Comparison of the effectiveness of RSWT treatment in two different energy densities with combined physical therapy modalities in the patients with knee osteoarthritis.

ABSTRACT Objective: The aim of this study was to comparwith e the effectiveness of RSWT treatment in two different energy densities with combined physical therapy modalities and also with placebo in the patients with knee osteoarthritis. Materials and methods: 60 patients over 45 years of age who admitted to Inonu University Faculty of Medicine, Department of Physical Therapy and Rehabilitation outpatient clinics with the knee pain lasting 3 months, radiological grade of 2-3 according to Kellgren-Lawrens scale and diagnosed as 'Primary Knee Osteoarthritis' according to the American College of Rheumatology (ACR) criterias were included in the study. The study was designed as a prospective, randomized, double-blind, placebo-controlled trial. Patients were randomly divided into 4 groups of 15 people by using the closed envelope method. RSWT treatment was administered with BTL brand, 6000 SWT Topline model RSWT apparatus and equipment to the groups 1-3 once in a week for 4 weeks with different energy levels. For group 1; 0.11 mJ/mm2 RSWT (1.5 bar pressure and at 5-10 Hz, 3000 shock wave per week), group 2; 0.25 mJ/mm2 RSWT (3.5 bar pressure and at 5-10 Hz, 3000 shock wave per week), group 3; a total of fifteen sessions of combined physical therapy modalities for three weeks (hot pack + transcutaneous electrical nerve stimulation + ultrasound + strengthening exercises) and group 4; sham (fake) RSWT was applied. Patients were assessed using WOMAC score, Lequesne index and VAS scores at movement, at rest and at night before and 1, 4 and 8 weeks after therapy. Results: There was no statistically significant difference between groups in demographic assessment before treatment. A statistically significant reduction was observed in WOMAC, Lequesne and VAS scores of groups 1, 2 and 3 compared with baseline at 1st, 4th and 8th weeks (p <0.05). There was no statistically significant difference in group 4. Although more improvement was observed in group 2 compared to group 1, there was no statistically significant difference between the groups at the assessment made at the end of the 8th week. Conclusion: It's concluded that, RSWT treatment is an effective and usable as combined physical therapy for pain reduction and functional improvement in knee osteoarthritis and it can be added to the existing treatment in the future. Key words: Knee Osteoarthritis, RSWT, shock waves, WOMAC, Lequesne Index