ABSTRACT
BACKGROUND AND OBJECTIVES:
Osteoarthritis is an inflammatory and degenerative joint disease, causing pain, musculoskeletal disorders and impact on functionality, daily life activities and quality of life. The action of physical agents by means of deep heating seems to be an alternative to treat such disease. This study aimed at verifying the effects of deep heating on osteoarthritis patients.
CONTENTS:
A systematic review was carried out in Medline, Scielo and LILACS databases as from keywords "Osteoarthritis", "Induced Hyperthermia", "Physiotherapy" and "Ultrasound", and other keywords such as "Deep heat", "Microwaves" and Short-waves", in Portuguese, English and Spanish, in the period from January 2005 to January 2016, and 986 articles were found. Initially, 16 potentially relevant articles were selected for the study and, after a judicious qualitative analysis, nine complete articles meeting inclusion criteria were selected.
CONCLUSION:
Physical deep heating physical agents (ultrasound, short-waves diathermy and microwaves) were beneficial to manage pain and other variables in individuals with osteoarthritis in different levels of severity, especially in the long term. However, these effects are better observed when applied simultaneously with kinesiotherapy.
Keywords:
Induced hyperthermia; Osteoarthritis; Pain; Physiotherapy; Ultrasound
RESUMO
JUSTIFICATIVA E OBJETIVOS:
A osteoartrite é uma doença articular inflamatória e degenerativa, que provoca dor, agravos osteoarticulares e impacto na funcionalidade, nas atividades de vida diária e na qualidade de vida. A ação de agentes físicos por meio do calor profundo parece ser uma alternativa no tratamento dessa doença. O objetivo deste estudo foi verificar os efeitos do calor profundo em indivíduos com osteoartrite.
CONTEÚDO:
Realizou-se uma revisão sistemática nas bases de dados Medline, Scielo e LILACS, a partir dos descritores "Osteoartrite", "Hipertermia Induzida", "Fisioterapia" e "Ultrassom" e outras palavras-chaves como "Calor profundo", "Micro-ondas" e "Ondas curtas", nas línguas portuguesa, inglesa e espanhola, no período de janeiro de 2005 a janeiro de 2016. Encontraram-se 986 artigos. Inicialmente, 16 artigos potencialmente relevantes foram selecionados para o estudo, e, após uma análise qualitativa criteriosa, selecionaram-se 9 artigos completos que preencheram os critérios de inclusão exigidos.
CONCLUSÃO:
Os agentes físicos em forma de calor profundo (ultrassom, diatermia por ondas curtas e micro-ondas) ofertam benefícios no manuseio da dor e outras variáveis em indivíduos com osteoartrite em diferentes graus de acometimento, especialmente no longo prazo. Contudo, esses efeitos são mais bem observados quando aplicados em concomitância à cinesioterapia.
Descritores:
Dor; Fisioterapia; Hipertermia induzida; Osteoa rtrite; Ultrassom
INTRODUCTION
Osteoarthritis (OA) is a degenerative inflammatory joint disease resulting from chondrocytes and synoviocytes-mediated responses, in addition to presenting higher serum and synovial inflammatory cytokine levels as compared to individuals not affected by the disease11 Sohn DH, Sokolove J, Sharpe O, Erhart JC, Chandra PE, Lahey LJ, et al. Plasma proteins present in osteoarthritic synovial fluid can stimulate cytokine production via Toll-like receptor 4. Arthritis Res Ther. 2012;14(1):7.
2 Wibelinger LM, Batista JS, Vidmar MF, Kayser B, Pasqualotti A, Schneider RH. Efeitos da fisioterapia convencional e da wiiterapia na dor e capacidade funcional de mulheres idosas com osteoartrite de joelho. Rev Dor. 2013;14(3):196-9.-33 Duarte VS, Santos ML, Rodrigues KA, Ramires JB, Arêas GP, Borges GF. Exercícios físicos e osteoartrose: uma revisão sistemática. Fisioter Mov. 2013;26(1):193-202..
