Effects of high-power pain threshold ultrasound technique in patients with knee osteoarthritis: A single-blind randomized controlled trial
Abstract
Osteoarthritis (OA) is a highly prevalent, degenerative disease of the joints manifested by joint pain, tenderness, decreased function, and limited range of motion (ROM). The current study aimed at evaluating the therapeutic effect of the high-power pain-threshold ultrasound technique (HPPTUS) in comparison with conventional ultrasound (US) techniques in patients with knee osteoarthritis (KOA). A single-masked, pre–post randomized controlled trial was conducted. Fifty participants of both sexes (between 40 and 50 years of age), diagnosed with stage II knee osteoarthritis, participated in this study. They were randomized into two groups: Group A (experimental group, n=25), which received HPPTUS on the knee joint in addition to the traditional treatment (hot packs and isometric exercise for quadriceps), and Group B (control group, n=25), which received conventional ultrasound on knee joint in addition to the traditional treatment (hot packs and isometric exercise for quadriceps). Both groups underwent a four-week treatment plan in which sessions were conducted twice per week. The visual analogue scale (VAS) was used to estimate the intensity of pain, Digital Electronic Pressure Algometer was used to measure pressure pain threshold (PPT) on trigger point around knee, and Digital goniometer was utilized to assess ROM of the knee joint before and after treatment. The MANOVA test revealed statistically significant improvements in all variables (VAS, PPT, knee ROM) post-treatment compared to pre-treatment values in the HPPTUS group (experimental group) (p < 0.05), while the control group revealed statistically significant improvement only in VAS post-treatment compared with pre-treatment (p < 0.05). Comparison between groups revealed statistically significant improvements in VAS, PPT, knee ROM in participants receiving HPPTUS compared with the control group (p < 0.05). High-power ultrasound can be effectively implemented in the treatment of knee OA as it produces significant improvements in the intensity of pain, pressure-pain threshold, and knee joint ROM.
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References
Ackerman, I. N., Graves, S. E., Wicks, I. P., Bennell, K. L., & Osborne, R. H. (2005). Severely compromised quality of life in women and those of lower socioeconomic status waiting for joint replacement surgery. Arthritis and Rheumatism, 53(5), 653–658. https://doi.org/10.1002/art.21439
Alburquerque-García, A., Rodrigues-de-Souza, D. P., Fernández-de-las-Peñas, C., & Alburquerque-Sendín, F. (2015). Association between muscle trigger points, ongoing pain, function, and sleep quality in elderly women with bilateral painful knee osteoarthritis. Journal of Manipulative and Physiological Therapeutics, 38(4), 262–268. https://doi.org/10.1016/j.jmpt.2014.10.018
Anwer, S., & Alghadir, A. (2014). Effect of isometric quadriceps exercise on muscle strength, pain, and function in patients with knee osteoarthritis: a randomized controlled study. Journal of Physical Therapy Science, 26(5), 745–748. https://doi.org/10.1589/jpts.26.745
Bajaj, P., Bajaj, P., Graven-Nielsen, T., & Arendt-Nielsen, L. (2001). Trigger points in patients with lower limb osteoarthritis. Journal of Musculoskeletal Pain, 9(3), 17-33.
Boonstra, A. M., Schiphorst Preuper, H. R., Reneman, M. F., Posthumus, J. B., & Stewart, R. E. (2008). Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. International Journal of Rehabilitation Research, 31(2), 165–169. https://doi.org/10.1097/MRR.0b013e3282fc0f93
Cameron, M. H. (2017). Physical Agents in Rehabilitation-E Book: An Evidence-Based Approach to Practice. Elsevier Health Sciences.
Chu, C. R., Williams, A. A., Coyle, C. H., & Bowers, M. E. (2012). Early diagnosis to enable early treatment of pre-osteoarthritis. Arthritis Research & Therapy, 14(3), 212. https://doi.org/10.1186/ar3845
Dor, A., & Leonid, K. (2017). A myofascial component of pain in knee osteoarthritis. Journal of Bodywork and Movement Therapies, 21(3), 642-647.
Edmonds, S. (2009). Therapeutic targets for osteoarthritis. Maturitas, 63(3), 191–194. https://doi.org/10.1016/j.maturitas.2009.03.015
Elhafez, H. M., Ali, I. A., Embaby, E. A., & Karkousha, R. N. (2020). Effect of Different Intensities of Ultrasound on Pain and Myoelectric Activities of Upper Trapezius Myofascial Trigger Points. Indian Journal of Public Health Research & Development, 11(4), 1092-1097
Esenyel, M., Aldemir, T., Gürsoy, E., Esenyel, C. Z., Demir, S., & Durmuşoğlu, G. (2007). Myofascial pain syndrome: efficacy of different therapies. Journal of Back and Musculoskeletal Rehabilitation, 20(1), 43-7.
