ORIGINAL PAPER
Extracorporeal shock wave therapy versus dexamethasone iontophoresis as a treatment for symptomatic knee osteoarthritis
 
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1
Basic Science Department Faculty of Physical Therapy, Cairo University, Giza, Egypt
 
2
Basic Science Department Faculty of Physical Therapy, Galala University, Suez, Egypt
 
3
Department of Orthopaedic, Faculty of Physical Therapy, Nahda University, Banei Suief, Egypt
 
4
Department of Physiotherapy, Faculty of Allied Medical Sciences, Applied Science Private University, Amman, Jordan
 
5
Department of Neurology and Neurosurgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
 
6
Department of Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
 
7
Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
 
 
Submission date: 2024-05-08
 
 
Acceptance date: 2024-06-26
 
 
Publication date: 2024-12-23
 
 
Corresponding author
Sahar Ahmed Abdalbary   

Nahda University, Beni Suief, Egypt
 
 
Hum Mov. 2024;25(4):16-27
 
KEYWORDS
TOPICS
ABSTRACT
Purpose:
The goal of this pilot study was to compare and evaluate the efficacy of extracorporeal shock wave therapy (ESWT) and dexamethasone sodium phosphate (DEX-P) iontophoresis in patients who have unilateral symptomatic knee OA (KOA).

Methods:
Pre-post single-blind randomised experimental trial. The therapeutic program was performed twice per week for 4 weeks. Sixty patients with unilateral symptomatic KOA were randomly divided into three groups. Intensity of pain, pressure threshold for pain, knee function, and knee range of motion (ROM) were measured before and after therapy in all three groups.

Results:
The improvement in the shock wave group was significantly greater than the iontophoresis group.

Conclusions:
ESWT has a superior therapeutic effect in patients with symptomatic KOA.

REFERENCES (49)
1.
Bannuru RR , Schmid CH, Kent DM, Vaysbrot EE, Wong JB, McAlindon TE. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta- analysis. Ann Intern Med. 2015;162(1):46–54; doi: 10.7326/M14-1231.
 
2.
Alnahdi AH, Zeni JA, Snyder-Mackler L. Muscle impairments in patients with knee osteoarthritis. Sports Health. 2012;4(4):284–92; doi: 10.1177/ 1941738112445726.
 
3.
Bhatia D, Bejarano T, Novo M. Current interventions in the management of knee osteoarthritis. J Pharm Bioallied Sci. 2013;5(1):30–8; doi: 10.4103/ 0975-7406.106561.
 
4.
Choi YJ, Ra HJ. Patient satisfaction after total knee arthroplasty. Knee Surg Relat Res. 2016;28(1):1– 15; doi: 10.5792/ksrr.2016.28.1.1.
 
5.
Jevsevar DS. Treatment of osteoarthritis of the knee: Evidence-based guideline, 2nd edition. J Am Acad Orthop Surg. 2013;21(9):571–6; doi: 10.5435/ JAAOS-21-09-571.
 
6.
Manjhi J, Rawat B, Sinha A. Effect of Balsamodendron mukul gum resin extract on pain response in osteoarthritic rats. Asian J Pharm Clin Res. 2014;7(3):115–120.
 
7.
Gutthann SP, Rodríguez LAG, Raiford DS. Individual nonsteroidal antiinflammatory drugs and other risk factors for upper gastrointestinal bleeding and perforation. Epidemiology. 1997;8(1):18– 24; doi: 10.1097/00001648-199701000-00003.
 
8.
Bhandari M, Bannuru RR , Babins EM, Martel- Pelletier J, Khan M, Raynauld J-P, Frankovich R, Mcleod D, Devji T, Phillips M, Schemitsch EH, Pelletier J-P. Intra-articular hyaluronic acid in the treatment of knee osteoarthritis: a Canadian evidence-based perspective. Ther Adv Musculoskelet Dis. 2017;9(9):231–46; doi: 10.1177/17597 20X17729641.
 
9.
Nguyen C, Rannou F. The safety of intra-articular injections for the treatment of knee osteoarthritis: a critical narrative review. Expert Opin Drug Saf. 2017;16(8):897–902; doi: 10.1080/147 40338.2017.1344211.
 