OA is multifactorial and involves changes in osteoarticular alignment causing joint instability44 Coelho Cde F, Leal-Junior EC, Biasotto-Gonzalez DA, Bley AS, de Carvalho Pde T, Politti F, et al. Effectiveness of phototherapy incorporated into an exercise program for osteoarthritis of the knee: study protocol for a randomized controlled trial. Trials. 2014;15:221.. This is the most common form of arthritis, being considered one of the ten more disabling diseases in developed countries and one of the most prevalent rheumatic diseases among the elderly55 Cunha-Miranda L, Faustino A, Alves C, Vicente V, Barbosa S. Avaliação da magnitude da desvantagem da osteoartrite na vida das pessoas: estudo MOVES. Rev Bras Reumatol. 2015;55(1):22-30.
6 Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. Lancet. 2011;377(9783):2115-26.-77 Guermazi A, Niu J, Hayashi D, Roemer FW, Englund M, Neogi T, et al. Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study). BMJ. 2012;345:e5339..
Although able to affect any body region, it preferably affects joints supporting major weight loads and requiring frequent use, such as the knees33 Duarte VS, Santos ML, Rodrigues KA, Ramires JB, Arêas GP, Borges GF. Exercícios físicos e osteoartrose: uma revisão sistemática. Fisioter Mov. 2013;26(1):193-202.. Clinical results show increased joint volume due to synovitis caused by synovial effusion or thickening, pain at rest, morning stiffness, deformities, instabilities, movements limitation, incapacity and muscle weakness88 Rezend MU, Campos GC. Is osteoarthritis a mechanical or inflammatory disease? Rev Bras Ortop. 2013;48(6):471-4.
9 Fellet A, Fellet AJ, Fellet L. Osteoartrose: uma revisão. Rev Bras Med. 2007;64(1):55-61.-1010 Akyol Y, Durmus D, Alayli G, Tander B, Bek Y, Canturk F, et al. Does short-wave diathermy increase the effectiveness of isokinetic exercise on pain, function, knee muscle strength, quality of life, and depression in the patients with knee osteoarthritis? A randomized controlled clinical study. Eur J Phys Rehabil Med. 2010;46(3):325-36.. Pain intensity may vary from no pain to individuals' immobilization and physical incapacity22 Wibelinger LM, Batista JS, Vidmar MF, Kayser B, Pasqualotti A, Schneider RH. Efeitos da fisioterapia convencional e da wiiterapia na dor e capacidade funcional de mulheres idosas com osteoartrite de joelho. Rev Dor. 2013;14(3):196-9..
In this sense, physiotherapy attempts to attenuate OAinduced injuries and adverse effects of drugs1111 Johnsen SP, Larsson H, Tarrone RE, McLaughlin JK, Friis S, Sorensen HT, et al. Risk of hospitalization for myocardial infarction among users of refecoxib, celecoxib, and other NSAIDs: a population-based case-control study. Arch Intern Med. 2005;165(9):978-84.. In addition to kinesiotherapy, some physical resources, such as deep heating involving tools such as ultrasound (US), short-waves diathermia (SWD) and microwaves (MW), have been used with analgesic and anti-inflammatory action1212 Ovanessian V, Cazarini Júnior C, Cunha RA, Carvalho NA, Fukuda TY. Use of different doses of pulsed short waves in the treatment of patients with osteoarthritis of the knee. Rev Cienc Med Campinas. 2008;17(3-6):149-55.,1313 Rabini A, Piazzini DB, Tancredi G, Foti C, Milano G, Ronconi G, et al. Deep heating therapy via microwave diathermy relieves pain and improves physical function in patients with knee osteoarthritis: a double-blind randomized clinical trial. Eur J Phys Rehabil Med. 2012;48(4):549-59., and have shown good results with regard to pain and functionality of OA patients1313 Rabini A, Piazzini DB, Tancredi G, Foti C, Milano G, Ronconi G, et al. Deep heating therapy via microwave diathermy relieves pain and improves physical function in patients with knee osteoarthritis: a double-blind randomized clinical trial. Eur J Phys Rehabil Med. 2012;48(4):549-59..
