Rufus R. Noble -
Introduction
Osteoarthritis is by far the most frequent kind of arthritis. It is the most common reason for chronic pain in the musculoskeletal system and impairment among the older population 1., 22. Knee joint osteoarthritis accounts for 50% of Rheumatology-related disorders. Nearly all people who are over 60 suffer from degenerative changes to their joints. 70-85 percent of people with OA exhibit symptoms and signs such as pain and stiffness in the morning 33 – 5[3 – 5]. These difficulties with daily activities result in physical limitations, lower quality of life and constraints on social interaction, and restrictions on social activities 66. OA is predicted to be the fourth-leading reason for disability by 2020. According to the most recent bulletin from WHO, moderate to severe disabilities caused by osteoarthritis account for 10 million. Of the population in countries with high incomes and 33.5 million. Of those in countries with less income. In general, disability due to osteoarthritis impacts 43.4 million. Of the world’s population 4, 5, 7]. This identifies the social and medical importance of osteoarthritis 6., 77.
Chronic pain, as per many authors, persists for more than six months 2, 8[ 2, 8. In that sense, it is necessary to continue therapy 5, 9[ 5, 9]. It is required to employ non-invasive treatment techniques that have been proven effective in clinical studies. It also encourages research into new ways to treat the symptoms and improveimprove functional capacity.
Laser radiation with high intensity is a new application technique in physical therapy because of the different mechanisms of action, as compared to low-intensity radiation 1010 – 13[ 10 – 13]. It is typically used in the field of surgery to aid in the process of destroying tissues. Recently, a few research studies have been published regarding the effects of intense laser radiation on cell culture in vitro or laboratory animals. Several clinical trials exist for patients suffering from various disorders 1419 19[ 14-19].
Objective. The study aims to assess the efficacy of high-intensity light therapy for patients suffering from knee osteoarthritis.
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Material and Methods
With criteria. In this study, patients suffering from osteoarthritis of the knee (proven clinically) are included, along with the duration of symptoms lasting over four years and X-ray stage II and III identified by Kerllgren and Lawrence with no local application of corticosteroids or acid in the past six months, and without physical therapy during the past six months; or being treated with physiotherapy or medication longer than six months prior.
Excluding Criteria. Criteria for exclusion include reactive synovitis (CRP > 6 and ESR > 25mm.) and urine acid that is above normal limits; corticosteroid and Hyaluronic Acid application in the past six months; malignant tumors; comorbidity leading to the divergence of locomotion and statics or limitations to laser therapy; chronic inflammatory diseases; the refusal of the study based on personal reasons.
It is a single-blinded, controlled, placebo-controlled trial. The study protocol divides patients into two groups: the treatment and control groups. Patients are enrolled in either group based on the time they visit for examination. Each patient is placed as part of the control group. The patients in the control group receive an imitation of laser treatment controlling the laser device but not turning off the beam of light (sham laser). The patients in the treatment group receive high-intensity lasers.
2.1. Methods
Semiconductive neodymium light IV generated by BTL is utilized, with a wavelength of 1064 nanometers and a maximum power of 12W. The procedure is carried out through a single application of laser therapy every day for seven sessions.
The three initial procedures provide analgesic effects dosed at 12J/cm 2 = 300 J for a treated area of 25 cm 2. The laser therapy is applied to the lateral and medial parts of the knee, with a distant application for 2 minutes, with a frequency of 25 Hz. The subsequent four sessions utilize bio-stimulating parameters. These are applied with the dose of 120J/cm 2. equals 3000J treatment area 25 centimeters 2 located to the medial aspect of the knee. It takes 10 minutes.
In this study, laser radiation is used to analgesics parameters in two opposing fields because, in the knee joint’s osteoarthritis stages, all intraarticular and interarticular tissues participate in the process. Therefore, nociceptive signals are produced by various structures.
Biostimulation parameters were applied to the medial field since the medial part of the joint was affected. This is determined by anatomical factors such as axis load, Q-angle, and the rotation of the medial condyle in the knee during the final degrees of its range of motion.
The pain was measured using a standard visual analog scale. Dolorimetry was measured using the standard Fisher dolorimeter.
Pedobarometric assessments were conducted for dynamic and static gait analysis during the test and control group using foot scans RS, Belgium, with an active sensor surface of 975 x 325 mm, 16 384 sensors, and a length of the active surface of 2 meters.
Static measurements were taken when patients remained motionless on the platform. The data gathered was the highest pressure under the heel, measured in N/cm 2. A dynamic gait study was conducted to determine the impact surface area:(i)total the plantar area of both legs in centimeters 2;(ii)the maximum pressure applied to each foot’s heel in N/cm 2.
The measurements are directly calculated using the program. After that, an analysis of the changes in the dynamics between the two legs was conducted.
2.2. Statistical Analysis
All analyses were conducted by using Statistical Package SSPS (17 versions). The methods of descriptive statistics and parametric and nonparametric methods were employed.