10.
Zhang Q, Yue J, Sun Z, Lu Y. Acupuncture for chronic knee pain: a protocol for an updated systematic review. BMJ Open. 2016;6(2):e008027; doi: 10.1136/bmjopen-2015-008027.
 
11.
Huh JE, Seo B-K, Lee J-W, Park Y-C, Baek Y-H. Analgesic effects of diluted bee venom acupuncture mediated by -opioid and 2-adrenergic receptors in osteoarthritic rats. Altern Ther Health Med. 2018;24(2):28–35.
 
12.
Li A, Wei Z-J, Liu Y, Li B, Guo X, Feng S-Q. Moxibustion treatment for knee osteoarthritis a systematic review and meta-analysis. Medicine. 2016; 95(14):e3244; doi: 10.1097/MD.000000000000 3244.
 
13.
Vickers AJ, De Craen AJM. Why use placebos in clinical trials? A narrative review of the methodological literature. J Clin Epidemiol. 2000;53(2): 157–61; doi: 10.1016/S0895-4356(99)00139-0.
 
14.
Li JQ, Guo W, Sun Z-G, Huang Q-S, Lee EY, Wang Y, Yao X-D. Cupping therapy for treating knee osteoarthritis: the evidence from systematic review and meta-analysis. Complement Ther Clin Pract. 2017;28:152–60; doi: 10.1016/j.ctcp.2017. 06.003.
 
15.
Zhang Y, Huang L, Su Y, Zhan Z, Li Y, Lai X. The effects of traditional Chinese exercise in treating knee osteoarthritis: a systematic review and meta- analysis. PLOS ONE. 2017;12(1):e0170237; doi: 10.1371/journal.pone.0170237.
 
16.
Liao C-D, Tsauo J-Y, Liou T-H, Chen H-C, Huang S-W. Clinical efficacy of extracorporeal shockwave therapy for knee osteoarthritis: a systematic review and meta-regression of randomized controlled trials. Clin Rehabil. 2019; 33(9):1419–30; doi: 10.1177/0269215519846942.
 
17.
Huang, Z. Chen J, Ma J, Shen B, Pei F, Kraus VB. Effectiveness of low-level laser therapy in patients with knee osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2015; 23(9):1437–44; doi: 10.1016/j.joca.2015.04.005.
 
18.
Hou X-D, Liu H-B, Liu K-M. Effects of extracorporeal shock wave therapy on interleukin-1beta and matrix metalloproteinase-13 expression in rabbits with knee osteoarthritis. Chin J Tissue Eng Res. 2014;18(15):2397–2402; doi: 10.3969/j.issn. 2095-4344.2014.15.017.
 
19.
An S, Li J, Xie W, Yin N, Li Y, Hu Y. Extracorporeal shockwave treatment in knee osteoarthritis: therapeutic effects and possible mechanism. Biosci Rep. 2020;40(11):BSR20200926; doi: 10.1042/ BSR20200926.
 
20.
Cheng J-H, Wang C-J. Biological mechanism of shockwave in bone. Int J Surg. 2015;24(Pt B):143– 6; doi: 10.1016/j.ijsu.2015.06.059.
 
21.
Anderson CR, Morris RL, Boeh SD, Panus PC, Sembrowich WL. Effects of iontophoresis current magnitude and duration on dexamethasone deposition and localized drug retention. Phys Ther. 2003;83(2):161–70; doi: 10.1093/ptj/83.2.161.
 
22.
Wang C-J, Hsu S-L, Weng L-H, Sun Y-C, Wang F-S. Extracorporeal shockwave therapy shows a number of treatment related chondroprotective effect in osteoarthritis of the knee in rats. BMC Musculoskelet Disord. 2013;14:44; doi: 10.1186/ 1471-2474-14-44.
 
23.
Nirschl RP, Ashman ES. Elbow tendinopathy: tennis elbow. Clin Sports Med. 2003;22(4):813– 36; doi: 10.1016/S0278-5919(03)00051-6.
 
