| Summary: | 碩士 === 中國醫藥學院 === 中國醫學研究所 === 91 === Gait Analysis in Knee Osteoarthritis Patients After Electro-Acupuncture Treatment
Po-Hsin Lin
Institute of Chinese Medical Sciences, China Medical College, Taiwan, ROC
ABSTRACT
Osteoarthritis (OA), a common type of arthritis, is mostly seen at the knee joint. Pain caused by OA is a major factor that affects patients’ quality of life and hence convinces patients to seek medical assistance. Clinically, pain relief is the first step in the treatment of OA. OA also has huge impact on patients’ financial and psychological situation. Therefore, accurate diagnosis and effective treatments at early stage can save a lot of unnecessary suffering to patients and resources later used on treatments.
The currently prevailing medicine treatments for OA are painkiller and antibiotic prescriptions, including non-steroid anti inflammation drugs（NSAIDs）and new generation cyclooxygenase-2（COX-2）inhibitors. Yet, both prescriptions have inevitable side effects. In addition, these prescriptions do not stop the progression of the disease or help increase or restore the capability and mobility of limbs. Knee joint replacements are thus necessary for advanced OA. In past thirty years, many researches have proved that electro-acupuncture treatments are effective in general pain relief, anesthesia, and treatment of functional disorders. It has also been shown very effective in the treatment of OA with almost no side effects.
Gait analysis has been widely used in human ambulation research, contributing to the diagnosis of neuromusculoskeletal pathology and the evaluation of subsequent treatment. Among the measurement equipment in gait analysis, force plates were used to measure the Ground Reaction Forces (GRF) of patients with knee OA during movements before and after treatment, giving quantitative data on the efficacy of the treatment.
Sixty-three OA patients were selected as subjects from Department of Acupuncture, Taipei Traditional Chinese Medicine Hospital. The subjects were randomized into electro-acupuncture group（n=37）and sham electro-acupuncture group（n=26）. X-ray was taken for each subject and used to categorize them into 4 K/L grades. A force plate was used to measure changes in the GRF during level walking before and after treatments. The visual analogue scale（VAS）and Pain Index of the Knee（PIK）scores were also used to measure the levels of improvement on pain and movements.
Typical curve patterns of the vertical component of the GRF for patients with same K/L grade were first established for all grades. The results showed that the worse the joint as indicated by the K/L grading, the more abnormal the curve pattern. These unique pathological curve patterns can serve as good clinical reference. The abnormal curve patterns of about thirty percent of the subjects became normal after treatment in the electro-acupuncture group. The statistical analysis also showed that the center of the foot pressure (COP) moved more rapidly after the electro-acupuncture treatment. The lower limbs were also more capable of body weight bearing, the stance phase time lasted longer, more body weight sustained, more energy generated, and the capability of joint and muscles to manage sudden changes of forces increases in electro-acupuncture group after treatment. The results of sham electro-acupuncture group did not show any statistically significant difference between before and after treatment. The parameters did not show any regular pattern either. The VAS assessment showed that electro-acupuncture was indeed effective in pain relief. Nevertheless, the psychological influences on patients should be considered when using VAS assessment. PIK measurement results showed that electro-acupuncture was effective in pain relief and the method was more sensitive in less severe joints.
In conclusion, the electro-acupuncture has been shown to be capable of easing the pain and stiffness symptoms of the OA patients, improving their gait performance. For patients with more severe symptoms and degeneration, electro-acupuncture seems to be a good choice, but prolonged treatments may be necessary to achieve good outcome.
Key words：osteoarthritis (OA), acupuncture, electro-acupuncture, gait analysis, ground reaction force (GRF), knee joint
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