Clin Rehabil , 269215520903786 2020 Feb 17
Patrícia Pereira Alfredo
Abstract
Objectives: To compare the effects of continuous and pulsed therapeutic ultrasound combined with strengthening exercises.
Design: This is a double-blind randomized controlled trial.
Setting: Pontifical Catholic University.
Subjects: One hundred participants with Grade 2-4 knee osteoarthritis and both genders were involved.
Intervention: Participants were randomized into five groups: Group I (n = 20; in the first month, continuous ultrasound was applied), Group II (n = 20; in the first month, pulsed ultrasound was applied), Group III (n = 20; in the first and second months, continuous ultrasound was applied), Group IV (n = 20; in the first and second months, pulsed ultrasound was applied) and Group V (n = 20; patients received only exercise sessions for eight weeks). All patients in the groups that received ultrasound application performed exercises in the second month of treatment. The sessions occurred three times a week.
Main measures: Pain was assessed using the visual analogical scale, functionality was assessed using the Lequesne questionnaire, range of motion was assessed using a universal goniometer, muscular strength was assessed using a dynamometer, mobility was assessed using the Timed Up and Go test and 8-meter walk test and the activity level was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire.
Results: Statistically significant differences (P < 0.05) were presented by Group III in the variables pain during activities of daily living (ADLs) 5.89 (2.18), mobility assessed by 8-meter test 2.68 (2.56), in pain 10.65 (4.40), function 25.50 (10.87) and total 38.65 (15.29) of WOMAC and functionality 9.10 (5.15).
Conclusion: Prolonged applications of continuous ultrasound combined with exercises are effective in providing pain, mobility, functionality and activity in subjects with knee osteoarthritis.
Ultrasound Parameters
The continuous ultrasound parameters are as follows: a frequency of 1MHz, an intensity of 1.5W/cm2 (spatial average, temporal average (SATA)), a duty cycle of 100% and an application time of 5 minutes on the medial side and 5 minutes on the lateral side of the knee. The pulsed ultrasound parameters are as follows: a frequency of 1MHz, an intensity of 2.5W/cm2 (SATA), a pulsed mode of 25% and an application time of 5minutes on the medial side and 5minutes on the lateral side of the knee.
All patients followed the same training program. The intervention was divided into three phases: Phase 1, Phase 2 and Phase 3; the total duration of the intervention was eight weeks, and there were three sessions per week. Each session
lasted 45 minutes:
- 10minutes for a warm-up (treadmill, ergometer bike or rowing machine);
- 30minutes for two to three sets of P-1, P-2 or P-3 exercises;
- 5minutes for stretching exercises (hamstrings, quadriceps, adductors and gastrocnemius).
Exercises
Phase 1 (week 5) – Each exercise had 30 repetitions and two sets:
Objectives: Range of motion, Motor learning, Balance, Coordination
• Sitting on the chair with a weight on the ankle, knee and stretch the foot to rotate alternately in and out then change legs.
• Lying prone. Bend the knee slowly as much as possible. Stretch the knee slowly.
• Standing with support. Bend the knees to approximately 60°. Push up again.
• Walk on a 3-m line without stepping beside the line.
• Walk-standing. Transfer your body weight from one leg to the other.
Phase 2 (week 6–7) – Each exercise had 20 repetitions and three sets:
Objective: Strengthening
• Standing. Bend your knees to approximately 60° and push up again.
• Walk sideward by crossing legs. To right and left.
• Standing on a balance board. Hold the balance.
• Lying prone. Bend one knee as much as possible.
• One foot-standing on a step. Bend your knee until the other foot touches the floor, push up again.
Phase 3 (week 8) – Each exercise had 20 repetitions and three sets:
Objective: Strengthening
• Walk sideward by crossing steps. To right and left.• Standing on one leg. Bend the knee to approximately 60° and push up again.
• Standing on a balance board. Keep the balance. More difficult if eyes are closed.
• Standing on the floor. Get up on your toes, hold 1–2 seconds and get down again
• Sitting with weight around the ankle. Stretch the knee slowly, hold the stretch 3–4 seconds, and slowly down again.