Ogura Dantas L.1, Carreira Breda C.1, Regina Mendes Silva Serrão P.1, Fatima Salvini T.1
1Federal University of São Carlos - UFSCar, Physical Therapy Department, São Carlos, Brazil
Background: Efforts have been made to retard the progressive debilitating pain and improve the quality of life in patients with knee osteoarthritis (KOA). Cryotherapy, a non-pharmacological intervention is widely used in skeletal muscles injuries to control painful symptoms, has also been used in patients with KOA. Some studies have evaluated cryotherapy effects associated or compared with other therapies in patients with KOA. However, there is still a lack of scientific evidence in relation to its isolated effects on the disease.
Purpose: To evaluate the isolated effects of cryotherapy on pain in subjects with KOA. Moreover, the secondary outcomes evaluated were function and quality of life.
Methods: Throughout a randomized controlled clinical trial, 17 males and 15 females, aged between 40-75 years old, with symptomatic and radiographic KOA (Visual Analogue Scale -VAS- ≥ 4; Kellgren and Lawrence grades 2 and 3) were allocated to a cryotherapy (n =14) or placebo (n=18) groups, and assessed pre- and post- interventions. The interventions involved the application of cryotherapy (crushed ice packs) or placebo therapy (sand packs) once a day (20 min) for four consecutive days. The VAS was the primary outcome and the secondary outcomes were Western Ontario & McMaster Universities Osteoarthritis (WOMAC), Timed Up and Go test (TUG) and 30 second chair stand test. All data were analyzed using SPSS software and Intention to Treat analysis was performed. The Kolmogorov-Smirnov test was used to assess the normality of the data and after, a two-way ANOVA with mixed-model design was the parametric test chosen to compare the mean of the dependent variables, considering two factors simultaneously, one from repeated measures (pre and post intervention) and other from independent samples (cryotherapy and placebo). Post hoc analyses of identified main effects were examined with a Bonferroni correction of α =.017.
Results: Both cryotherapy and placebo groups improved the primary and secondary outcomes when pre and post-interventions were compared. Furthermore, no significant group versus evaluation time interactions were found on VAS (F=0.012, P=0.912), total WOMAC (F=1.118, P=0.299), TUG (F=0.033, P=0.857) and 30 second chair stand test (F=3.098, P=0.089). There was a main effect of evaluation time for VAS (F=158.43, P 0.001), total WOMAC (F= 96.14, P 0.001), TUG (F=12.02, P=0.002) and for 30 second stand test (F=63.51, P=0.001). However, there was no group effect for VAS (F=2.42, P=0.13), total WOMAC (F=0.83, P=0.36), TUG (F=5.9, P=0.02) and for 30 second stand test (F=1.59, P=0.21).
Conclusion(s): The short-term use of isolated cryotherapy relieves pain, improves function and quality of life in subjects with knee osteoarthritis. Cryotherapy can be considered as a conservative and non pharmacological complementary treatment for the pain control in these individuals.
ClinicalTrials.gov (NCT02725047).
Implications: Our results indicate a better understanding about the effectiveness of cryotherapy in subjects with symptomatic and radiographic knee osteoarthritis.
Funding acknowledgements: Grants #2011/22122-5 and #2015/21422-6, São Paulo Research Foundation (FAPESP)
Topic: Rheumatology
Ethics approval: Ethics Committee on Human Research from Federal University of São Carlos (Process: 126614/2015)
All authors, affiliations and abstracts have been published as submitted.