This study aimed at reviewing in the literature sources documenting the effects of deep heating on pain management of OA individuals.
CONTENTS
A systematic search was carried out looking for articles published in journals indexed in Medline, Scielo and LILACS databases. Descriptors used for search were according to Health Science Descriptors, as from the primary descriptor "osteoarthritis" crossed with secondary descriptors such as "induced hyperthermia", "physiotherapy" and "ultrasound". In addition, the following keywords were used: "deep heating", "microwaves" and "short waves". A search was also carried out with variations of these words in Portuguese and Spanish.
Included in the study were randomized clinical trials; studies carried out exclusively with humans; studies with pain evaluation as outcome, being or not followed by other variables, such as mobility, joint movement amplitude, muscle strength, gait velocity, functionality, incapacity and/or quality of life; studies found in full and available for free; studies in Portuguese, English or Spanish; studies published between January 2005 and December 2015.
Exclusion criteria were unfinished studies, studies involving individuals submitted to some surgical procedures due to OA or those not complying with mentioned criteria.
Initially, titles and abstracts were identified and independently evaluated by a reviewer, to select those meeting eligibility criteria. Potentially relevant studies were kept for further analysis of the full text.
Table 1 shows the strategy for studies search and selection.
Among selected studies, four involved the use of SWD, four the use of US (continuous or pulsed) and one involved MW. Sample size of included studies has varied from 25 to 203 OA individuals, being that 100% had knee joint affected. Most samples were predominantly females and elderly. All studies had comparison between at least two groups.
Table 2 shows sample characterization of included studies. Table 3 shows used evaluative tools and intervention protocols, as well as outcomes found in included studies. Selected studies suggest a limitation of the subject proposed by this review, since in a period of tem years, just nine studies have contemplated the effects of deep heating on pain management of OA patients, according to required criteria. It is possible to observe that scientific interest on the subject seems to be recent, because seven studies were carried out in the last five years.
Sample characterization of recruited studies on deep heating effects for osteoarthritis pain management
Evaluative tools, intervention protocols and outcomes of studies on the effect of deep heating on osteioarthritis pain management
However, included studies have shown that heating tools are beneficial for pain management of OA patients. Although they do not stand out with regard to conventional kinesiotherapy, they may complement treatment when used simultaneously with physical exercises. Such measures were of major interest for managing OA-induced impacts and complications, especially with regard to pain.
DISCUSSION
OA is a disease causing more persistent musculoskeletal pain and may affect one out of five individuals, especially females and the elderly, causing chronic pain and incapacity especially on the knees55 Cunha-Miranda L, Faustino A, Alves C, Vicente V, Barbosa S. Avaliação da magnitude da desvantagem da osteoartrite na vida das pessoas: estudo MOVES. Rev Bras Reumatol. 2015;55(1):22-30.,2121 Marley J, Tully MA, Porter-Armstrong A, Bunting B, O'Hanlon J, McDonough SM. A systematic review of interventions aimed at increasing physical activity in adults with chronic musculoskeletal pain protocol. Syst Rev. 2014;3:106., which can be observed in selected studies, since in 100% of the reviewed content, samples had knee OA (levels from I to IV, with predominance of level III among studies), and in eight out of nine studies mean age was above 60 years, characterizing predominantly elderly samples.
Interaction of factors such as disease worsening, pain, associated comorbidities, psychological and social factors, decreased aerobic work and lower limbs muscle weakness are determining factors for physical incapacity in OA individuals1515 Silva AL, Imoto DM, Croci AT. Estudo comparativo entre a aplicação de crioterapia, cinesioterapia e ondas curtas no tratamento da osteoartrite de joelho. Acta Ortop Bras. 2007;15(4):204-9..
