Analysis of the effect of cryotherapy in thermographic images in individuals with knee osteoarthritis: randomized clinical trial

Abstract

Osteoarthritis (OA) is a major cause of disability in adults and seniors; it decreases quality of life, and is responsible for one-eighth of all restriction of daily living activities in patients with it. Among the weight-bearing joints, the knee is the most affected by OA. Knee Osteoarthritis (KOA) causes symptoms such as joint stiffness, pain, physical dysfunction, and this leads to a considerable impact in individuals quality of life. Currently, different treatment options are available for KOA. A combination of non-pharmacological treatments, which include patient education, exercise, lifestyle changes and physiotherapy, associated with pharmacological treatments are the best option. Cryotherapy, a non-pharmacological intervention widely used in muscle skeletal injuries to control pain symptoms, has also been used in KOA. However, there is still a lack of scientific evidence regarding its effects in KOA. Few studies have evaluated the analgesic effects and outcomes on quality of life of patients with KOA, after the use of cryotherapy isolated. In addition, systematic review studies point to a weak scientific evidence for the use of cryotherapy in KOA due to deficiencies in methodological design of most studies. Thus, the results of a randomized controlled clinical trial about the effects of cryotherapy in KOA might contribute to a better scientific basis for the role of cryotherapy in KOA. Objectives: To assess the effect of cryotherapy (ice bag shredded) around the knee of individuals with KOA in the pain control, function and quality of life of these individuals. Methodology: This is a randomized controlled clinical trial, double-blinded. Will participate in the study 54 patients with KOA, diagnosed with clinical and radiographic criteria of the American College of Rheumatology, of both sexes, aged between 40 and 65 years. The total number of subjects will be divided randomly into two groups of 27 subjects each. During four consecutive days, for a period of 20 min, each group will receive one type of intervention around the knee with OA: the cryotherapy group will receive an application of ice bags with compression and the placebo group will receive an application of sand bags with compression, the weight and volume of the sand bags will be similar to that used in cryotherapy. Every individual will have the following variables evaluated pre- and post-intervention: pain index (VAS), pressure pain threshold (Algometry)and temperature (Termography images). Aditional tools to complement study data will be used: Two physical function questionnaires (WOMAC, KOOS), one physical activity questionnaire (IPAQ) and two physical function tests (the 30s sitting and standing chair and the Timed Up and Go test). Thermographic images will also be obtained for further temperature analysis of the knee with OA. Data analysis: The normality of the data will be evaluated and parametric or non-parametric tests could be used. The comparison between the means of the dependent variables will be done. The independent study factors will be cryotherapy versus placebo and the factor of repeated measures pre- versus post-intervention. Possible correlations between the dependent interest variables of the study will also be evaluated. Keywords: Physiotherapy, Osteoarthritis, Ice therapy, Thermotherapy, Analgesia, Hypothermia, Knee. (AU)