TX_1~ABS:AT/ADD:TX_2~ABS:AT 128 http://journals.cihanuniversity.edu.iq/index.php/cuesj CUESJ 2024, 8 (2): 128-131 ReseaRch aRticle Effect of Deep Thermal Therapy on Knee Osteoarthritis Noora N. Sharif1, Karzan N. Saleh2,3, Tanya S. Salih1, Asma G. Mohammad1 1Department of Physiotherapy, Cihan University-Erbil, Kurdistan Region, Iraq, 2Department of Physics, College of Science, Salahaddin University-Erbil, Kurdistan Region, Iraq, 3Department of Radiological Imaging Technologies, Cihan University-Erbil, Kurdistan Region, Iraq ABSTRACT This study investigates the efficacy of deep thermal therapy, specifically shortwave and microwave diathermy, in managing knee osteoarthritis. Osteoarthritis, characterized by joint degeneration and cartilage erosion, poses a significant health concern, particularly in weight-bearing joints such as the knee. Physical modalities, including thermal therapies, have been widely employed for their potential to elevate tissue temperature, improve blood circulation, and mitigate pain. The research, conducted at Erbil Teaching Hospital, focuses on 30 participants aged 38–68 with knee osteoarthritis. Shortwave and microwave diathermy were applied every other day for 2 weeks. The study aims to assess the impact of these interventions on pain reduction, quality of life, and range of motion. Initial findings indicate a substantial improvement, with the average pain score decreasing from 4.3 to 2.86 out of 10 post-treatment. In conclusion, the study suggests that deep thermal therapy, when coupled with regular physical exercise, offers significant benefits in managing knee osteoarthritis. The findings underscore the potential of these interventions in enhancing the well-being and functionality of individuals affected by this prevalent rheumatic ailment. Further research and exploration in this direction hold promise for advancing osteoarthritis management strategies. Keywords: Deep thermal therapy, shortwave/microwave diathermy, pain reduction, range of motion, swelling reduction INTRODUCTION Osteoarthritis (OA) is the pre-eminent rheumatic ailment in developed nations, distinguished by joint degeneration, cartilage erosion, bone hardening, and the development of osteophytes.[1] It can be categorized as either primary or secondary, where primary OA arises from a combination of hereditary and environmental factors, whereas secondary OA is caused by factors such as joint trauma or excessive use.[2] Knee OA is a primary cause of impairment, particularly in females, and is linked to pain, inflexibility, and diminished mobility in weight- bearing joints.[3] The primary objective of treatment is alleviating symptoms and enhancing functionality, with interventions comprising weight reduction, medication, surgical procedures, and physical therapy.[4] Physical modalities, such as shortwave diathermy and microwave diathermy, are frequently employed in physical therapy for joint disorders, as they can elevate tissue temperature, enhance blood circulation, mitigate pain, and modify the physical characteristics of fibrous tissue.[5] These interventions have the objective of mitigating joint discomfort, enhancing physical movement, and augmenting the overall quality of life for individuals affected by knee osteoarthritis.[6] MATERIALS AND METHODS The study conducted at Erbil Teaching Hospital aimed to determine the effect of deep therapy and exercise on knee osteoarthritis, specifically in terms of pain reduction, improved quality of life, and increased range of motion. The study included 30 patients aged 38–68 with knee osteoarthritis. The physical diagnosis was obtained through medical history, pain score, and swelling by Tap measurements. Shortwave and microwave diathermy were used for 2 weeks every other day. Shortwave electromagnetic energy with a frequency of 27.12MHz and a wavelength of 11.06 m was applied for 10 min. Microwave energy with a frequency of 2450MHz was also used. The study aimed to improve the methodology for assessing the effects of deep therapy and exercise on knee osteoarthritis.