Functional impairment may negatively interfere with quality of life of these people, especially if they are old aged, females and symptomatic. OA knee pain prevalence is high (32.2% for males and 58.0% for females) which increases in up to five times the risk of poorer lower limbs function2222 Muraki S, Akune T, Oka H, En-yo Y, Yoshida M, Saika A, et al. Association of radiographic and symptomatic knee osteoarthritis with health-related quality of life in a populationbased cohort study in Japan: the ROAD study. Osteoarthr Cartil. 2010;18(9):1227-34.,2323 Kim IJ, Kim HA, Seo YI, Jung YO, Canção YW, Jeong JY, et al. Prevalence of knee pain and its influence on quality of life and physical function in the Korean elderly population: a community based cross-sectional study. J Korean Med Sci. 2011;26(9):1140-6..
Lequesne and WOMAC indices are specific and reliable tools for OA evaluation1515 Silva AL, Imoto DM, Croci AT. Estudo comparativo entre a aplicação de crioterapia, cinesioterapia e ondas curtas no tratamento da osteoartrite de joelho. Acta Ortop Bras. 2007;15(4):204-9.. It was observed that studies have used such protocols, being that five have used WOMAC index1010 Akyol Y, Durmus D, Alayli G, Tander B, Bek Y, Canturk F, et al. Does short-wave diathermy increase the effectiveness of isokinetic exercise on pain, function, knee muscle strength, quality of life, and depression in the patients with knee osteoarthritis? A randomized controlled clinical study. Eur J Phys Rehabil Med. 2010;46(3):325-36.,1313 Rabini A, Piazzini DB, Tancredi G, Foti C, Milano G, Ronconi G, et al. Deep heating therapy via microwave diathermy relieves pain and improves physical function in patients with knee osteoarthritis: a double-blind randomized clinical trial. Eur J Phys Rehabil Med. 2012;48(4):549-59.,1717 Carlos KP, Belli BS, Alfredo PP. Efeito do ultrassom pulsado e do ultrassom contínuo associado a exercícios em pacientes com osteoartrite de joelho: estudo piloto. Fisioter Pesqui. 2012;19(3):275-81.
18 Atamaz FC, Durmaz B, Baydar M, Demircioglu OY, Iyiyapici A, Kuran B, et al. Comparison of the efficacy of transcutaneous electrical nerve stimulation, interferential currents, and shortwave diathermy in knee osteoarthritis: a double-blind, randomized, controlled, multicenter study. Arch Phys Med Rehabil. 2012;93(5):748-56.-1919 Mascarin NC, Vancini RL, Andrade ML, Magalhães EP, Lira CA, Coimbra IB. Effects of kinesiotherapy, ultrasound and electrotherapy in management of bilateral knee osteoarthritis: prospective clinical trial. BMC Musculoskelet Disord. 2012;22(13):182., three have used Lequesne index1515 Silva AL, Imoto DM, Croci AT. Estudo comparativo entre a aplicação de crioterapia, cinesioterapia e ondas curtas no tratamento da osteoartrite de joelho. Acta Ortop Bras. 2007;15(4):204-9.,1717 Carlos KP, Belli BS, Alfredo PP. Efeito do ultrassom pulsado e do ultrassom contínuo associado a exercícios em pacientes com osteoartrite de joelho: estudo piloto. Fisioter Pesqui. 2012;19(3):275-81.,2020 Chen TW, Lin CW, Lee CL, Chen CH, Chen YJ, Lin TY, et al. The efficacy of shock wave therapy in patients with knee osteoarthritis and popliteal cyamella. Kaohsiung J Med Sci. 2014;30(7):362-70. and one has used the KOOS questionnaire, a scale of 11 questions to evaluate pain and functionality1616 Fukuda TY, Alves da Cunha R, Fukuda VO, Rienzo FA, Cazarini C Jr, Carvalho Nde A, et al. Pulsed shortwave treatment in women with knee osteoarthritis: a multicenter, randomized, placebo-controlled clinical trial. Phys Ther. 2011;91(7):1009-17..
