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Our previous study has demonstrated that 6 weeks of Tai Chi exercise significantly improves knee pain and stiffness in elderly with knee osteoarthritis. This study also examine the effects of Tai Chi exercise on gait kinematics, physical function, pain, and pain self-efficacy in elderly with knee osteoarthritis. In this prospective, pretest-posttest clinical trial, 40 men and women (64.4 ± 8.3 years) diagnosed with knee osteoarthritis participated in 6 weeks of instructed Tai Chi training, 1 hour/session, 2 sessions/week. The following measures were taken at baseline and the conclusion of the intervention: (a) gait kinematics including stride length, stride frequency, and gait speed quantified using video analysis, (b) physical function, (c) knee pain, and (d) pain self-efficacy. Data were analyzed using repeated MANCOVA, MANOVA, ANOVA and Wilcoxon tests. After 6 weeks of Tai Chi exercise, stride length (p = 0.023; 1.17 ± 0.17 vs. 1.20 ± 0.14 m), stride frequency (p = 0.014; 0.91 ± 0.08 vs. 0.93 ± 0.08 strides/s), and consequently gait speed (p < 0.025; 1.06 ± 0.19 vs. 1.12 ± 0.15 m/s) increased in the participants. Physical function was significantly improved (p < 0.001) and knee pain was significantly decreased (p = 0.002), while no change was observed in pain self-efficacy. In conclusion, these findings support that Tai Chi is beneficial for gait kinematics in elderly with knee osteoarthritis, and a longer term application is needed to substantiate the effect of Tai Chi as an alternative exercise in management of knee osteoarthritis.

Objective: To assess effect of physical therapy including both physical agents and exercise on pain, physical functioning and quality of life in patients with knee osteoarthritis.

Methods: Twenty-seven patients (25 female and two male) with knee osteoarthritis were included in the study. Besides sociodemographic variables, presence of chronic diseases, analgesic use, recreational activites were recorded. A standard knee examination was performed and anteroposterior and lateral knee radiographs were obtained. Pain was measured using visual analogue scale (VAS), numeric scale and Likert scale. Pain, stiffness and physical function was assessed using Likert-scaled version of the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC). For quality of life evaluation Medical Outcomes Study Short Form 36 (SF-36) was utilized. Evaluations were done at baseline and 1 month after completion of physical therapy sessions.

Results: Significant reduction of pain measurements namely VAS, numeric scale and Likert scale was observed as a result of physical treatment (p = 0.0001, p = 0.0001 and p = 0.001 respectively). In all 3 subscores of WOMAC (pain, stiffness and physical function) significant improvement was noted due to treatment (p = 0.0001, p = 0.012 and p = 0.0001 respectively). Similarly, physical functioning, role-physical, bodily pain and vitality and social functioning subscores demonstrated significant reductions after therapy. (p = 0.039, p = 0.001, p = 0.0001, p = 0.001 and p = 0.035 respectively).

Conclusion: Physical therapy including both physical agents and exercise leads to signifcant improvements in pain, physical functioning and quality of life. This change was demonstrated by both generic and disease specific outcome measures.

Objective: To clarify the pathophysiology of knee arthropathy, articular sound in the knee joint was recorded using an accelerometer, vibroarthrography (VAG), during standing-up and sitting-down movements in patients with osteoarthropathy (OA) of the knees. Methods: VAG signals and angular changes of the knee joint during standing-up and sitting-down movements were recorded in patients with OA, including 17 knees with OA at Kellgren–Lawrence stage I and II, 16 knees with OA at III and IV stages, and 20 knees of age-matched control subjects. Results: The level of VAG signals was greater in knees with a higher stage of OA at 50–99 and 100–149 Hz among the groups (ANOVA with Tukey–Kramer multiple comparisons test, p < 0.01). The VAG signals did not correlate with WOMAC-pain or physical scores. Conclusions: We considered that the increase in VAG signals in these ranges of frequency corresponded with pathological changes of OA, but not self-reported clinical symptoms. This method of VAG can be used by clinicians during interventions to obtain pathological information regarding structural changes of the knee joint.

Background: Ankle proprioception may be affected in knee Osteoarthritis (OA), but there is a lack of evidence showing changes in ankle proprioception within the grades of severity of knee OA.

Objective: To assess ankle proprioception in patients with knee OA and find its change within the grades of severity of knee OA knee based on the Kellgren and Lawrence (KL) classification. A secondary aim was to see the association between ankle proprioception and functional status.

Methodology: It was a cross-sectional study. Sixty-three patients with knee OA were included in the study. X-rays of the patients were interpreted according to KL classification system to grade the severity of knee OA by an experienced orthopedic surgeon. Ankle joint reposition sense (reposition error) was measured using the active to active method with the Saunders digital inclinometer. The assessor was blinded to the grades of the knee OA. The functional status was evaluated using the WOMAC scale.

Results: The mean joint reposition error was 2.68 ± 1.80 (0.33-8.33), and WOMAC scores were 45.99 ± 11.67 (30.2–84.37). The WOMAC scores were significant ($p$ = 0.005) but not the joint reposition error ($p$ = 0.14) with the increasing severity of knee OA. When compared within the grades of severity, both were not significant. The correlation between WOMAC scores and joint reposition error scores was $r$ = 0.16 and $p$ = 0.22.

Conclusion: The joint reposition error did not vary with the severity of knee OA within the grades. It was also not found to be associated with the functional status of knee

Background: The role of prolotherapy in the healing process of damaged tissues has been confirmed in patients with degenerative joint disease. Hypertonic dextrose has been introduced as the most common solution in prolotherapy for reducing pain and improving mobility in people with knee osteoarthritis (KOA). This study aimed to compare the KOA patients undergoing hypertonic dextrose prolotherapy (DPT) with the placebo in terms of pain intensity and functional level.

Methods: This triple-blind study randomized clinical trial (RCT) was conducted on patients with mild to moderate KOA who were referred to the Rheumatic Diseases Research Center (RDRC), Mashhad University of Medical Sciences, Mashhad, Iran, in the year 2021. Patients were randomly assigned to two groups of the DPT ($n$ = 47) and normal saline placebo prolotherapy ($n$ = 50) intra- and peri-articular knee joints. Treatment was monthly for three months. Western Ontario and McMaster Universities’ Arthritis Index (WOMAC) and Anterior Knee Pain Scale (AKPS) were completed before and after intervention (weeks 0, 4, 8, 12, and 16). The variables were compared between the two study groups at a significance level of less than 0.05 ($P$ < 0.05).

Results: The WOMAC score improved significantly compared to the baseline in both groups ($P$ < 0.005). An increase in WOMAC score (the last follow-up compared to baseline) was 97.4% and 85.7% in DPT and placebo groups, respectively ($P$= 0.06). Before the intervention and also after the first injection, the AKPS score in the normal saline group was significantly better than the dextrose group ($P$= 0.03). The AKPS score did not differ significantly between the two groups ($P$ > 0.05) in the next two visits and two-month follow-ups. Improvement of AKPS score in the last follow-up compared to baseline was reported in 66.7% and 68.4% of patients in the normal saline group and dextrose group, respectively, ($P$= 0.86).

Conclusion: Prolotherapy as intra- and peri-articular injections of hypertonic dextrose could be used to relieve pain and improve functional status in patients with mild to moderate KOA as much as a placebo does. Although no remarkable difference was observed between dextrose and placebo in the outcomes, the rate of improvement (last follow-up compared to the baseline) was relatively higher in the dextrose group than in the normal saline group.