Terapia de ondas de choque focal para osteoartrose de joelho: um ensaio clínico randomizado duplo-cego

Cavalieri, F; Shinzato, Gilson Tanaka; Leite, Victor Figueiredo; Uchiyama, Sabrina Saemy Tome; Miyazaki, Margarida Margarida; Kirihara, André Kazuyoshi; Battistella, Linamara Rizzo

doi:10.11606/issn.2317-0190.v24i4a154184

Cited by 2 publications

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“…The protocol used in previous studies reached up to 0.44 mJ/mm 2 with high-energy machines ( 34 – 36 ). However, our findings demonstrated that lower doses of 0.12 mJ/mm 2 have also reduced pain and improved functioning in a large percentage of patients ( 22 ).…”

Section: Discussionmentioning

confidence: 59%

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The Institute of Physical Medicine and Rehabilitation, Hospital das Clínicas University of São Paulo School of Medicine comprehensive rehabilitation program for elderly people with knee osteoarthritis

Imamura

Shinzato²,

Sugawara³

et al. 2022

Front. Med.

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BackgroundKnee osteoarthritis (OA) is a leading cause of disability in the elderly population. Chronic disabling pain is associated with maladaptive neuroplastic changes in brain networks, commonly associated with central sensitization. The main clinical features of nociplastic pain conditions include combined peripheral and central sensitization, and it is crucial to recognize this type of pain, as it responds to different therapies than nociceptive and neuropathic pain.ObjectiveTo report the effect of the Institute of Physical Medicine and Rehabilitation (IMREA) comprehensive rehabilitation program to reduce pain and to improve functioning in elderly people with knee OA, under the DEFINE cohort.MethodsThis is a retrospective observational cohort of 96 patients with knee OA, recruited from October 2018 to December 2019. All patients were evaluated by a trained multidisciplinary team using the Kellgren Lawrence classification, bilateral knee ultrasonography, the visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain, rigidity and difficulty scores, the Timed Up and Go Test (TUG), 10-m and 6-min walking test (10 and 6 MWT), Berg Balance Scale, isokinetic dynamometry for knee extension and flexion strength, and pain pressure thresholds. The rehabilitation program included paraspinous lidocaine blocks, focal extracorporeal shockwaves combined with radial pressure waves and functional electrical stimulation according to individual needs. The baseline was compred with the treatment results with a paired t-test.ResultsThe study sample is composed of 96 participants, mostly females (n = 81, 84.38%), with bilateral osteoarthritis (n = 91, 94.79%), and a mean age of 68.89 (SD 9.73) years. Functional improvement was observed in TUG (p = 0.019), 6-mwt (p = 0.033), right knee flexion strength (p < 0.0001), WOMAC rigidity and difficulty domains (p < 0.0001). Pain was reduced from baseline as measured by WOMAC pain domain (p < 0.0001), VAS for both knees (p < 0.0001), and SF-36 pain domain (p < 0.0001). Pressure pain threshold was modified above the patella (p = 0.005 and p = 0.002 for right and left knees, respectively), at the patellar tendons (p = 0.015 and p = 0.010 for right and left patellar tendons, respectively), left S2 dermatome (p = 0.017), and L1-L2 (p = 0.008).ConclusionsThe IMREA comprehensive rehabilitation program improved functioning and reduced disabling pain in elderly people with knee OA. We highlight the relevance and discuss the implementation of our intervention protocol. Although this is an open cohort study, it is important to note the significant improvement with this clinical protocol.

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Section: Discussionmentioning

confidence: 59%

“…A verbal pain score was registered at the beginning of the stimulus and at the end of the shock waves train of 2,000 pulses for each segment treated. When the level zero of pain was achieved before reaching these 2,000 pulses, the application was interrupted and the number of pulses was registered ( 22 ).…”

Section: Methodsmentioning

confidence: 99%

The Institute of Physical Medicine and Rehabilitation, Hospital das Clínicas University of São Paulo School of Medicine comprehensive rehabilitation program for elderly people with knee osteoarthritis

Imamura

Shinzato²,

Sugawara³

et al. 2022

Front. Med.