In this sense, induced hyperthermia seems to be a strategy to manage OA pain since it is a conservative, low cost and noninvasive therapy2424 Takahashi KA, Tonomura H, Arai Y, Terauchi R, Honjo K, Hiraoka N, et al. Hyperthermia for the treatment of articular cartilage with osteoarthritis. Int J Hipertermia. 2009;25(8):661-7., which has led to the choice of this therapy as the target of our study.
Four recruited studies1010 Akyol Y, Durmus D, Alayli G, Tander B, Bek Y, Canturk F, et al. Does short-wave diathermy increase the effectiveness of isokinetic exercise on pain, function, knee muscle strength, quality of life, and depression in the patients with knee osteoarthritis? A randomized controlled clinical study. Eur J Phys Rehabil Med. 2010;46(3):325-36.,1515 Silva AL, Imoto DM, Croci AT. Estudo comparativo entre a aplicação de crioterapia, cinesioterapia e ondas curtas no tratamento da osteoartrite de joelho. Acta Ortop Bras. 2007;15(4):204-9.,1717 Carlos KP, Belli BS, Alfredo PP. Efeito do ultrassom pulsado e do ultrassom contínuo associado a exercícios em pacientes com osteoartrite de joelho: estudo piloto. Fisioter Pesqui. 2012;19(3):275-81.,1818 Atamaz FC, Durmaz B, Baydar M, Demircioglu OY, Iyiyapici A, Kuran B, et al. Comparison of the efficacy of transcutaneous electrical nerve stimulation, interferential currents, and shortwave diathermy in knee osteoarthritis: a double-blind, randomized, controlled, multicenter study. Arch Phys Med Rehabil. 2012;93(5):748-56. have used physical agents as aid or intervention to physical exercises (kinesiotherapy). It was observed that groups adopting deep heating as treatment strategy have improved pain and other evaluated variables, without the adverse effects of individuals submitted to intervention protocols. From these, one has compared the action of physical agents and their placebos and has observed improved pain and functionality, movement amplitude and functional independence, without statistically significant difference among groups1818 Atamaz FC, Durmaz B, Baydar M, Demircioglu OY, Iyiyapici A, Kuran B, et al. Comparison of the efficacy of transcutaneous electrical nerve stimulation, interferential currents, and shortwave diathermy in knee osteoarthritis: a double-blind, randomized, controlled, multicenter study. Arch Phys Med Rehabil. 2012;93(5):748-56.. However, intervention groups have presented lower drug ingestion, indicating higher impact on OA treatment.
So, it is possible to observe the importance of conventional kinesiotherapy to decrease pain and improve other variables of knee OA individuals, being that physical agents may act as optimizers of the physiotherapeutic protocol. In addition, such resources decrease the use of drugs by OA patients and their possible adverse effects.
Studies suggest that US is beneficial to treat knee OA, because it is a safe strategy, decreases pain and improves physical functions, regardless of the mode (continuous or pulsed). Treatment duration should be adapted to specific needs of each individual2525 Zhang C, Xie Y, Luo X, Ji Q, Lu C, He C, et al. Effects of therapeutic ultrasound on pain, physical functions and safety outcomes in patients with knee osteoarthritis: A systematic review and meta-analysis. Clin Rehabil. 2015. [Epub ahead of print]..