[6,7] Cihan University-Erbil Scientific Journal (CUESJ) Corresponding Author: Noora N. Sharif, Department of Physiotherapy, Cihan University-Erbil, Kurdistan Region, Iraq. E-mail: noora.nasraddin@cihanuniversity.edu.iq Received: June 26, 2024 Accepted: October 25, 2024 Published: December 10, 2024 DOI: 10.24086/cuesj.v8n2y2024.pp128-131 Copyright © 2024 Noora N. Sharif, karzan N. Saleh, Tanya S. Salih, Asma G. Mohammad. This is an open-access article distributed under the Creative Commons Attribution License. Sharif, et al.: Effect of Deep Thermal Therapy on Knee Osteoarthritis 129 http://journals.cihanuniversity.edu.iq/index.php/cuesj CUESJ 2024, 8 (2): 128-131 RESULTS In this study, a total of 30 cases, evenly distributed across both genders, were examined. Before the initiation of treatment, participants reported an average pain score of 4.3 out of 10. Following the prescribed treatment, there was a notable improvement, with the post-treatment pain score decreasing to 2.86 out of 10. These findings are graphically represented in Figure 1. In this study, 30 participants, with an equal distribution of male and female cases, were analyzed. The baseline pain score reported by participants averaged 4.3 out of 10. Following the treatment protocol, a statistically significant reduction in pain was observed, with the post-treatment pain score averaging 2.86 out of 10 (P < 0.05, 95% CI: [2.3, 3.4]). Table 1 provides a graphical representation of pain scores over time, highlighting the trend in pain reduction for the group. Descriptive statistics for the sample of 30 participants are presented in the Table 2. The age of the participants ranged from 32 to 78, with a mean age of 57.27 years and a standard deviation of 11.182. Regarding weight, participants had a weight range of 60–111, with a mean weight of 82.17 and a standard deviation of 11.061. These statistics provide a snapshot of the central tendency and variability within the sample for both age and weight. The “Valid N (listwise)” row indicates that there were no missing values in the dataset, and all 30 cases were considered for the analysis. The Table 3 presents a breakdown of the gender distribution in the sample, including frequency, percentage, valid percentage, and cumulative percentage. The participants are divided into two categories: Male and female. Each gender constitutes 50% of the sample, with 15 participants in each category. The “valid percent” column indicates that all responses are valid, contributing to 100% of the dataset. The “cumulative percent” column illustrates the cumulative proportion of participants as we progress through the categories. The Figure 2 and Table 4 outlines the distribution of cases based on the affected side, detailing frequency, percentage, valid percentage, and cumulative percentage. Participants were categorized into three groups: Right, left, and bilateral. • The “Right” side was affected in 20% of cases (six participants) • The “Left” side was affected in 26.7% of cases (eight participants) • Bilateral effects were observed in 53.3% of cases (16 participants). DISCUSSION In this study, a total of 30 cases, evenly distributed across both genders, were examined. Before the initiation of treatment, participants reported an average pain score of 4.3 out of 10. Following the prescribed treatment, there was a notable improvement, with the post-treatment pain score decreasing to 2.86 out of 10. These findings are graphically represented in table 1.[8] Among the patients, 26.67% experienced effects specifically on the left side, 20.0% reported impact on the right side, and a significant portion, accounting for 53.33%, exhibited bilateral involvement.[9] Descriptive statistics for the sample of 30 participants are presented in the table below. The age of the participants ranged from 32 to 78, with a mean age of 57.27 years and a standard deviation of 11.182. Regarding weight, participants had a weight range of 60–111, with a mean weight of 82.17 and a standard deviation of 11.061.[10]. The table presents a breakdown of the gender distribution in the sample, including frequency, percentage, valid percentage, and cumulative percentage. The participants are divided into two categories: Male and female. Each gender constitutes 50% of the sample, with 15 participants in each category.[11] The table outlines the distribution of cases based on the affected side, detailing frequency, percentage, valid percentage, and cumulative percentage. Participants were categorized into three groups: Right, left, and bilateral. The “Right” side was affected in 20% of cases (six participants), the “Left” side was affected in 26.7% of cases (eight participants), and bilateral effects were observed in 53.3% of cases (16 participants).