Effect of electrotherapy on pain, functional activity, and health-related quality of life of Nigerian individuals with knee osteoarthritis.
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Abstract Osteoarthritis (OA) of the knee is a chronic degenerative articular disease that causes pain, limits joint mobility and physical function and reduces quality of life. Electrotherapeutic modalities such as interferential current (IFC) and therapeutic ultrasound (US) are used in the management of chronic pain and reduced physical activity in individuals with knee OA. It is not clear whether simultaneous application of these physical agents as a combination therapy (CT) would improve pain, physical activity and health-related quality of life (HRQoL) of individuals with knee OA. Objective: This study aimed to determine the effects of CT, IFC, and US on pain, functional activity and HRQoL of individuals with knee osteoarthritis in Nigeria. Participants: Participants diagnosed with knee osteoarthritis according to the American College of Rheumatology, attending the Physiotherapy Outpatient Units of Rasheed Shekoni Specialist Hospital (RSSH), the Federal Medical Centre (FMC), and Dutse General Hospital were recruited for the study. A total of 133 participants, with ages ranging between 58 and 82 years (mean = 66.19 ± 8.50 years) and out of which 53 (40%) were male and 80 (60%) were female (median = 56 years), participated in the study. Methods: This is a multi-center randomized controlled study. The participants were randomly assigned to 4 groups: US (n = 34), IFC (n=34), CT (n=33), and control (n=32). Each group had 3 treatment sessions per week for 12 weeks. Participants in the control group received heat therapy using infrared radiation (IRR). The visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, Short Form-36 Health Survey (SF-36) questionnaire, and goniometer were used to assess pain severity, functional activity, HRQoL and knee range of motion (ROM) respectively. All measurements were taken and recorded at baseline and post-treatment. Main outcome measures: The primary outcome measures were pain, functional activity, and health-related quality of life, with active and passive knee range of motion being secondary outcomes. The variables were analyzed using one-way ANOVA, and independent and dependent sample t-test using the Statistical Package for the Social Sciences. Results: At baseline, there were no significant differences (p<0.05) between all the groups on the primary (pain, physical function and HRQoL), and secondary (ROM) outcomes. One-way between-subjects ANOVA was conducted to compare the post-intervention effects of the electrotherapy combination (US & IFC) therapy with the control group on pain, functional ii activity, and HRQoL. There were significant differences in the pain severity, physical function, and HRQoL scores (p<0.05) of participant in the electrotherapy (US, IFC & CT) groups compared to the control group. Post-hoc comparisons using the Tukey HSD test indicated that the mean scores of the electrotherapy groups differed significantly from the control group. However, comparisons were made between the intervention (US, IFC & CT) groups post-treatment. There was no significant difference (p>0.05) between each of the intervention groups (US, IFC &CT) on pain, functional activity and HRQoL post-treatment. In terms of effects, no interventional group was superior to another among the experimental groups. Between-group comparison at follow-up (each group compared with the control group) showed significant improvement in measures of pain severity, improved physical activity and quality of life in each group. Changes in secondary outcomes, over time, were statistically significant (p<0.05) in the experimental groups (US, IFC, & CT). There were increases in knee range of motion, both active and passive. No differences were observed in knee range of motion, both active and passive, in the control group (P >0.05). Conclusion: The use of electrotherapy modalities ‒ CT (US & IFC), US and IFC ‒ was beneficial as they elicited improvement in pain severity, functional activity and HRQoL in individuals with knee osteoarthritis, but none of the modalities proved to be more effective than the others.