Esposito, C. J., Veal, S. J., & Farman, A. G. (1984). Alleviation of myofascial pain with ultrasonic therapy. The Journal of Prosthetic Dentistry, 51(1), 106–108. https://doi.org/10.1016/s0022-3913(84)80115-8
Fischer, A. A. (1998). Algometry in diagnosis of musculoskeletal pain and evaluation of treatment outcome: an update. Journal of Musculoskeletal Pain, 6(1), 5-32.
Haran, H. R., & Kumar, S. N. (2013). Effect of High Power Pain Threshold Static Ultrasound Combined with Transverse Friction Massage and Stretching on Upper Trapezius Myofascial Trigger Point. Indian Journal of Physiotherapy and Occupational Therapy, 7(3), 113-117.
Henry, R., Cahill, C. M., Wood, G., Hroch, J., Wilson, R., Cupido, T., & Vandenkerkhof, E. (2012). Myofascial pain in patients waitlisted for total knee arthroplasty. Pain Research & Management, 17(5), 321–327. https://doi.org/10.1155/2012/547183
Hogan, R. D., Burke, K. M., & Franklin, T. D. (1982). The effect of ultrasound on microvascular hemodynamics in skeletal muscle: effects during ischemia. Microvascular Research, 23(3), 370–379. https://doi.org/10.1016/s0026-2862(82)80009-5
Itoh, K., Hirota, S., Katsumi, Y., Ochi, H., & Kitakoji, H. (2008). Trigger point acupuncture for treatment of knee osteoarthritis--a preliminary RCT for a pragmatic trial. Acupuncture in Medicine, 26(1), 17–26. https://doi.org/10.1136/aim.26.1.17
Johnson, V. L., & Hunter, D. J. (2014). The epidemiology of osteoarthritis. Best practice & research. Clinical Rheumatology, 28(1), 5–15. https://doi.org/10.1016/j.berh.2014.01.004
Kang, T., Horton, L., Emery, P., & Wakefield, R. J. (2013). Value of ultrasound in rheumatologic diseases. Journal of Korean Medical Science, 28(4), 497–507. https://doi.org/10.3346/jkms.2013.28.4.497
Kellgren, J., & Lawrence, J. (1957). Radiological assessment of osteo-arthrosis. Annals of the Rheumatic Diseases, 16(4), 494–502. https://doi.org/10.1136/ard.16.4.494
Kim, Y., Yang, H. R., Lee, J. W., & Yoon, B. C. (2014). Effects of the high-power pain threshold ultrasound technique in the elderly with latent myofascial trigger points: a double-blind randomized study. Journal of Back and Musculoskeletal Rehabilitation, 27(1), 17–23. https://doi.org/10.3233/BMR-130414
Koca, I., Tutoglu, A., Boyaci, A., Ucar, M., Yagiz, E., Isik, M., & Bahsi, A. (2014). A comparison of the effectiveness of low-, moderate- and high-dose ultrasound therapy applied in the treatment of myofascial pain syndrome. Modern Rheumatology, 24(4), 662–666. https://doi.org/10.3109/14397595.2013.860001
Kornaat, P. R., Bloem, J. L., Ceulemans, R. Y., Riyazi, N., Rosendaal, F. R., Nelissen, R. G., Carter, W. O., Hellio Le Graverand, M. P., & Kloppenburg, M. (2006). Osteoarthritis of the knee: association between clinical features and MR imaging findings. Radiology, 239(3), 811–817. https://doi.org/10.1148/radiol.2393050253
Kotlarz, H., Gunnarsson, C. L., Fang, H., & Rizzo, J. A. (2009). Insurer and out-of-pocket costs of osteoarthritis in the US: evidence from national survey data. Arthritis and Rheumatism, 60(12), 3546–3553. https://doi.org/10.1002/art.24984
Loyola-Sánchez, A., Richardson, J., & MacIntyre, N. J. (2010). Efficacy of ultrasound therapy for the management of knee osteoarthritis: a systematic review with meta-analysis. Osteoarthritis and Cartilage, 18(9), 1117–1126. https://doi.org/10.1016/j.joca.2010.06.010
MacIntyre, N. J., Busse, J. W., & Bhandari, M. (2013). Physical therapists in primary care are interested in high quality evidence regarding efficacy of therapeutic ultrasound for knee osteoarthritis: a provincial survey. The Scientific World Journal, 2013, 348014. https://doi.org/10.1155/2013/348014
Majlesi, J., & Unalan, H. (2004). High-power pain threshold ultrasound technique in the treatment of active myofascial trigger points: a randomized, double-blind, case-control study. Archives of Physical Medicine and Rehabilitation, 85(5), 833–836. https://doi.org/10.1016/j.apmr.2003.07.023
Majlesi, J., & Unalan, H. (2004). High-power pain threshold ultrasound technique in the treatment of active myofascial trigger points: a randomized, double-blind, case-control study. Archives of Physical Medicine and Rehabilitation, 85(5), 833–836. https://doi.org/10.1016/j.apmr.2003.07.023
Molina, M. R., Garcia, M. S., & Mayoral, G. M. L. (2000). Effect of muscular ultrasound stimulation on power spectrum electromyography during a strengthening training. Electromyography and Clinical Neurophysiology, 40(3), 163–168.