Two studies1919 Mascarin NC, Vancini RL, Andrade ML, Magalhães EP, Lira CA, Coimbra IB. Effects of kinesiotherapy, ultrasound and electrotherapy in management of bilateral knee osteoarthritis: prospective clinical trial. BMC Musculoskelet Disord. 2012;22(13):182.,2020 Chen TW, Lin CW, Lee CL, Chen CH, Chen YJ, Lin TY, et al. The efficacy of shock wave therapy in patients with knee osteoarthritis and popliteal cyamella. Kaohsiung J Med Sci. 2014;30(7):362-70. have compared the effects of deep heating (US) and conventional kinesiotherapy or even other nonthermal physical agents. Their results show benefits with regard to pain, functionality, movement amplitude, functional independence1919 Mascarin NC, Vancini RL, Andrade ML, Magalhães EP, Lira CA, Coimbra IB. Effects of kinesiotherapy, ultrasound and electrotherapy in management of bilateral knee osteoarthritis: prospective clinical trial. BMC Musculoskelet Disord. 2012;22(13):182. and muscle strength2020 Chen TW, Lin CW, Lee CL, Chen CH, Chen YJ, Lin TY, et al. The efficacy of shock wave therapy in patients with knee osteoarthritis and popliteal cyamella. Kaohsiung J Med Sci. 2014;30(7):362-70., without significant difference among approaches1919 Mascarin NC, Vancini RL, Andrade ML, Magalhães EP, Lira CA, Coimbra IB. Effects of kinesiotherapy, ultrasound and electrotherapy in management of bilateral knee osteoarthritis: prospective clinical trial. BMC Musculoskelet Disord. 2012;22(13):182.. However, it is worth highlighting that such experiments were carried out just with US and in one of them US with kinesiotherapy has been superior in the distance travelled by the individual1919 Mascarin NC, Vancini RL, Andrade ML, Magalhães EP, Lira CA, Coimbra IB. Effects of kinesiotherapy, ultrasound and electrotherapy in management of bilateral knee osteoarthritis: prospective clinical trial. BMC Musculoskelet Disord. 2012;22(13):182.. The other has shown just immediate US effects2020 Chen TW, Lin CW, Lee CL, Chen CH, Chen YJ, Lin TY, et al. The efficacy of shock wave therapy in patients with knee osteoarthritis and popliteal cyamella. Kaohsiung J Med Sci. 2014;30(7):362-70., which is in disagreement with most authors, since they report deep heating as therapy with long term benefits.
MW is a noninvasive method increasing in vivo temperature of internal tissues (±0.2°C), in a depth of 3 to 7cm2626 Zampeli E, Raftakis I, Michelongona A, Nikolaou C, Elezoglou A, Toutouzas K, et al. Detection of subclinical synovial inflammation by microwave radiometry. PLoS One. 2013;8(5):e64606.. Its properties are beneficial to treat OA, since joint heat stimulation increases chondrocytes metabolism and partially generates cartilaginous matrix2424 Takahashi KA, Tonomura H, Arai Y, Terauchi R, Honjo K, Hiraoka N, et al. Hyperthermia for the treatment of articular cartilage with osteoarthritis. Int J Hipertermia. 2009;25(8):661-7..
A study has compared MW therapy (deep heating) with the use of hot compresses (superficial heat) and has concluded that deep approach has significant effect on pain, stiffness, physical limitation and muscle strength in knee OA individuals1313 Rabini A, Piazzini DB, Tancredi G, Foti C, Milano G, Ronconi G, et al. Deep heating therapy via microwave diathermy relieves pain and improves physical function in patients with knee osteoarthritis: a double-blind randomized clinical trial. Eur J Phys Rehabil Med. 2012;48(4):549-59., in the long term, since such disease is chronic and generates severe pain.
SWD aims at decreasing pain in the clinical practice1010 Akyol Y, Durmus D, Alayli G, Tander B, Bek Y, Canturk F, et al. Does short-wave diathermy increase the effectiveness of isokinetic exercise on pain, function, knee muscle strength, quality of life, and depression in the patients with knee osteoarthritis? A randomized controlled clinical study. Eur J Phys Rehabil Med. 2010;46(3):325-36.. SW therapy in low (power of 14.5W; duration 19 minutes; total energy 17kJ) or high doses (power of 14.5W; duration 38 minutes; total energy 33kJ) is beneficial for pain relief and increased muscle strength in the long term, especially in low doses1616 Fukuda TY, Alves da Cunha R, Fukuda VO, Rienzo FA, Cazarini C Jr, Carvalho Nde A, et al. Pulsed shortwave treatment in women with knee osteoarthritis: a multicenter, randomized, placebo-controlled clinical trial. Phys Ther. 2011;91(7):1009-17.. It may decrease joint inflammatory process, being or not associated to drugs1414 Jan MH, Chai HM, Wang CL, Lin YF, Tsai LY. Effects of repetitive shortwave diathermy for reducing synovitis in patients with knee osteoarthritis: an ultrasonographic study. Phys Ther. 2006;86(2):236-44..