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“…The mean age in the intervention and control groups ranged from 49.9 to 70 and 49.7 to 72.4 years old, respectively. The mean body mass index was reported only in 25,29–36 ranging from 23.91 to 31 kg/m 2 in the intervention group and from 24.6 to 31.1 kg/m 2 in the control group.…”

Section: Resultsmentioning

confidence: 99%

“…RCT: Randomized Clinical Trial. 0.28 mJ/mm²) for seven studies, [25][26][27][30][31][32]36 and high energy intensity (< 0.60 mJ/mm²) by a single study. 33 Four studies did not mention the energy density used.…”

Section: Resultsmentioning

confidence: 99%

“…Then, 12 studies were included in the qualitative synthesis and the meta-analysis, totaling 403 (W:271 / M:112) individuals submitted to the intervention and 331 (W:229 / M:82) control individuals. [25][26][27][28][29][30][31][32][33][34][35][36] One study did not report the gender distribution among intervention and control groups. 28 A flowchart of the selection process is displayed in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

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Effect of extracorporeal shock wave therapy on pain and function in patients with knee osteoarthritis: a systematic review with meta-analysis and grade recommendations

et al. 2022

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Objective To investigate extracorporeal shock wave therapy effect on knee osteoarthritis compared to a sham or kinesiotherapy by a systematic review and meta-analysis of randomized clinical trials. Data Sources The search was performed in: Cochrane Library, PubMed, PEDro, Web of Science, EMBASE, Scopus, LILACS, and Scielo. Review methods We performed the online search until October, 2022. The following terms were used (Osteoarthritis) AND (“knee joint”) AND (“Extracorporeal Shockwave Therapy”). Eligibility criteria: (1) randomized clinical trials; (2) effects comparison of shockwave therapy to a sham or kinesiotherapy in individuals with knee osteoarthritis; (3) pain and physical function as outcome variables. Risk of bias assessed using the PEDro scale. PROSPERO registration (CRD42021235597). Results We identified 4217 studies, and 12 were included in the qualitative synthesis and the meta-analysis, totaling 403 individuals submitted to the intervention and 331 control individuals. Compared to sham, shockwave was favored in short-term for the function outcome (SMD = −1.93; 95%CI: [−2.77; −1.09]; I² = 83%; P < 0.01). For the pain outcome, the shockwave was favored in the short (MD = −2.05; 95%CI: [−2.59; −1.51]; I² = 84%; P < 0.01), medium (MD = −3.46; 95%CI: [−4.03; −2.89]; I² = 0%; P < 0.01) and long-term (MD = −2.01; 95%CI: [−3.36; −0.65]; I² = 98%; P < 0.01). The association with kinesiotherapy was favored in the short term for the function outcome (SMD = -1.88; 95%CI: [−2.98; −0.78]; I² = 94%; P < 0.01) and favored for the pain outcome in the short (MD = −1.44; 95%CI: [−1.81; −1.07]; I² = 37%; P = 0.14), medium (MD = −1,31; 95%CI: [−1.76; −0,85]; I² = 0%; P = 0.41), and long terms (MD = −1.63; 95%CI: [−1.73; −1.52]; I² = 0%; P = 0.43). Conclusion Shockwave therapy may improve functionality in patients with knee osteoarthritis in the short term and pain in all follow-up moments, compared with sham. When associated to kinesiotherapy, it may improve function in the short term and pain in all follow-up time points, although improvement in pain may not be clinically significant.

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Terapia de ondas de choque focal para osteoartrose de joelho: um ensaio clínico randomizado duplo-cego

Cited by 2 publications

References 0 publications

The Institute of Physical Medicine and Rehabilitation, Hospital das Clínicas University of São Paulo School of Medicine comprehensive rehabilitation program for elderly people with knee osteoarthritis

The Institute of Physical Medicine and Rehabilitation, Hospital das Clínicas University of São Paulo School of Medicine comprehensive rehabilitation program for elderly people with knee osteoarthritis

Effect of extracorporeal shock wave therapy on pain and function in patients with knee osteoarthritis: a systematic review with meta-analysis and grade recommendations

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