EVALUATION OF THE EFFECTS OF CAPACITIVE AND RESISTIVE DIATHERMY ON KNEE OSTEOARTHRITIS

Gianpaolo Ronconi, Alessandro Specchia, Loredana Maggi, Alessia Rabini, Paola Emilia Ferrara, Eugenia Amabile, Diana Barbara Piazzini, Carlo Bertolini

A. Gemelli” University Hospital– Catholic University of the Sacred Heart – Rome

Materials and methods From November 2010 we are carrying on a single-center study on the effectiveness of diathermy in the treatment of knee OA. We recruited 56 patients aged

between 43 and 85 years. We randomily assigned all recruited patients into two groups. The first group of patients were treated with diathermy on a daily

basis, Monday through Friday, for a total of 10 sessions with a total duration of the treatment course of two weeks. Each session had the total duration of 20

minutes. The patients of the second group underwent a cycle of 6 sessions of treatment on alternate days for a total duration of the treatment of two weeks. Each

session has had the total duration of 20 minutes. The treatment was performed by setting the machine in a “free" modality, letting the therapist to operate in total

autonomy of power. Patients were evaluated before (T0), at the end (T1) and after one month (T2) after treatment, by assessment of joint ROM and muscle

strength (BMRC) and administration of rating scales (VAS, KOOS , WOMAC and DI).

Introduction Osteoarthritis (OA) is the most common chronic degenerative disease of the knee in older age.

In the international guidelines the conservative treatment of knee OA is becoming

increasingly important. Recently it has been introduced in the field of physical

therapy in Rehabilitation Medicine diathermy therapy (Resistive Capacitive Energy Transfer), which

is a therapy based on energy and heat transfer. It is a technique that stimulates energy production

from biological tissues, reactivating the cellular metabolism and natural anti-

inflammatory and reparative processes.

Bibliografia 1. Benizet M.P., Colmer J.F.,”Tecarterapia®nella patologia del ginocchio e della colonna vertebrale” Centro di Medicina Omeopatica e Biologica, Barcellona. 2. Parolo E, Onesta MP. “Ipertermia a transferimento energetico resistivo e capacitivo nel trattamento di lesioni muscolo-scheletriche acute e croniche”. La Riabilitazione 1998. 3. Marchese D. e altri, “Valutazione dell’efficacia del trattamento energetico capacitivo e resistivo nella sindrome del piriforme: prime esperienze” EUR MED PHYS, Vol. 44 - Suppl. 1 to No. 3,2008. 4. Brotzman S.B, Wilk K.E. “La riabilitazione in ortopedia” II Ed. Excerpta Medica Italia Srl, 2004.

Conclusions Our study confirmed the positive effects of Diathermy in the treatment of knee OA, as observed in various studies. We also could say that the 6 sessions protocol can be preferable to the 10 sessions protocol as it leads to similar results, but it has the advantage to use

a reduced amount of costs and energy. Another important and encouraging tip is that we observed a great compliance of patients with respect to the therapy and its immeadiate effectiveness, bringing it among the fast-therapies.

Moreover, the diathermy machine is operator-dependent, so it is important to emphasize the role of the therapist in the treatment, as it has the possibility to adjust the parameters during each session depending on the tissue responses and the feelings reported by the

patient.

Results

We observed a general upward trend throughout the sample. In most of the

evaluated items, we observed a slightly increased efficacy in the

“6 sessions” group, compared to the “10 sessions” group.

We observed a general improvement both in “motion” VAS and ” at

rest” VAS. This finding was partially confirmed by the analysis of the KOOS

domains (pain, ADL, quality of life) but not in the domain "symptoms" (where

the treatment was more effective than 10 sessions). This trend is also

confirmed by the WOMAC Osteoarthritis INDEX scale. In fact, among the

three domains composing the scale (pain, stiffness and ADL) only the

stiffness domain demonstrates an advantage of the 10 sessions

protocol. The study of motion and muscle strength confirms the

recovery of function observed in the other scales, particularly it is

interesting to note that in the 10 sessions protocol there is an

improvement after one month from the end of treatment. this allows us to

state that these subjects have acquired greater stability and security, and

feel less pain. The trend of general improvement is confirmed by the

analysis of the "Deambulation Index“ scale. The trend towards

improvement in deambulation was also confirmed not only at the end of

treatment but also in the evaluation after one month.

31,91

33,5619,04

13,9417,6113,68

0

10

20

30

40

50

60

pu

nte

gg

io

T0 T1 T2

tempo

WOMAC ADL

10 SEDUTE

6 SEDUTE

WOMAC ADL

10 SESSIONS

6 SESSIONS

TIME

3,914,38

2,002,06

1,962,06

0

1

2

3

4

5

6

7

8

pu

nte

gg

io

T0 T1 T2

tempo

WOMAC RIGIDITA'

10 SEDUTE

6 SEDUTE

WOMAC STIFFNESS

10 SESSIONS

6 SESSIONS

TIME

5,96 6,47 6,26 6,56 6,22 6,71

1

2

3

4

5

6

7

pu

nte

gg

io

T0 T1 T2

tempo

DEAMBULATION INDEX

10 SEDUTE

6 SEDUTE

DEAMBULATION INDEX

10 SESSIONS

6 SESSIONS

TIME

9,39

9,12

5,484,09

5,094,00

0

2

46

8

10

12

14

1618

20

pu

nte

gg

io

T0 T1 T2

tempo

WOMAC DOLORE

10 SEDUTE

6 SEDUTE

WOMAC PAIN

10 SESSIONS

6 SESSIONS

TIME

6,65

7,15

2,87

2,62

2,74

1,62

0

1

2

3

4

5

6

7

8

9

10

pu

nte

gg

io

T0 T1 T2

tempo

VAS MOVIMENTO

10 SEDUTE

6 SEDUTE

10 SESSIONS

6 SESSIONS

VAS MOTION

TIME