Patrícia Pereira Alfredo

Efficacy of low level laser therapy associated with exercises in knee osteoarthritis: a randomized double-blind study

Objectives: To estimate the effects of low level laser therapy in combination with a programme of exercises on pain, functionality, range of motion, muscular strength and quality of life in patients with osteoarthritis of the knee. Design: A randomized double-blind placebo-controlled trial with sequential allocation of patients to different treatment groups. Setting: Special Rehabilitation Services. Subjects: Forty participants with knee osteoarthritis, 2–4 osteoarthritis degree, aged between 50 and 75 years and both genders. Intervention: Participants were randomized into one of two groups: the laser group (low level laser therapy dose of 3 J and exercises) or placebo group (placebo laser and exercises). Main measures: Pain was assessed using a visual analogue scale (VAS), functionality using the Lequesne questionnaire, range of motion with a universal goniometer, muscular strength using a dynamometer, and activity using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaire at three time points: (T1) baseline, (T2) after the end of laser therapy (three weeks) and (T3) the end of the exercises (11 weeks). Results: When comparing groups, significant differences in the activity were also found (P = 0.03). No other significant differences (P > 0.05) were observed in other variables. In intragroup analysis, participants in the laser group had significant improvement, relative to baseline, on pain (P = 0.001), range of motion (P = 0.01), functionality (P = 0.001) and activity (P < 0.001). No significant improvement was seen in the placebo group. Conclusion: Our findings suggest that low level laser therapy when associated with exercises is effective in yielding pain relief, function and activity on patients with osteoarthritis of the knees.

Effects of phonophoresis with Arnica montana onto acute inflammatory process in rat skeletal muscles: An experimental study

This study aimed at verifying the effects of phonophoresis associated with Arnica montana on the acute phase of an inflammatory muscle lesion. Forty Wistar male rats (300+/-50 g), of which the Tibialis Anterior muscle was surgically lesioned, were divided into four groups (n=10 each): control group received no treatment; the ultrasound group (US) was treated in pulsed mode with 1-MHz frequency, 0.5 W/cm(2) intensity (spatial and temporal average - SATA), duty cycle of 1:2 (2 ms on, 4 ms off, 50%), time of application 3 min per session, one session per day, for 3 days; the phonophoresis or ultrasound plus arnica (US+A) group was treated with arnica with the same US parameters plus arnica gel; and the arnica group (A) was submitted to massage with arnica gel, also for 3 min, once a day, for 3 days. Treatment started 24h after the surgical lesion. On the 4th day after lesion creation, animals were sacrificed and sections of the lesioned, inflamed muscle were removed for quantitative (mononuclear and polymorphonuclear cell count) and qualitative histological analysis. Collected data from the 4 groups were statistically analyzed and the significance level set at p<0.05. Results show higher mononuclear cell density in all three treated groups with no significant difference between them, but values were significantly different (p<0.0001) when compared to control groups. As to polymorphonuclear cell density, significant differences were found between control group (p=0.0134) and US, US+A and A groups; the arnica group presented lesser density of polymorphonuclear cells when compared (p=0.0134) to the other groups. No significant difference was found between US and US+A groups. While the massage with arnica gel proved to be an effective anti-inflammatory on acute muscle lesion in topic use, these results point to ineffectiveness of Arnica montana phonophoresis, US having seemingly checked or minimized its anti-inflammatory effect.

Short-term efficacy of low-level laser therapy in patients with knee osteoarthritis: a randomized placebo-controlled, double-blind clinical trial

Objective: This study was designed to evaluate the short-term efficacy of low-level laser therapy (LLLT) for improving pain and function in patients with knee osteoarthritis. Methods: Forty-seven patients with knee osteoarthritis (79 knees), of both genders, participated in this randomized controlled double-blind clinical trial. They were randomly allocated to two groups: laser group with 25 patients (41 knees) and placebo group with 22 patients (38 knees). LLLT was performed three times a week, totaling nine sessions, using a AsGa 904 nm laser with mean power of 60 mW and beam area of 0.5 cm2. Nine points were irradiated on the knee, with energy of 3.0 J/point. The placebo group was treated with the same laser device, but with a sealed probe. Evaluations using Lequesne, visual numerical scale (VNS), Timed Up and Go (TUG), goniometry and dynamometry were conducted before the treatment started and after the nine sessions of LLLT. Results: A significant improvement in pain and function was found in all the assessments applied to the laser group. On comparing the laser group with the placebo group, significant differences were found in the VNS-resting and Lequesne evaluations. Conclusion: Treatment with LLLT improves pain and function over the short term in patients with knee osteoarthritis.