Two recruited studies1414 Jan MH, Chai HM, Wang CL, Lin YF, Tsai LY. Effects of repetitive shortwave diathermy for reducing synovitis in patients with knee osteoarthritis: an ultrasonographic study. Phys Ther. 2006;86(2):236-44.,1616 Fukuda TY, Alves da Cunha R, Fukuda VO, Rienzo FA, Cazarini C Jr, Carvalho Nde A, et al. Pulsed shortwave treatment in women with knee osteoarthritis: a multicenter, randomized, placebo-controlled clinical trial. Phys Ther. 2011;91(7):1009-17. have evaluated the effects of deep heating exclusively with physical agents, observing positive effects on evaluated variables, such as those measured by WOMAC index, pain, joint movement amplitude or muscle strength. However, authors are not sure about its isolated efficacy.
CONCLUSION
Physical agents in the form of deep heating (US, SWD and MW) are beneficial to manage pain and other variables such as muscle strength, joint movement amplitude, functionality, stiffness, daily life activities and quality of life in individuals with different levels of OA, especially in the long term. However, it has to be highlighted that such effects are better observed when applied simultaneously with kinesiotherapy.
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Sponsoring sources: none.
REFERENCES
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1Sohn DH, Sokolove J, Sharpe O, Erhart JC, Chandra PE, Lahey LJ, et al. Plasma proteins present in osteoarthritic synovial fluid can stimulate cytokine production via Toll-like receptor 4. Arthritis Res Ther. 2012;14(1):7.
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2Wibelinger LM, Batista JS, Vidmar MF, Kayser B, Pasqualotti A, Schneider RH. Efeitos da fisioterapia convencional e da wiiterapia na dor e capacidade funcional de mulheres idosas com osteoartrite de joelho. Rev Dor. 2013;14(3):196-9.
-
3Duarte VS, Santos ML, Rodrigues KA, Ramires JB, Arêas GP, Borges GF. Exercícios físicos e osteoartrose: uma revisão sistemática. Fisioter Mov. 2013;26(1):193-202.
-
4Coelho Cde F, Leal-Junior EC, Biasotto-Gonzalez DA, Bley AS, de Carvalho Pde T, Politti F, et al. Effectiveness of phototherapy incorporated into an exercise program for osteoarthritis of the knee: study protocol for a randomized controlled trial. Trials. 2014;15:221.
-
5Cunha-Miranda L, Faustino A, Alves C, Vicente V, Barbosa S. Avaliação da magnitude da desvantagem da osteoartrite na vida das pessoas: estudo MOVES. Rev Bras Reumatol. 2015;55(1):22-30.
-
6Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. Lancet. 2011;377(9783):2115-26.
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7Guermazi A, Niu J, Hayashi D, Roemer FW, Englund M, Neogi T, et al. Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study). BMJ. 2012;345:e5339.
-
8Rezend MU, Campos GC. Is osteoarthritis a mechanical or inflammatory disease? Rev Bras Ortop. 2013;48(6):471-4.
-
9Fellet A, Fellet AJ, Fellet L. Osteoartrose: uma revisão. Rev Bras Med. 2007;64(1):55-61.
-
10Akyol Y, Durmus D, Alayli G, Tander B, Bek Y, Canturk F, et al. Does short-wave diathermy increase the effectiveness of isokinetic exercise on pain, function, knee muscle strength, quality of life, and depression in the patients with knee osteoarthritis? A randomized controlled clinical study. Eur J Phys Rehabil Med. 2010;46(3):325-36.
