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Background: It is not yet clear which of the various electrophysical modalities used in clinical practice is the one that contributes most positively when added to an exercise program in patients with knee osteoarthritis (OA). The aim of the present study was to analyze the clinical effects of the inclusion of interferential current therapy (ICT), shortwave diathermy therapy (SDT) and photobiomodulation (PHOTO) into an exercise program in patients with knee OA., Methods: This prospective, five-arm, randomised, placebo-controlled trial was carried out with blinded participants and examiners. We recruited 100 volunteers aged 40 to 80 years with knee OA. Participants were allocated into five groups: exercise, exercise + placebo, exercise + ICT, exercise + SDT, and exercise + PHOTO. The outcome measures included Western Ontario and McMaster Universities (WOMAC), numerical rating pain scale (NRPS), pressure pain threshold (PPT), self-perceived fatigue and sit-to-stand test (STST), which were evaluated before and after 24 treatment sessions at a frequency of three sessions per week., Results: In all groups, there was a significant improvement (p < 0.05) in all variables over time, except pressure pain threshold. We observed significant differences (p < 0.05) between the groups for WOMAC function (exercise vs. exercise + placebo, mean difference [MD] = 5.55, 95% confidence interval [CI] = 3.63 to 7.46; exercise vs. exercise + ICT, MD = 3.40, 95% CI = 1.46 to 5.33; exercise vs. exercise + SDT, MD = 4.75, 95% CI = 1.85 to 7.64; exercise vs. exercise + PHOTO, MD = 5.45, 95% CI = 3.12 to 7.77) and WOMAC pain, with better scores achieved by the exercise group. However, these differences were not clinically relevant when considering the minimum clinically important difference., Conclusion: The addition of ICT, SDT or PHOTO into an exercise program for individuals with knee OA is not superior to exercise performed in isolation in terms of clinical benefit. clinicaltrials.gov: NCT02636764, registered on March 29, 2014.

Objective: To evaluate the efficacy and safety of short-wave therapy with sham or no intervention for the management of patients with knee osteoarthritis., Methods: We searched the following databases from their inception up to 26 October 2016: MEDLINE, CENTRAL, EMBASE, Physiotherapy Evidence Database, CINAHL and OpenGrey. Studies included randomized controlled trials compared with a sham or no intervention in patients with knee osteoarthritis. The results were calculated via standardized mean difference (SMD) and risk ratio for continuous variables outcomes as well as dichotomous variables, respectively. Heterogeneity was explored by the I 2 test and inverse-variance random effects analysis was applied to all studies., Results: Eight trials (542 patients) met the inclusion criteria. The effect of short-wave therapy on pain was found positive (SMD, -0.53; 95% CI, -0.84 to -0.21). The pain subgroup showed that patients received pulse modality achieved clinical improvement (SMD, -0.83; 95% CI, -1.14 to -0.52) and the pain scale in female patients decreased (SMD, -0.53; 95% CI, -0.98 to -0.08). In terms of extensor strength, short-wave therapy was superior to the control group ( p < 0.05, I 2  = 0%). There was no significant difference in the physical function (SMD, -0.16; 95% CI, -0.36 to 0.05). For adverse effects, there was no significant difference between the treatment and control group., Conclusion: Short-wave therapy is beneficial for relieving pain caused by knee osteoarthritis (the pulse modality seems superior to the continuous modality), and knee extensor muscle combining with isokinetic strength. Function is not improved.