24.
Grossi E, Monza GC, Pollavini S, Bona L. NSAID ionisation in the management of soft-tissue rheumatism: role played by the drug, electrical stimulation and suggestion. Clin Exp Rheumatol. 1986; 4(3):265–7.
 
25.
Dakowicz A, Dzięcioł-Anikiej Z, Hryniewicz A, Judycka M, Ciołkiewicz M, Moskal-Jasińska D, Kuryliszyn-Moskal A. Evaluation of the effectiveness of iontophoresis with perskindol gel in patients with osteoarthritis of the knee joints. Int J Environ Res Public Health. 2022;19(14):8489; doi: 10.3390/ijerph19148489.
 
26.
Kim J-H, Kim J-Y, Choi C-M, Lee J-K, Kee H-S, Jung K-I, Yoon S-R. The dose-related effects of extracorporeal shock wave therapy for knee osteoarthritis. Ann Rehabil Med. 2015; 39(4):616- 23; doi: 10.5535/arm.2015.39.4.616.
 
27.
Yarrobino TE, Kalbfleisch JH, Ferslew KE, Panus PC. Lidocaine iontophoresis mediates analgesia in lateral epicondylalgia treatment. Physiother Res Int. 2006;11(3):152–60; doi: 10.1002/ pri.338.
 
28.
Creaby MW, Bennell KL, Hunt, MA. Gait differs between unilateral and bilateral knee osteoarthritis. Arch Phys Med Rehabil. 2012;93(5):822–7; doi: 10.1016/j.apmr.2011.11.029.
 
29.
Lizis P, Kobza W, Manko G. Extracorporeal shockwave therapy vs. kinesiotherapy for osteoarthritis of the knee: a pilot randomized controlled trial. J Back Musculoskelet Rehabil. 2017;30(5):1121–8; doi: 10.3233/BMR-169781.
 
30.
Joshi A, Stagni G, Cleary A, Patel K, Weiss DS, Hagins M. Iontophoresis successfully delivers dexamethasone sodium phosphate to dermis as measured by microdialysis. J Pharm Sci. 2014;103(1): 191–6; doi: 10.1002/jps.23771.
 
31.
Phipps JB, Padmanabhan RV, Lattin GA. Iontophoretic delivery model inorganic and drug ions. J Pharm Sci. 1989;78(5):365–9; doi: 10.1002/ jps.2600780505.
 
32.
Yamashita M, Yamashita M, Suzuki M, Hirai H, Kajigaya H. Iontophoretic delivery of calcium for experimental hydrofluoric acid burns. Crit Care Med. 2001;9(8):1575–8; doi: 10.1097/00003246- 200108000-00013.
 
33.
Clijsen R, Taeymans J, Baeyens, J, Barel AO, Clarys P. The effects of iontophoresis in the treatment of musculoskeletal disorders – a systematic review and meta-analysis. Drug Deliv Lett. 2012;2(3): 180–94; doi: 10.2174/2210304x11202030180.
 
34.
Paturi J, Kim HD, Chakraborty B, Friden PM, Banga AK. Transdermal and intradermal iontophoretic delivery of dexamethasone sodium phosphate: quantification of the drug localized in skin. J Drug Target. 2010;18(2):134–40; doi: 10.3109/ 10611860903278015.
 
35.
Nirschl RP, Rodin DM, Ochiai DH, Maartmann- -Moe C. Iontophoretic administration of dexamethasone sodium phosphate for acute epicondylitis: a randomized, double-blinded, placebo-controlled study. Am J Sports Med. 2003;31(2):189–95; doi: 10.1177/03635465030310020601.
 
36.
Perruccio AV, Lohmander LS, Canizares M, Tennant A, Hawker GA, Conaghan PG, Roos EM, Jordan JM, Maillefert J-F, Dougados M, Davis AM. The development of a short measure of physical function for knee OA KOOS-Physical Function Shortform (KOOS-PS) – an OARSI/OMERACT initiative. Osteoarthritis Cartilage. 2008; 16(5): 542–50.; doi: 10.1016/j.joca.2007.12.014.
 