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11Johnsen SP, Larsson H, Tarrone RE, McLaughlin JK, Friis S, Sorensen HT, et al. Risk of hospitalization for myocardial infarction among users of refecoxib, celecoxib, and other NSAIDs: a population-based case-control study. Arch Intern Med. 2005;165(9):978-84.
-
12Ovanessian V, Cazarini Júnior C, Cunha RA, Carvalho NA, Fukuda TY. Use of different doses of pulsed short waves in the treatment of patients with osteoarthritis of the knee. Rev Cienc Med Campinas. 2008;17(3-6):149-55.
-
13Rabini A, Piazzini DB, Tancredi G, Foti C, Milano G, Ronconi G, et al. Deep heating therapy via microwave diathermy relieves pain and improves physical function in patients with knee osteoarthritis: a double-blind randomized clinical trial. Eur J Phys Rehabil Med. 2012;48(4):549-59.
-
14Jan MH, Chai HM, Wang CL, Lin YF, Tsai LY. Effects of repetitive shortwave diathermy for reducing synovitis in patients with knee osteoarthritis: an ultrasonographic study. Phys Ther. 2006;86(2):236-44.
-
15Silva AL, Imoto DM, Croci AT. Estudo comparativo entre a aplicação de crioterapia, cinesioterapia e ondas curtas no tratamento da osteoartrite de joelho. Acta Ortop Bras. 2007;15(4):204-9.
-
16Fukuda TY, Alves da Cunha R, Fukuda VO, Rienzo FA, Cazarini C Jr, Carvalho Nde A, et al. Pulsed shortwave treatment in women with knee osteoarthritis: a multicenter, randomized, placebo-controlled clinical trial. Phys Ther. 2011;91(7):1009-17.
-
17Carlos KP, Belli BS, Alfredo PP. Efeito do ultrassom pulsado e do ultrassom contínuo associado a exercícios em pacientes com osteoartrite de joelho: estudo piloto. Fisioter Pesqui. 2012;19(3):275-81.
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18Atamaz FC, Durmaz B, Baydar M, Demircioglu OY, Iyiyapici A, Kuran B, et al. Comparison of the efficacy of transcutaneous electrical nerve stimulation, interferential currents, and shortwave diathermy in knee osteoarthritis: a double-blind, randomized, controlled, multicenter study. Arch Phys Med Rehabil. 2012;93(5):748-56.
-
19Mascarin NC, Vancini RL, Andrade ML, Magalhães EP, Lira CA, Coimbra IB. Effects of kinesiotherapy, ultrasound and electrotherapy in management of bilateral knee osteoarthritis: prospective clinical trial. BMC Musculoskelet Disord. 2012;22(13):182.
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20Chen TW, Lin CW, Lee CL, Chen CH, Chen YJ, Lin TY, et al. The efficacy of shock wave therapy in patients with knee osteoarthritis and popliteal cyamella. Kaohsiung J Med Sci. 2014;30(7):362-70.
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21Marley J, Tully MA, Porter-Armstrong A, Bunting B, O'Hanlon J, McDonough SM. A systematic review of interventions aimed at increasing physical activity in adults with chronic musculoskeletal pain protocol. Syst Rev. 2014;3:106.
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22Muraki S, Akune T, Oka H, En-yo Y, Yoshida M, Saika A, et al. Association of radiographic and symptomatic knee osteoarthritis with health-related quality of life in a populationbased cohort study in Japan: the ROAD study. Osteoarthr Cartil. 2010;18(9):1227-34.
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23Kim IJ, Kim HA, Seo YI, Jung YO, Canção YW, Jeong JY, et al. Prevalence of knee pain and its influence on quality of life and physical function in the Korean elderly population: a community based cross-sectional study. J Korean Med Sci. 2011;26(9):1140-6.
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Publication Dates
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Publication in this collection
Jan-Mar 2017
History
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Received
14 July 2016 -
Accepted
20 Jan 2017