Clinical and Biomechanical Effects of the Traditional Chinese Medical Treatments in Individuals with Medial Knee Osteoarthritis
Background: Knee otesoarthritis (OA) is the most common of the arthritises, affecting an estimated over 300 million people worldwide. Traditional Chinese Medicine (TCM) therapies have been widely used in the management of knee OA in China, however, there has been a lack of studies evaluated the effects of TCM therapies on clinical and biomechanical outcomes in individuals with knee OA. This thesis was designed to identify the clinical and biomechanical effects of the Chinese herbal (CH) patch, acupuncture treatment (AT), and Chinese massage (CM) in comparison with a control group with neutral flat insole (CN), where the results could help to improve the understanding of both clinical and biomechanical effects of the different TCM therapies in the management of knee OA.Methods: To accomplish this research, we preformed several trials; a) test-retest reliability studies on both healthy individuals and individuals with medial knee OA were conducted to determine the reliability of the outcome measures and the minimal clinically important difference for the future study; b) sixty participants with medial knee OA were recruited and randomly divided into four groups (CN, CH, AT, and CM). The six-week effect of TCM treatments on biomechanical and clinical outcomes were measured and assessed by comparing the outcomes with the baseline and six-week CN.Results: The CH showed significant improvements in WOMAC pain and total scores when compared with baseline (P<0.05). Although no significant improvement was found in biomechanical variables when compared with the baseline and the six-week CN (P>0.05), a slight trend toward reduced muscle co-contraction was found in most of the selected paired muscles in the CH group after receiving six-week treatment. The six-week AT showed significant improvements in WOMAC pain, stiffness, function, and total scores when compared with the baseline, the six-week CN, and CH (P<0.05). Furthermore, the six-week AT showed significant improvements in temporal-spatial, kinematic and kinetic variables when compared with the baseline and six-week CN (P<0.05). The results indicated that the improvement of clinical symptoms has resulted in the recovery in walking mobility and dynamicity even it might lead to higher joint loading in the medial compartment of the knee. Moreover, the six-week AT also showed a slight trend toward reduced muscle co-contraction when compared with the baseline and six-week CN. The six-week CM also showed significant improvements in WOMAC pain, stiffness, function, and total scores when compared with the baseline, the six-week CN, and CH (P<0.05). Furthermore, improvements were also found in the temporal-spatial, kinetics, and kinematics outcomes. Moreover, the six-week CM showed significant improvements in medial muscle co-contraction when compared with the baseline, the six-week CN, AT, and CH (P<0.05), which indicated that the CM might help to reduce the loading at the knee during gaitConclusion: In conclusion, the results of this study confirmed the short-term clinical and biomechanical effects of CH, AT, and CM. However, a long-term study may be needed to provide more results to clarify the issues like some statistically insignificant variations.
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