[12,13] 4.3 2.866666667 0 5 1 2 Pain score Figure 1: Pain scores over time for group Patient information and history Clinical assessment using pain scale Treatment Used microwave and shortwave for 3 times per weeks for 2 weeks. SWD frequency of 27.12MHz and a wavelength of 11 m. for 10 min duration. The frequency most commonly used for microwave diathermy is 2,450 MHz and wavelength 12 cm for 10 min duration Follow up (after 2 weeks) pain scale Sharif, et al.: Effect of Deep Thermal Therapy on Knee Osteoarthritis 130 http://journals.cihanuniversity.edu.iq/index.php/cuesj CUESJ 2024, 8 (2): 128-131 CONCLUSION The utilization of physical equipment, specifically in the form of deep thermal therapy such as shortwave and microwave, proves to be advantageous for enhancing the range of motion and managing various factors associated with osteoarthritis. These benefits encompass the mitigation of pain, reduction of swelling, and improvement in variables such as muscle strength, joint movement amplitude, and stiffness, as well as enhancements in daily life activities and overall quality of life among individuals with varying levels of osteoarthritis. It is noteworthy that the positive effects of this treatment approach are further amplified when coupled with regular physical exercise. This combined intervention demonstrates a promising avenue for improving the well-being and functionality of individuals grappling with osteoarthritis. RECOMMENDATIONS Optimizing osteoarthritis management includes individualized treatment plans, a multidisciplinary approach involving health-care professionals, encouragement of regular physical exercise, comprehensive patient education, long-term follow-up strategies, ensuring accessibility and affordability, ongoing research and innovation, and collaboration with rehabilitation centers. Implementing these recommendations can contribute to more effective and accessible interventions, ultimately improving the well-being of individuals dealing with osteoarthritis. REFERENCES 1. I. B. McInnes and G. Schett. Pathogenetic insights from the treatment of rheumatoid arthritis. The Lancet, vol. 389, no. 10086, pp. 2328-2337, 2017. 2. A. E. Karateev. Analgesics for rheumatic diseases - a necessary component of therapy aimed at improving the quality of life. Modern Rheumatology Journal, vol. 16, no. 5, pp. 101-107, 2022. 3. A. Minerbi and M. A. Fitzcharles. Clinical pain management in the rheumatic diseases. In: Clinical Pain Management: A Practical Guide. Wiley, Blackwell, UK, pp. 325-335, 2022. 4. F. Perez-Ruiz. Opening editorial for exploration in musculoskeletal diseases. Exploration of Musculoskeletal Diseases, vol. 1, pp. 1-3, 2022. 5. A. Thoker. Post stroke risk factors of fall during rehabilitation in elderly patients. Journal of Physiotherapy and Rehabilitation, vol. 6, p. 208, 2021. 6. O.O. Melnyk. Immunobiological drugs in the treatment of rheumatic diseases. KIDNEYS, vol. 4, no. 3, pp. 220-226, 2023. https://doi.org/10.22141/2307-1257.8.3.2019.176456 7. F. N. Hidayah, A. F. Naufal and A. Pradana. Physiotherapy management in bilateral knee osteoarthritis by providing Table 4: Distribution of cases based on the affected side Side Affected side Frequency Percent Valid percent Cumulative percent Right 6 20.0 20.0 20.0 Left 8 26.7 26.7 46.7 Bilateral 16 53.3 53.3 100.0 Total 30 100.0 100.0 Table 2: Descriptive statistics Variable N Minimum Maximum Mean Std. deviation Age 30 32 78 57.27 11.182 Weight 30 60 111 82.17 11.061 Table 3: Gender Genders Frequency Percent Valid percent Cumulative percent Male 15 50.0 50.0 50.0 Female 15 50.0 50.0 100.0 Total 30 100.0 100.0 Table 1: Pain scores over time for group Group Sample Size (n) Pre-treatment pain score (Mean±SD) Post-treatment pain score (Mean±SD) Mean difference P-value 95% Confidence interval Total Participants 30 4.3±1.2 2.86±1.1 1.44 <0.05 [2.3, 3.4] Figure 2: Side direction illustration of the patient Sharif, et al.: Effect of Deep Thermal Therapy on Knee Osteoarthritis 131 http://journals.cihanuniversity.edu.iq/index.php/cuesj CUESJ 2024, 8 (2): 128-131 manual therapy and exercise therapy: Case report. 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