| Objective: To evaluate the efficacy and safety of extracorporeal shock wave(ESW)combined with microwave therapy for patients with early to moderate knee osteoarthritis(KOA)from functional and gait aspects.Methods:1.Part Ⅰ: Based on the inclusion and exclusion criteria,30 patients(Affected group)with unilateral knee osteoarthritis who were treated in the Department of Rehabilitation Medicine of the First Hospital of Hebei Medical University from August 2021 to September 2022 were selected,and 30 normal people(Normal group)of the same age without neuromuscular skeletal diseases and joint deformities of the lower limbs were selected as the control.Gait analysis,6-minute walk test and stair climbing test were performed in both groups to explore the gait characteristics and physical performance of patients with KOA;2.Part Ⅱ: According to the inclusion and exclusion criteria,a total of 90 patients with KOA who visited and regularly treated in the Department of Rehabilitation Medicine,the First Hospital of Hebei Medical University between August 2021 and September 2022 were selected and randomly divided into three groups of 30 patients each: combined treatment group(Group A),extracorporeal shock wave treatment group(Group B),and microwave treatment group(Group C).Group A received combined microwave and extracorporeal shock wave therapy,in which microwave therapy was performed first,and extracorporeal shock wave therapy was performed after the end of treatment,and the treatment parameters were the same as those in groups B and C;Group B underwent extracorporeal shock wave therapy at a frequency of 6 Hz and an energy of 1.5-4 bar,with the upper limit as tolerated by the patient,2000 shocks per session,with a 7-day interval between the two treatments;Group C was subjected to microwave treatment for 20 min once daily.In all three groups,pressure points around the affected knee joint were selected as the treatment site,and a course of treatment was given for 2 weeks.Patients were assessed by visual analog scale(VAS),The Western Ontario and Mc Master Universities Osteoarthritis Index(WOMAC),12-Item short form survey(SF-12)before treatment and after one course of treatment,and were assessed by gait analysis,balance meter assessment,6-minute walk test,and stair climbing test.Related adverse events during treatment were recorded.Results:1.Part Ⅰ: Compared with the normal group,the percentage of supporting phase on the affected side was significantly increased in the affected group during walking,and the difference was statistically significant(P < 0.01);The walking speed,hip flexion-extension angle,knee flexion-extension angle,ankle dorsiflexion and metatarsal flexion angle,and the sagittal hip,knee and ankle motion range were decreased,and the difference was statistically significant(P < 0.05);There was no significant difference in step length between the two groups(P > 0.05).The 6-minute walking distance of the affected group is obviously shorter than that of the normal group,and the time required for climbing stairs is obviously prolonged,with statistical difference(P < 0.01).2.Part Ⅱ: After one course of treatment,the VAS score,the WOMAC total score and each single item score,the physical component summary(PCS)in the SF-12 scale were better than before treatment in all three groups(P <0.05),and the mental component summary(MCS)in the SF-12 scale was not significantly different between before and after treatment(P > 0.05);Among groups,all scores in group A were better than those in groups B and C(P <0.05),and there was no significant difference between groups B and C(P >0.05).After treatment,the gait speed,support phase percentage,swing phase percentage,and knee range of motion in the three groups were significantly different from those before treatment(P < 0.05),while the differences of step size,various indicators of balance function and hip and ankle joint range of motion before and after treatment were not statistically significant(P > 0.05).When compared between groups,the gait speed,percentage of supporting phase,knee movement angle and range of motion of group A were better than those of groups B and C,with statistically significant differences(P < 0.05),but not between groups B and C(P > 0.05);There were no significant differences in all measures of step size or balance function or in hip and ankle range of motion among the three groups(P > 0.05).After treatment,the6-minute walk distance of patients in group A was greater than that in groups B and C,and the time for climbing stairs was shorter than that in groups B and C,and the difference was statistically significant(P < 0.05),and there was no statistical difference between groups B and C(P > 0.05).The results of correlation analysis showed that patients’ knee pain and functional situation were positively correlated with gait speed and walking distance,respectively,and negatively correlated with the time to climb the stairs.No treatment-related adverse events were observed during treatment in all patients.Conclusions:1.Compared with normal people,the range of motion of each joint of the lower limb on the affected side of KOA patients decreased,the gait speed slowed down,the percentage of support phase increased,and the physical condition decreased.2.Both microwave therapy and extracorporeal shock wave therapy can relieve pain,improve knee function,and relieve clinical symptoms in patients with early and middle KOA.The efficacy of the combination was significantly better than that of monotherapy,and it could effectively relieve pain and improve knee function in patients with KOA in the early and middle stages,which deserves clinical promotion.3.Both microwave therapy and extracorporeal shock wave therapy can improve walking and physical performance of patients with KOA in the early and middle stages,and the effect of the combination of the two is significantly better than that of monotherapy. |
PDF Full Text Request