Eficácia a curto prazo do laser de baixa intensidade em pacientes com osteoartrite do joelho: ensaio clínico aleatório, placebo-controlado e duplo-cego

OBJETIVO: Este estudo foi designado para avaliar a eficacia a curto prazo da laserterapia de baixa intensidade (LBI) na melhora da dor e funcao em pacientes portadores de osteoartrite (OA) do joelho. METODOS: Participaram deste ensaio clinico aleatorio, duplo-cego e controlado 47 pacientes (79 joelhos) de ambos os sexos portadores de OA do joelho, que foram distribuidos aleatoriamente em dois grupos; grupo laser com 25 pacientes (41 joelhos) e grupo placebo com 22 pacientes (38 joelhos). A LBI foi realizada tres vezes por semana totalizando nove sessoes, com uso do laser AsGa de 904nm, 60mW de potencia media e 0,5cm2 de area do feixe, sendo irradiados nove pontos no joelho com energia de 3,0J por ponto. O grupo placebo foi tratado com o mesmo aparelho de laser, porem com uma caneta selada. As avaliacoes Lequesne, escala visual numerica (EVN), Timed Up and Go (TUG), goniometria e dinamometria foram realizadas antes do inicio do tratamento e apos as nove sessoes da LBI. RESULTADOS: Foi encontrada melhora significante da dor e funcao para todas as avaliacoes aplicadas no grupo laser. Quando comparado o grupo laser ao grupo placebo encontrou-se diferenca significante para as avaliacoes EVN-Repouso e Lequesne. CONCLUSAO: O tratamento com a LBI melhora a dor e funcao a curto prazo de pacientes portadores de OA do joelho.

Análise qualitativa dos efeitos da sonoforese com Arnica montana sobre o processo inflamatório agudo do músculo esquelético de ratos

Este estudo visou verificar o efeito da sonoforese com Arnica montana sobre a fase inflamatoria aguda de uma lesao muscular. Para isso, 40 ratos Wistar machos, lesados cirurgicamente, foram divididos em 4 grupos: controle (C), 10 ratos lesados e nao tratados; grupo ultra-som (US), 10 lesados, tratados com US; grupo ultra-som com arnica (US+A), 10 ratos lesados, tratados com sonoforese de gel de arnica; grupo arnica (A), 10 ratos lesados, tratados com massagem de gel de arnica. O tratamento dos tres grupos foi iniciado 24h apos a lesao, sendo aplicado uma vez ao dia durante 3 minutos, por tres dias. Quatro dias apos a lesao, os animais foram sacrificados e o terco medio do musculo tibial anterior lesado foi removido e tratado histologicamente. Os resultados da analise qualitativa mostram que, no grupo C, formou-se um intenso infiltrado de celulas inflamatorias no espaco intersticial e um processo de regeneracao apenas iniciado. Nos grupos US e US+A foi detectado um avancado processo inflamatorio, com tecido conjuntivo mais organizado e consistente. No grupo A foi detectada diminuicao no numero de celulas inflamatorias e uma desorganizacao em sua disposicao, o que poderia levar a um atraso no processo de regeneracao. Conclui-se que os grupos que receberam a aplicacao do ultra-som e ultra-som com arnica apresentaram semelhante aceleracao do processo inflamatorio agudo, sugerindo ineficacia da sonoforese quando comparada a aplicacao de apenas ultra-som.

Long-term results of a randomized, controlled, double-blind study of low-level laser therapy before exercises in knee osteoarthritis: laser and exercises in knee osteoarthritis:

