A Comparison between Knee Joint Stability Training and Diclofenac in the Treatment of Osteoarthritis of the Knee_West China Medical Journal

Authors：

 WangJinsong ¹ ,  ZuoChuan ²

1. Student Affairs Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

ZuoChuan, Email: zcsiren@163.com

Keywords：

Knee joint stability training; Diclofenac; Osteoarthritis; Efficacy; Safety

DOI：

10.7507/1002-0179.201600544

Video：

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Objective To evaluate the efficacy and safety of knee joint stability training in treating patients with knee osteoarthritis. Methods Sixty-one patients with knee osteoarthritis treated between April 2014 and April 2015 were randomly divided into 2 groups:rehabilitation group (n=30) and control group (n=31).Patients in the rehabilitation group received knee joint stability training (30-40 minutes once, once every day); the control group received diclofenac sodium orally at 75 mg/d (25 mg per time, 3 times every day).The Western Ontario and McMaster Universities Arthritis index (WOMAC) and short-form health survey (SF-36) were used before and after treatment.Patients' and physicians' assessment of the total efficacy rate was also analyzed. Results After 5 weeks of treatment, the total efficacy rate assessed by the patients for the rehabilitation group and the control group was respectively 93.33% and 87.10%, and those two numbers assessed by physicians were respectively 86.67% and 80.65%;the differences were not statistically significant (P > 0.05).Significant improvement was observed in the results of WOMAC and SF-36 in both two groups (P < 0.05).There was no significant difference in the clinical efficacy between the two groups (P > 0.05).No incidence of related adverse events occurred in the rehabilitation group, while the incidence of adverse events was 16.13% in the control group (P < 0.05). Conclusion The knee joint stability training is as effective as diclofenac sodium in treating patients with knee osteoarthritis, but the joint stability training is better tolerated than the latter.

Citation： WangJinsong, ZuoChuan. A Comparison between Knee Joint Stability Training and Diclofenac in the Treatment of Osteoarthritis of the Knee. West China Medical Journal, 2016, 31(12): 1981-1985. doi: 10.7507/1002-0179.201600544 Copy

1.	Crofford LJ. COX-1 and COX-2 tissue expression:implications and predictions[J]. J Rheumatol, 1997, 49:15-19.
2.	Chang JK, Wu SC, Wang GJ, et al. Effects of non-steroidal anti-inflammatory drugs on cell proliferation and death in cultured epiphyseal-articular chondrocytes of fetal rats[J]. Toxicology, 2006, 228(2/3):111-123.
3.	Altman R. Criteria for the classification of osteoarthritis[J]. J Rheumatol, 1991, 27(Suppl 65):10-12.
4.	左川, 尹耕, 岑筱敏, 等.復方夏天無與雙氯芬酸鈉治療膝骨關節炎的臨床對照研究[J].中國中藥雜志, 2015, 40(1):149-153.
5.	陽筱甜, 王樸, 周予婧, 等.基于循證醫學的骨關節炎康復治療方法[J].華西醫學, 2014, 29(9):1791-1794.
6.	姜俊良, 周予婧, 林海丹, 等.膝骨關節炎運動療法國內研究進展[J].華西醫學, 2015, 30(12):2373-2376.
7.	Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis[J]. Ann Rheum Dis, 1957, 16(4):494-502.
8.	陳蔚, 郭燕梅, 李曉英, 等.西安大略和麥克馬斯特大學骨關節炎指數的重測信度[J].中國康復理論與實踐, 2010, 16(1):23-24.
9.	Mchorney CA, Ware JE, Lu JF, et al. The MOS 36-item Short-Form Health Survey (SF-36):Ⅲ. Tests of data quality, scaling assumptions, and reliability across diverse patient groups[J]. Med Care, 1994, 32(1):40-66.
10.	DoiT, Akai M, Fujino K, et al. Effect of home exercise of quadriceps on knee osteoarthritis compared with nonsteroidal antiinflammatory drugs:a randomized controlled trial[J]. Am J Phys Med Rehabil, 2008, 87(4):258-269.
11.	Flaxman TE, Speirs AD, Benoit DL. Joint stabilisers or moment actuators:the role of knee joint muscles while weight-bearing[J]. J Biomech, 2012, 45(15):2570-2576.
12.	Jordan KM, Arden NK, Doherty M, et al. EULAR recommendations 2003:an evidence based approach to the management of knee osteoarthritis:report of a task force of the standing committee for international clinical studies including therapeutic trials[J]. Ann Rheum Dis, 2003, 62(12):1145-1155.
13.	Alnahdi AH, Zeni JA, Snyder-Mackler L. Muscle impairments in patients with knee osteoarthritis[J]. Sports Health, 2012, 4(4):284-292.
14.	Slemenda C, Heilman DK, Brandt KD, et al. Reduced quadriceps strength relative to body weight:a risk factor for knee osteoarthritis in women?[J]. Arthritis Rheum, 1998, 41(11):1951-1959.
15.	Slemenda C, Brandt KD, Heilman DK, et al. Quadriceps weakness and osteoarthritis of the knee[J]. Ann Intern Med, 1997, 127(2):97-104.
16.	Mcalindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis[J]. Osteoarthritis Cartilage, 2014, 22(3):363-388.
17.	Topp R, Woolley S, Hornyak J, et al. The effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee[J]. Arch Phys Med Rehabil, 2002, 83(9):1187-1195.
18.	Mündermann A, Dyrby CO, Andriacchi TP. Secondary gait changes in patients with medial compartment knee osteoarthritis:increased load at the ankle, knee, and hip during walking[J]. Arthritis Rheum, 2005, 52(9):2835-2844.
19.	Hinman RS, Hunt MA, Creaby MW, et al. Hip muscle weakness in individuals with medial knee osteoarthritis[J]. Arthritis Care Res (Hoboken), 2010, 62(8):1190-1193.
20.	Bennell KL, Hunt MA, Wrigley TV, et al. Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment:a randomised controlled trial[J]. Osteoarthritis Cartilage, 2010, 18(5):621-628.