37.
Cleffken B, van Breukelen G, Brink P, van Mameren H, Damink SO. Digital goniometric measurement of knee joint motion. Evaluation of usefulness for research settings and clinical practice. Knee. 2007);14(5):385–9; doi: 10.1016/j.knee.2007. 07.004.
 
38.
Armstrong RA. Recommendations for analysis of repeated-measures designs: testing and correcting for sphericity and use of manova and mixed model analysis. Ophthalmic Physiol Opt. 2017; 37(5):585–93; doi: 10.1111/opo.12399.
 
39.
Fields HL, Levine JD. Pain – mechanisms and management. West J Med. 1984;141(3):347–57; doi: 10.1136/jnnp.51.5.744.
 
40.
Melzack, R. From the gate to the neuromatrix. Pain. 1999;Suppl 6:121–6; doi: 10.1016/S0304- 3959(99)00145-1.
 
41.
Hildebrandt A, Dietrich T, Weber J, Günderoth MM, Zhou S, Fleckenstein FN, Jiang S, Winkler T, Duda GN, Tsitsilonis S, Keller J, Maleitzke T, The dual pro-inflammatory and bone-protective role of calcitonin gene-related peptide alpha in age-related osteoarthritis. Arthritis Res Ther. 2023; 25(1):244; doi: 10.1186/s13075-023-03215-3.
 
42.
Simplicio CL, Purita J, Murrell W, Santos GS, Dos Santos RG, Lana JFSD. Extracorporeal shock wave therapy mechanisms in musculoskeletal regenerative medicine. J Clin Orthop Trauma. 2020; 11(Suppl 3):309–18; doi: 10.1016/j.jcot.2020.02.004.
 
43.
Roerdink RL, Dietvorst M, Zwaard BVD, van der Worp H, Zwerver J. Complications of extracorporeal shockwave therapy in plantar fasciitis: aystematic review. Int J Surg. 2017;46:133–45 doi: 10.1016/j.ijsu.2017.08.587.
 
44.
Ioppolo, F. Saracino F, Rizzo RS, Monacelli G, Lanni D, Di Sante L, Cacchio A, Santilli V, Venditto T. Comparison between extracorporeal shock wave therapy and intra-articular hyaluronic acid injections in the treatment of first carpometacarpal joint osteoarthritis. Ann Rehabil Med. 2018;42(1): 92–100 doi: 10.5535/arm.2018.42.1.92.
 
45.
Schulz KF, Altman DC, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. J Pharmacol Pharmacother. 2010;1(2):100–7; doi: 10.4103/0976- 500X.72352.
 
46.
Altman RE, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M, Howell D, Kaplan D, Koopman W, Longley III S, Mankin H, McShane DJ, Medsger Jr. T, Meenan R, Mikkelsen W, Moskowitz R, Murphy W, Rothschild B, Segal M, Sokoloff L, Wolfe F. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis Rheum. 1986;29(8):1039–49; doi: 10.1002/art.1780290816.
 
47.
Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4): 494–502 doi: 10.1136/ard.16.4.494. [48] Imamura M, Alamino S, Hsing WT, Alfieri FM, Schmitz C, Battistella LR. Radial extracorporeal shock wave therapy for disabling pain due to severe primary knee osteoarthritis. J Rehabil Med. 2017; 49(1):54–62; doi: 10.2340/16501977-2148. [49] Li R. Sun P, Zhan Y, Xie X, Yan W, Luo C. Efficacy of leg swing versus quadriceps strengthening exercise among patients with knee osteoarthritis: study protocol for a randomized controlled trial. Trials. 2022;23(1):323; doi: 10.1186/s13063-022- 06282-0.
 
48.
Imamura M, Alamino S, Hsing WT, Alfieri FM, Schmitz C, Battistella LR. Radial extracorporeal shock wave therapy for disabling pain due to severe primary knee osteoarthritis. J Rehabil Med.2017; 49(1):54–62; doi: 10.2340/16501977-2148.
 
49.
Li R. Sun P, Zhan Y, Xie X, Yan W, Luo C. Efficacy of leg swing versus quadriceps strengthening exercise among patients with knee osteoarthritis: study protocol for a randomized controlled trial. Trials. 2022;23(1):323; doi: 10.1186/s13063-022-06282-0.
 
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