Department of Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
Department of Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
J Orthop Surg Res. 2024 Oct 26;19(1):689. doi: 10.1186/s13018-024-05120-0.
Knee osteoarthritis (KOA) is a common musculoskeletal disorder. Therapeutic ultrasound (US) is a safe and effective treatment for KOA. It relieves knee pain and enhances function. Metformin (MF) regulates chondrocytes, hence providing chondroprotection. Furthermore, it efficiently reduces knee articular cartilage degeneration and retards the progression of osteoarthritis. However, the localized administration of MF by phonophoresis for KOA has yet to be studied.
To assess the possible effects of metformin phonophoresis (MFPH) plus exercise therapy (EX) compared to MFPH alone or the US on knee pain, function, and range of motion (ROM) in chronic KOA patients.
Seventy-eight patients with unilateral mild to moderate chronic KOA were included. Patients were randomly assigned to three groups: group A (MFPH + EX), group B (MFPH alone), and group C (US). The US group used an acoustic-neutral gel, while the MFPH group used a gel containing 1.2% MF. The exercises included hamstring stretches, calf stretches, and knee strengthening exercises. Treatment in the three groups continued for four weeks (three sessions per week). The Visual Analog Scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the goniometer were used to assess knee pain, function disability, and ROM, respectively. All measures were recorded before, 2 weeks, and 4 weeks after the intervention in all groups. Multivariate Analysis of Variance (MNOVA) was performed to compare the effects within and between groups for knee ROM and function disability. The Kruskal-Wallis test and the Friedman test analyzed the pain intensity.
When the baseline patient characteristics were compared, there were no significant differences in means of age, gender, body mass index (BMI), or lower limb dominance across the three groups (p > 0.05). After 4 weeks of intervention, clinical outcomes significantly improved in all three groups (p < 0.05). However, patients in the MFPH + EX group improved significantly in all outcomes compared to the MFPH and US groups (p < 0.05).
Post-treatment results showed a statistically and clinically significant improvement in pain intensity, knee ROM, and function in the MFPH group; however, combining MFPH with exercises is more beneficial in reducing KOA symptoms.
Clinical Trial Registry at (pactr.samrc.ac.za) database. NO: PACTR202311507335269. Date: November 9, 2023 (retrospectively registered).
膝骨关节炎（KOA）是一种常见的肌肉骨骼疾病。治疗性超声波（US）是治疗 KOA 的一种安全有效的方法。它可以缓解膝关节疼痛并增强功能。二甲双胍（MF）调节软骨细胞，从而提供软骨保护。此外，它还能有效减少膝关节关节软骨退化，延缓骨关节炎的进展。然而，超声透药疗法（MFPH）局部应用于 KOA 尚未得到研究。
评估与单独使用 MFPH 或 US 相比，MFPH 加运动疗法（EX）对慢性 KOA 患者膝关节疼痛、功能和活动范围（ROM）的可能影响。
纳入 78 例单侧轻度至中度慢性 KOA 患者。患者被随机分为三组：A 组（MFPH+EX）、B 组（MFPH 单独使用）和 C 组（US）。US 组使用声学中性凝胶，MFPH 组使用含 1.2%MF 的凝胶。运动包括腘绳肌伸展、小腿伸展和膝关节强化运动。三组治疗均持续四周（每周三次）。视觉模拟评分（VAS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）和量角器分别用于评估膝关节疼痛、功能障碍和 ROM。所有措施均在干预前、2 周和 4 周后在所有组中记录。多变量方差分析（MNOVA）用于比较组内和组间膝关节 ROM 和功能障碍的效果。Kruskal-Wallis 检验和 Friedman 检验分析疼痛强度。
当比较三组患者的基线特征时，年龄、性别、体重指数（BMI）或下肢优势在三组之间无显著差异（p>0.05）。干预 4 周后，三组患者的临床结局均显著改善（p<0.05）。然而，与 MFPH 和 US 组相比，MFPH+EX 组在所有结局中均显著改善（p<0.05）。
治疗后结果显示，MFPH 组的疼痛强度、膝关节 ROM 和功能均有统计学和临床意义上的显著改善；然而，将 MFPH 与运动相结合更有利于减轻 KOA 症状。
Clinical Trial Registry at (pactr.samrc.ac.za) 数据库。注册号：PACTR202311507335269。日期：2023 年 11 月 9 日（追溯注册）。
