Background Osteoarthritis (OA) of the knee is the most common joint disease in the elderly and it is associated with significant physical disability (1). Physiotherapy is widely used to treat the pain, stifness and loss of function (2). The use of Doppler ultrasound in rheumatology has grown in recent years. Both colour Doppler and power Doppler are used to evaluate the degree of intra and peri-articular inflamation (3)
Objectives The aim of this study is to present efficiency of physical therapy with patients suffering from knee OA and evaluate quantitative changes of synovial perfusion after termotherapy
Methods In this study 60 patients (22 men, 38 women) were included, the average age of them being 64 years. After being instructed in the study protocol, the participants were divided in two groups of 30. 30 patients received 10 minute - shortwave diathermy (SWD) whereas 30 of them received 10 minute-kriotherapy. All patients were given kinesitherapy for knee OA and the length of treatment was 15 days. Sonoace ultrasound system was used for ultrasound examination by means of a linear probe at the frequency of 6-10 MHz. Blood flow in the synovial membrane was visualised with colour Doppler ultrasonography. The colour Doppler settings were the same for all joints and all the patients with gain setting just below the noise level using our set up for low flow. With spectral Doppler analysis the cardiac cycles were identified and then unit calculated resistive index (RI) as indicator of synovial perfusion. Spectral Doppler measurements were done before the treatment, immediately after kriotherapy and SWD, and 1 hour later. Clinical evaluation included pain in the knee on a 100 mm visual analogue scale (VAS) and Western Ontario and McMaster Osteoarthritis Index (WOMAC 3.0). Both parameters were observed before starting with physical therapy, after 15 days of therapy and 4 months after the treatment had been applied.
Results Statystical analysis was carried out using Excell 2003, namely PHStat with t- test above the level of p<0,001. Clinical parameters(VAS and WOMAC) showed statistically significant improvement after 15 days and also 4 months after physical therapy in both groups of patients. There were no significant changes of RI value after kriotherapy, while we found a significant decrease in mean RI immediately after SWD. There were no statisticaly significant differences in clinical improvement between two groups of patients.
Conclusions Physical therapy proved to be highly efficient in treating knee OA. Kriotherapy had no influence on synovial perfusion, while SWD had only a short term increased synovial perfusion which did not influence either early or long term outcome of treatment applied.
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Jordan KM et al. EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a task of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003;(12): 1145-55.
Iagnocco A et al. Ultrasound imaging for the rheumatologist XVII. Role of colour Doppler and power Doppler Clin Exp Rheumatol 2008;26:759-762.
Disclosure of Interest None Declared