Bias tool. Study population, methods, and results data were extracted and tabulated by 3 authors.Results: 12 studies reported that DPT was as effective or even more effective in improving functional outcomes compared with other interventions whilst others found that HA, PRP, EP, and ACS were more effective. 14 studies assessed the effectiveness of DPT and ten of them reported that DPT was more effective in reducing pain compared with other interventions.Conclusion: Dextrose prolotherapy in osteoarthritis confers potential benefits for pain and functional outcomes, but this systematic review found that the studies to date are at high risk of bias. LAY ABSTRACTOsteoarthritis is a long-term chronic illness defined by the degeneration of cartilage in joints, causing bones to rub together and causing stiffness, discomfort, and decreased movement. Current treatment options for osteoarthritis do not address the fundamental cause. Dextrose prolotherapy is a potential alternative approach for OA, due to its capacity to help tissue regeneration, improve clinical symptoms, and repair damaged tissue structures, which are pathogenic in osteoarthritis. Despite several comparison studies, the superiority of dextrose prolotherapy in osteoarthritis remains equivocal due to contradictory outcomes. Based on this review, dextrose prolotherapy should be considered as a possible treatment for osteoarthritis.

Background: Knee osteoarthritis (KOA) is a degenerative joint disease with relatively high prevalence globally and is one of the leading causes of disability in the elderly population. Dextrose prolotherapy (DPT) has been proven effective in improving functional outcomes in knee osteoarthritis. The effect of hypertonic dextrose on cartilage biomarkers has not been evaluated. Purpose: To evaluate the association between a cartilage biomarker and changes in clinical outcomes among patients with KOA who received dextrose prolotherapy (DPT). Patients and methods: This study was conducted with a cross-sectional design. Twenty-six participants received DPT at weeks 1, 5, and 9. Our primary measures were urinary c-terminal telopeptides of type II collagen (uCTX-II), measured by an enzyme-linked immunosorbent assay (ELISA), and the WOMAC score, measured at baseline and week 12. Results: There were significant improvements in all WOMAC subscales and uCTX-II levels after DPT. There is no significant correlation between biomarker levels with the WOMAC score as a functional outcome indicator in KOA after DPT (p > 0.05), but there are positive correlations between pain, functional, total WOMAC score, and uCTX-II. Conclusion: DPT may reduce cartilage degradation and improve functional outcomes in osteoarthritic knees. Significant drops in uCTX-II levels can affect functional outcomes, especially pain, functional and total WOMAC scores.

Case series Patients: Male, 53-year-old • Male, 68-year-old Final Diagnosis: COVID-19 Symptoms: Cough • desaturation • paraparesis • shortness of breath Medication: — Clinical Procedure: — Specialty: Rehabilitation Objective: Unusual setting of medical care Background: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease first reported in Wuhan, China in December 2019 that has subsequently become pandemic worldwide. The more severe the symptoms, the more comprehensive and complex are the methods needed to treat patients. The World Health Organization (WHO) has highlighted the role of rehabilitation as one of the pillars in COVID-19 management, considering its advantages. It has been implemented in some countries’ guidelines, but it is not stated in Indonesia’s guideline. Thus, rehabilitation intervention is sometimes neglected or delayed. This case report aims to describe the possible benefit of optimizing the rehabilitation program during hospitalization. Case Reports: We describe 2 patients with severe COVID-19: Patient A was a 53-year-old man without comorbidities and Patient B was a 68-year-old man with several comorbidities. Patient A was discharged from the hospital with respiratory sequelae (dyspnea, cough, and desaturation) and muscle weakness in both limbs after 2 months of hospitalization without rehabilitation intervention. Then, he returned to work 3 months after rehabilitation. Patient B was discharged without any significant sequelae after undergoing rehabilitation during hospitalization. Conclusions: Early physical rehabilitation in severe cases of COVID-19 has several potential benefits, including improved muscle strength, physical function, and quality of life, as well as reduced health care costs and length of stay (LOS). We believe that an early rehabilitation program in severe cases of COVID-19 is needed, but the physician still has to consider the patients’ condition and capacity into to decide what kind of exercise should be programmed by the team.

Background: Osteoarthritis currently remains a significant health problem due to its high prevalence and morbidity rate. Radiological examination is still used as a gold standard to determine the severity of knee osteoarthritis by using Kellgren-Lawrence grading. Dextrose prolotherapy has been known to be effective in treating pain in knee osteoarthritis, but none has compared the efficacy between mild and moderate-severe knee osteoarthritis. Objective: This study aims to compare the effectiveness of prolotherapy based on its radiological and symptomatic severity in knee osteoarthritis.Methods: In this pre-post study, the participants who underwent dextrose prolotherapy injection (25% intra-articular and 15% periarticular) for three sessions with four weeks intervals were grouped into mild (grade 1-2) and severe (grade 3-4) groups. Participants’ functional status was measured with Western Ontario and McMaster Universities’ arthritis index scores at baseline and week 12.Results: A total of 21 patients (average age 61.42 ± 8.33, BMI 26.81± 3.72) received three therapy sessions. Both groups had significantly better Western Ontario and McMaster Universities arthritis index scores than baseline (-22.57± 11.9; p = 0.002 and -15.42 ± 15.75; p = 0.003). All parameters were improved significantly (p <0.05) in both groups, except the stiffness score (p = 0.292; p = 0.057). There were no differences in functional outcome improvements in both groups (p > 0.05; CI 95%: -21.3 – 7.05).Conclusion: Prolotherapy effectively improves functional outcomes in all stages of knee osteoarthritis.