復健介入對退化性膝關節炎接受玻尿酸注射患者之健康促進效益研究

Knee osteoarthritis (knee OA) is a common chronic disease that affects elderly. Intra-articular injection of hyaluronic acid (IAHA) and physical therapy for knee OA have been shown to have clinical benefits in randomized, clinical trials separately. However, it is generally accepted that optimal management of knee OA requires a combination of pharmacologic and nonpharmacologic treatment. Currently, few studies have directly evaluated the benefits of combining the 2 treatments for knee OA. The purpose of this study explored the efficacy of interventions in patients with knee osteoarthritis through combined IAHA and physical therapy. This study investigated the potential benefit of two strategies of interventions: 1) receiving IAHA and physical therapy at the same period; 2) receiving physical therapy after IAHA. Methods: This is a prospective purposive control trial study. The subjects with knee OA were distributed to three groups purposively: group I - IAHA group, group II - receiving IAHA and physical therapy at the same period, and group III-after receiving 5 times IAHA, receiving physical therapy for 5 weeks. Experiment I executed to compare group I with group II and Experiment II executed to compare group I with group III. The measurements included: 1) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC index) ; 2) Short Form-36 (SF-36) ; 3) muscle rate of whole body and muscle mass of lower extremities; 4) maximal isometric muscle strength of knee extensors and knee flexors; 5) range of motion of knee. Results: Experiment I-After 5 weeks intervention, both groups improved in WOMAC index scores and SF-36 scores significantly. The subjects of group II also improved in the strength of knee extensors (P＜0.001), flexors (P＜0.001) significantly. Between group comparison, the group II had a greater significant improvement than group I in above mentioned variables, except WOMAC stiffness subindex (P＞0.050). After 10 weeks, the group II had a significant increase in maximal isometric muscle strength of knee flexors and knee extensors (P＜0.050). Experiment II - After 5 weeks, group I improved in WOMAC index and SF-36 score significantly. Group III had a greater significant improvement in WOMAC index (P＜0.001), SF36 score (P＜0.001), the strength of knee extensors (P＜0.001), flexors (P＜0.001). Between group comparison, the group III had a greater significant improvement than group I in above mentioned variables, except WOMAC pain and stiffness subindex (P＞0.050). Conclusion: Both interventions of IAHA and combining IAHA and physical therapy relieve symptoms in patients with knee OA. However, combining two treatments is superior to IAHA for patients with knee osteoarthritis in muscle strength, functional ability and quality of life.