Nicholson, S., Dickman, K., & Maradiegue, A. (2009). Reducing premature osteoarthritis in the adolescent through appropriate screening. Journal of Pediatric Nursing, 24(1), 69–74. https://doi.org/10.1016/j.pedn.2008.03.009
Pop, T., Szczygielska, D., & Druzbicki, M. (2007). Epidemiology and cost of conservative treatment of patients with degenerative joint disease of the hip and knee. Ortopedia, Traumatologia, Rehabilitacja, 9(4), 405–412.
Quintana, J. M., Arostegui, I., Escobar, A., Azkarate, J., Goenaga, J. I., & Lafuente, I. (2008). Prevalence of knee and hip osteoarthritis and the appropriateness of joint replacement in an older population. Archives of Internal Medicine, 168(14), 1576–1584. https://doi.org/10.1001/archinte.168.14.1576
Rutjes, A. W., Nüesch, E., Sterchi, R., & Jüni, P. (2010). Therapeutic ultrasound for osteoarthritis of the knee or hip. The Cochrane Database of Systematic Reviews, 1, CD003132. https://doi.org/10.1002/14651858.CD003132.pub2
Sadeghnia, M., Shadmehr, A., Hadian, R. M., Mir, S. M., & Jalaei, S. (2021). Evaluate the Immediate Effect of High-power Pain Threshold Ultrasound on Treatment of Upper Trapezius Active Myofascial Trigger Points. Journal of Modern Rehabilitation, 15(3), 167-172.
Sangtong, K., Chupinijrobkob, C., Putthakumnerd, W., & Kuptniratsaikul, V. (2019). Does adding transcutaneous electrical nerve stimulation to therapeutic ultrasound affect pain or function in people with osteoarthritis of the knee? A randomized controlled trial. Clinical Rehabilitation, 33(7), 1197–1205. https://doi.org/10.1177/0269215519838017
Schulz, K. F., Altman, D. G., Moher, D., & CONSORT Group (2010). CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Medicine, 18(8), 1-9. https://doi.org/10.1186/1741-7015-8-18
Simons, D. G., Travell, J. G., & Simons, L. S. (1999). Travell & Simons' myofascial pain and dysfunction: upper half of body. Lippincott Williams & Wilkins.
Smith, T., Collier, T. S., Smith, B., & Mansfield, M. (2019). Who seeks physiotherapy or exercise treatment for hip and knee osteoarthritis? A cross-sectional analysis of the English Longitudinal Study of Ageing. International Journal of Rheumatic Diseases, 22(5), 897–904. https://doi.org/10.1111/1756-185X.13480
Svensson, M., Lind, V., & Löfgren Harringe, M. (2019). Measurement of knee joint range of motion with a digital goniometer: A reliability study. Physiotherapy Research International, 24(2), e1765. https://doi.org/10.1002/pri.1765
Travell, J.G., & Simons, D.G. (1983). Myofascial pain and dysfunction: the trigger point manual. Lippincott Williams & Wilkins.
Unalan, H., Majlesi, J., Aydin, F. Y., & Palamar, D. (2011). Comparison of high-power pain threshold ultrasound therapy with local injection in the treatment of active myofascial trigger points of the upper trapezius muscle. Archives of Physical Medicine and Rehabilitation, 92(4), 657–662. https://doi.org/10.1016/j.apmr.2010.11.030
Watson, T. (2000). The role of electrotherapy in contemporary physiotherapy practice. Manual Therapy, 5(3), 132–141. https://doi.org/10.1054/math.2000.0363
Zeng, C., Li, H., Yang, T., Deng, Z. H., Yang, Y., Zhang, Y., Ding, X., & Lei, G. H. (2014). Effectiveness of continuous and pulsed ultrasound for the management of knee osteoarthritis: a systematic review and network meta-analysis. Osteoarthritis and Cartilage, 22(8), 1090–1099. https://doi.org/10.1016/j.joca.2014.06.028
Zhang, Y., Jia, J., Yang, S., Liu, X., Ye, S., & Tian, H. (2014). MicroRNA-21 controls the development of osteoarthritis by targeting GDF-5 in chondrocytes. Experimental & Molecular Medicine, 46(2), 79. https://doi.org/10.1038/emm.2013.152
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