Objectives: To assess the long-term effects of low-level laser therapy (LLLT), in combination with strengthening exercises in patients with osteoarthritis of the knee. Design: Follow-up results at three and six months in a previously published randomized, double-blind, placebo-controlled trial. Setting: Specialist Rehabilitation Services. Subjects: Forty participants of both genders, aged 50–75 years with knee osteoarthritis grade 2–4 on Kellgren–Lawrence scale. Intervention: The LLLT group received 10 LLLT treatments with invisible infrared laser (904 nm, 3 Joules/point) over three weeks followed by an eight-week supervised strengthening exercise program. The placebo LLLT group received identical treatment, but the infrared laser output was disabled. Main measures: Pain on a visual analogue scale, paracetamol consumption, and osteoarthritis severity measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne Index. Results: The new data obtained during the follow-up period showed that all outcomes remained stable and there were no significant differences between the groups at three and six months. However, daily consumption of rescue analgesics (paracetamol) was significantly lower in the LLLT group throughout the follow-up period, ending at a group difference of 0.45 vs. 3.40 units (P < 0.001) at six months follow-up. We conclude that within the limitations of this small study, the previously reported improvement after LLLT plus exercise was maintained for a period of six months. Conclusion: We find that the immediate post-intervention improvements from LLLT plus strengthening exercises were maintained for six months.

Efeitos da craniopuntura de Yamamoto na osteoartrite de joelho: estudo de caso

O objetivo deste estudo foi verificar os efeitos da craniopuntura de Yamamoto na dor, na amplitude de movimento, qualidade de vida e funcionalidade de paciente com osteoartrite (OA) de joelho. Foi realizado um estudo de caso de uma paciente de 59 anos apresentando quadro de dor no joelho, reducao funcional nos ultimos tres meses e radiografia constando o grau 3 de OA de joelhos. A avaliacao foi feita antes e apos o tratamento atraves da Escala Visual Analogica (EVA) para avaliacao da dor, da qualidade de vida pelo questionario Western Ontario and McMaster Universities Osteoarthritis (WOMAC), da funcionalidade pelo Knee injury and Osteoarthritis Outcome Score (KOOS) e da amplitude de movimento do joelho pela goniometria. A craniopuntura foi realizada duas vezes por semana, com duracao de 40 minutos cada, totalizando 10 sessoes. A analise dos dados foi feita de forma descritiva. A variavel utilizada foi o ganho relativo (GR) medido no pre e no pos-tratamento. A dor no joelho diminuiu (GR=100%), enquanto a amplitude de movimento aumentou em ambos os joelhos (GR=20%). Observou-se melhora na dor (GR=83%), na rigidez (GR=50%), na funcao (GR=80%) e no escore total da WOMAC (GR= 79%). Verificou-se, atraves da KOOS, melhora nos sintomas (GR=8%), na dor (GR=26%), nas atividades de vida diaria (GR=21%) e na qualidade de vida (GR= 17%). Conclui-se que a craniopuntura foi efetiva no alivio da dor, na amplitude de movimento, qualidade de vida e funcionalidade de paciente com OA de joelho.

FRI0594-HPR Pain, function and quality of life in different degrees of knee osteoarthritis: is there a difference?

Background Osteoarthritis (OA) is a prevalent disease associated with significant morbidity and is one of most common causes of pain, functional limitations and dependence, possibly compromising the quality of life. Objectives To compare pain, function and quality of life in different degrees of knee OA. Methods The study included 100 patients of both sexes, aged between 50 and 75 years and grade 2, 3 or 4 of OA by Kellgren and Lawrence’s classification1. The patients were divided into three groups according to the degree of knee OA: Group G2 - patients with grade 2 (n = 35), group G3 - patients with grade 3 (n = 40) and G4 group - patients with grade 4 (n = 25). Pain intensity was assessed by visual analog scale (VAS), quality of life by the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and functionality by the Lequesne Functional Questionnaire. Statistical analysis was performed using one way ANOVA with Holm-Sidak method for intergroup analysis and the Kruskal-Wallis for non-parametric values. The significance level was α=0.05. Results The age and body mass index were similar between groups. For the WOMAC function subscale, WOMAC total score and LEQUESNE there was a significant difference between G2 and G3 (p <0.05) as well as for the functionality between G2 and G4 (p = 0.004). Image/graph Conclusions Patients with grade 3 of knee osteoarthritis had a poorer quality of life and function compared to patients with grade 2 and 4. There was no significant difference for pain and for WOMAC pain and stiffness subscales in the three groups. References Kellgren JH, Lawrence JS. Radiological assessment of osteoarthritis. Ann Rheum Dis. 1957;16(4):494-501. Acknowledgements Fundação de Amparo à Pesquisa do Estado de São Paulo - FAPESP Disclosure of Interest None Declared