EFFECTIVENESS OF MULTITHERAPY IN PAIN CONTROL AND MOTOR FUNCTION IMPROVEMENT IN PATIENTS WITH KNEE OSTEOARTHRITIS

Mai Duc Han1, Phi Thi Ngoc1, Nguyen Thi Hoa Tuoi1, Bui Quoc Hung1, Bui Thanh Tung2
1 Faculty of Traditional Medicine - Thai Binh University of Medicine and Pharmacy
2 Thai Binh Traditional Medicine Hospital

Main Article Content

Abstract

Background: Osteoarthritis of the knee is a common chronic musculoskeletal disease causing prolonged pain, limited mobility, and reduced quality of life, especially in the elderly. In conservative treatment, multimodal approaches are increasingly used to optimise symptom control and improve function. This study was conducted to evaluate the added value of shockwave therapy, in combination with a basic Traditional Chinese Medicine (TCM) protocol, for patients with primary knee osteoarthritis.


Subjects and Methods: This was a controlled, pre- and post-hoc clinical intervention study of 60 inpatients with primary knee osteoarthritis. Patients were conveniently selected and divided into two equal groups. The study group received shockwave therapy combined with the "Tam Ty Thang" herbal formula, electroacupuncture, and massage; the control group received a TCM protocol without shockwave therapy. The primary endpoints included pain level on the VAS, motor function on the WOMAC, and knee flexion range of motion. The follow-up period was 15 days.


Results: Before treatment, the two groups were similar in age, gender, duration of illness, BMI, initial pain level, WOMAC score, knee flexion range of motion, and radiographic injury severity (p > 0.05). After 15 days of treatment, the mean VAS score in the study group decreased to 2.73 ± 0.69, lower than that in the control group (3.23 ± 0.57; p < 0.05). The overall WOMAC score in the study group decreased to 19.72 ± 2.56, lower than that of the control group (21.83 ± 3.43; p < 0.05). The increased knee flexion range of motion after 15 days in the study group reached 17.53 ± 3.51 degrees, higher than in the control group at 13.97 ± 4.39 degrees (p < 0.05). Adverse effects were observed at a low rate, mainly transient mild pain increase or mild bruising at the treatment site; no serious events or treatment discontinuations were recorded.


Conclusion: In the 15-day short-term follow-up period, the addition of shockwave therapy to the basic Traditional Chinese Medicine regimen was associated with greater improvements in pain and selected functional indicators in patients with primary knee osteoarthritis. Further large-scale studies with a more rigorous design and longer follow-up periods are needed to confirm the method's sustained efficacy.

Article Details

References

[1] GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(9):e508-e522. doi:10.1016/S2665-9913(23)00163-7.
[2] Dantas LO, Salvini TF, McAlindon TE. Knee osteoarthritis: key treatments and implications for physical therapy. Braz J Phys Ther. 2021;25(2):135-146. doi:10.1016/j.bjpt.2020.08.004.
[3] Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2020;72(2):149-162. doi:10.1002/acr.24131.
[4] Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578-1589. doi:10.1016/j.joca.2019.06.011.
[5] Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis: Classification of osteoarthritis of the knee. Arthritis Rheum. 1986;29(8):1039-1049. doi:10.1002/art.1780290816.
[6] Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494-502. doi:10.1136/ard.16.4.494.
[7] Huskisson EC. Measurement of pain. Lancet. 1974;2(7889):1127-1131. doi:10.1016/S0140-6736(74)90884-8.
[8] Ackerman IN. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Aust J Physiother. 2009;55(3):213. doi:10.1016/S0004-9514(09)70088-1.
[9] Imamura M, Alamino S, Hsing WT, Alfieri FM, Schmitz C, Battistella LR. Radial extracorporeal shock wave therapy for disabling pain due to severe primary knee osteoarthritis. J Rehabil Med. 2017;49(1):54-62. doi:10.2340/16501977-2148.
[10] Avendaño-Coy J, Comino-Suárez N, Grande-Muñoz J, Avendaño-López C, Gómez-Soriano J. Extracorporeal shockwave therapy improves pain and function in subjects with knee osteoarthritis: a systematic review and meta-analysis of randomized clinical trials. Int J Surg. 2020;82:64-75. doi:10.1016/j.ijsu.2020.07.055.