Objective: To investigate the efficacy of intermittent and continuous traction in the treatment of knee osteoarthritis., Design: A randomized, controlled, observer-blind seven-week trial., Setting: Hospital-based outpatient practice., Subjects: Ninety-eight patients with stage 3 knee osteoarthritis according to Kellgren-Lawrence radiological rating scale., Interventions: All 98 patients were randomly assigned to three treatment groups, for three weeks (weekends excluded). The control group (n=30, mean age: 59.30±8.16) received hot pack and short wave diathermy; the intermittent group (n=30, mean age: 58.20±7.78) received hot pack, short wave diathermy and intermittent traction; and the continuous group (n=30, mean age: 57.97±9.53) received hot pack, short wave diathermy and continuous traction., Outcome Measurements: The values of the Turkish version of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale, and knee passive range of motion were measured at baseline, three-week and seven-week follow-up., Results: Compared with baseline at weeks 3 and 7, all the outcome measures, except range of motion, were significantly reduced in all groups (all P≤0.001). In terms of the change data from baseline to week 3, both traction groups were significantly superior to the control in the WOMAC physical function scores. Considering the change data from baseline to week 7, both traction groups were significantly superior to the control in the pain scores, physical function and total scores, while only the continuous group was significantly better than the control in the stiffness scores (control: 1.17 ± 1.64; continuous: 2.38 ± 1.44) (P=0.014). Compared with baseline at weeks 3 and 7, range of motion values significantly increased in both traction groups (P<0.05) but not in the control (P>0.05). However, there were no significant differences among the three groups considering the change data from baseline to week 7 in range of motion values (P=0.300)., Conclusions: Joint traction was found to be beneficial for the improvement of pain and physical function loss related to knee osteoarthritis.

The aim of this study is to observe the effect of different treatment time of millimeter wave (MMW) on chondrocyte apoptosis, caspase-3, caspase-8, and matrix metalloproteinase-13 (MMP-13) in rabbit knee osteoarthritis induced by anterior cruciate ligament transection (ACLT). Thirty-two New Zealand White rabbits were randomly assigned into 4 groups: millimeter wave treatment for 20-min group (MWT20); millimeter wave treatment for 40-min group (MWT40); model control group (MC) and normal control group (NC). All groups received anterior cruciate ligament transection in the right knee except NC group. Six weeks after transection, the MWT20 group and MWT40 group were given millimeter wave (MMW) at 37.5 GHz frequency, 8 mm wavelength, and 10 mW/cm(2) power for 20 and 40 min, respectively, for 10 days. Eight weeks after transection, all animals were killed. Modified Mankin Score was assessed for histological assessment. Chondrocytes apoptosis was tested by the TUNEL assessment, and the expressions of related proteins were tested by the immunohistochemistry observation and Western blot. The modified Mankin Score, the chondrocyte apoptosis, and the expression of caspase-3 and MMP-13 in MWT40 group were significantly lower than those in MC group. Only a decreasing trend of modified Mankin Score and caspase-3 and MMP-13 expression was found in MWT20 group. The caspase-8 expression of the treatment groups was lower than model control group and higher than normal control group, but no significant difference was found. This study revealed MWT40 had a better therapeutic benefit to osteoarthritis cartilage structure, decreased the apoptosis of chondrocyte, and caspase-3 and MMP-13 expression compared to MWT20. But only a decreasing trend of caspase-8 expression was found.

Background and Purpose: Shortwave (SW) diathermy can be used to improve vascular circulation and reduce inflammation and pain for patients with osteoarthritis. However, reduction in synovial inflammation has never been explored. The purpose of this study was to investigate whether repetitive SW diathermy, using ultrasonographic examination, could reduce synovitis in patients with knee osteoarthritis., Subjects and Methods: Thirty subjects with 44 osteoarthritic knees participated in this study. Eleven subjects received SW, and 10 subjects received SW and nonsteroidal anti-inflammatory drugs. Nine subjects received no treatment and served as a control group. Synovial sac thickness superior, medial, and lateral to the patella was measured using ultrasonography. The sum of these 3 measurements was taken as the total synovial sac thickness. Subjects in the treatment groups underwent ultrasonographic examination before and after 10, 20, and 30 treatments, whereas control subjects underwent ultrasonographic examination before the experiment and then once every 2 or 3 weeks for a total of 3 follow-up measurements., Results: After 10 SW diathermy treatments, the total synovial sac thickness in both treatment groups was significantly less than the initial thickness, and the synovial sac continued to become significantly thinner with 20 sessions of treatment. These observations were not made in the control subjects., Discussion and Conclusion: The results indicate that SW diathermy in patients with knee osteoarthritis can significantly reduce both synovial thickness and knee pain. Such reductions of synovial sac thickness and pain index continue over treatment sessions.