1. Crofford LJ. COX-1 and COX-2 tissue expression:implications and predictions[J]. J Rheumatol, 1997, 49:15-19.
2. Chang JK, Wu SC, Wang GJ, et al. Effects of non-steroidal anti-inflammatory drugs on cell proliferation and death in cultured epiphyseal-articular chondrocytes of fetal rats[J]. Toxicology, 2006, 228(2/3):111-123.
3. Altman R. Criteria for the classification of osteoarthritis[J]. J Rheumatol, 1991, 27(Suppl 65):10-12.
4. 左川, 尹耕, 岑筱敏, 等.復方夏天無與雙氯芬酸鈉治療膝骨關節炎的臨床對照研究[J].中國中藥雜志, 2015, 40(1):149-153.
5. 陽筱甜, 王樸, 周予婧, 等.基于循證醫學的骨關節炎康復治療方法[J].華西醫學, 2014, 29(9):1791-1794.
6. 姜俊良, 周予婧, 林海丹, 等.膝骨關節炎運動療法國內研究進展[J].華西醫學, 2015, 30(12):2373-2376.
7. Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis[J]. Ann Rheum Dis, 1957, 16(4):494-502.
8. 陳蔚, 郭燕梅, 李曉英, 等.西安大略和麥克馬斯特大學骨關節炎指數的重測信度[J].中國康復理論與實踐, 2010, 16(1):23-24.
9. Mchorney CA, Ware JE, Lu JF, et al. The MOS 36-item Short-Form Health Survey (SF-36):Ⅲ. Tests of data quality, scaling assumptions, and reliability across diverse patient groups[J]. Med Care, 1994, 32(1):40-66.
10. DoiT, Akai M, Fujino K, et al. Effect of home exercise of quadriceps on knee osteoarthritis compared with nonsteroidal antiinflammatory drugs:a randomized controlled trial[J]. Am J Phys Med Rehabil, 2008, 87(4):258-269.
11. Flaxman TE, Speirs AD, Benoit DL. Joint stabilisers or moment actuators:the role of knee joint muscles while weight-bearing[J]. J Biomech, 2012, 45(15):2570-2576.
12. Jordan KM, Arden NK, Doherty M, et al. EULAR recommendations 2003:an evidence based approach to the management of knee osteoarthritis:report of a task force of the standing committee for international clinical studies including therapeutic trials[J]. Ann Rheum Dis, 2003, 62(12):1145-1155.
13. Alnahdi AH, Zeni JA, Snyder-Mackler L. Muscle impairments in patients with knee osteoarthritis[J]. Sports Health, 2012, 4(4):284-292.
14. Slemenda C, Heilman DK, Brandt KD, et al. Reduced quadriceps strength relative to body weight:a risk factor for knee osteoarthritis in women?[J]. Arthritis Rheum, 1998, 41(11):1951-1959.
15. Slemenda C, Brandt KD, Heilman DK, et al. Quadriceps weakness and osteoarthritis of the knee[J]. Ann Intern Med, 1997, 127(2):97-104.
16. Mcalindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis[J]. Osteoarthritis Cartilage, 2014, 22(3):363-388.
17. Topp R, Woolley S, Hornyak J, et al. The effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee[J]. Arch Phys Med Rehabil, 2002, 83(9):1187-1195.
18. Mündermann A, Dyrby CO, Andriacchi TP. Secondary gait changes in patients with medial compartment knee osteoarthritis:increased load at the ankle, knee, and hip during walking[J]. Arthritis Rheum, 2005, 52(9):2835-2844.
19. Hinman RS, Hunt MA, Creaby MW, et al. Hip muscle weakness in individuals with medial knee osteoarthritis[J]. Arthritis Care Res (Hoboken), 2010, 62(8):1190-1193.
20. Bennell KL, Hunt MA, Wrigley TV, et al. Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment:a randomised controlled trial[J]. Osteoarthritis Cartilage, 2010, 18(5):621-628.

West China Medical Journal

A Comparison between Knee Joint Stability Training and Diclofenac in the Treatment of Osteoarthritis of the Knee

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