Effect Of Manual Traction Physotherapy On Knee Injury And Osteoarthritis Outcome Score And Interleukin-6 Levels In Patient Knee Osteoarthritis
DOI:
https://doi.org/10.35451/qfcdnb48Keywords:
Knee osteoarthritis, Manual traction, Interleukin-6, KOOSAbstract
Background: Knee osteoarthritis (OA) is the most common degenerative joint disease with a high global prevalence. It causes pain, joint stiffness, muscle weakness, and reduced functional activity, significantly affecting patients' quality of life. Inflammatory factors, particularly interleukin-6 (IL-6), play a role in the pathogenesis of knee OA, contributing to inflammation and pain sensitization. Non-pharmacological management of knee OA includes physiotherapy manual traction therapy, aimed at reducing pain and improving joint function. However, the relationship between manual traction and the reduction of IL-6 levels as well as improvements in the Knee Injury and Osteoarthritis Outcome Score (KOOS) has not been widely studied. Objective: To analyze the effect of physiotherapy manual traction on KOOS values and serum interleukin-6 (IL-6) levels in patients with knee osteoarthritis. Methods: This experimental study used a pre-post test design involving 36 patients with knee OA who received manual traction interventions twice a week for four weeks. KOOS values and IL-6 levels were measured before and after the intervention. Data were analyzed using the Wilcoxon test and Spearman correlation.
Results: A significant increase in KOOS scores was observed after the intervention (p = 0.001), but no significant reduction in IL-6 levels was found (p = 0.491). The correlation between changes in IL-6 levels and KOOS scores was very weak and not statistically significant (r = 0.122; p = 0.760).
Conclusion: Manual traction physiotherapy significantly improves knee joint function and quality of life in patients with knee OA, but does not significantly reduce serum IL-6 levels over a short intervention period. Moreover, the correlation between changes in IL-6 and KOOS scores is very weak and not statistically significant
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[1] Cui A, Li H, Wang D, Zhong J, Chen Y, & Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. Eclinicalmedicine. 2020;29
[2] Sasono B, Amanda NA, & Dewi DNSS. Faktor dominan pada penderita osteoarthritisdi Rsud Dr. Mohamad Soewandhie, Surabaya, Indonesia.
[3] Sukerkar PA, & Doyle Z. Imaging of osteoarthritis of the knee. Radiologic Clinics. 2022;60(4):605–616
[4] Ahmad IW, Rahmawati LD, & Wardhana TH. Demographic profile, clinical and analysis of osteoarthritis patients in Surabaya. Age. 2018;40(49):7
[5] Hunter DJ, March L, & Chew M. Osteoarthritis in 2020 and beyond: a Lancet Commission. The Lancet. 2020;396(10264):1711–1712
[6] Kamsan SS, Singh DKA, Tan MP, & Kumar S. The knowledge and self-management educational needs of older adults with knee osteoarthritis: a qualitative study. PLOS ONE. 2020;15(3):e0230318
[7] Fu K, Robbins SR, & Mcdougall JJ. Osteoarthritis: the genesis of pain. Rheumatology. 2018;57(Suppl_4):iv43–iv50
[8] Thomas S, Browne H, Mobasheri A, & Rayman MP. What is the evidence for a role for diet and nutrition in osteoarthritis? Rheumatology. 2018;57(Suppl_4):iv61–iv74
[9] Batushansky A, Zhu S, Komaravolu RK, South S, Mehta-D’souza P, & Griffin TM. Fundamentals of OA. An initiative of osteoarthritis and cartilage. Obesity and metabolic factors in OA. Osteoarthritis and Cartilage. 2022;30(4):501–515
[10] Koyama T, Uchida K, Fukushima K, Ohashi Y, Uchiyama K, Inoue G, Takahira N, & Takaso M. Elevated levels of TNF-α, IL-1β and IL-6 in the synovial tissue of patients with labral tear: a comparative study with hip osteoarthritis. BMC Musculoskeletal Disorders. 2021;22:1–7
[11] Mathiessen A, & Conaghan PG. Synovitis in osteoarthritis: current understanding with therapeutic implications. Arthritis Research & Therapy. 2017;19:1–9
[12] Liu S, Deng Z, Chen K, Jian S, Zhou F, Yang Y, Fu Z, Xie H, Xiong J, & Zhu W. Cartilage tissue engineering: from proinflammatory and anti-inflammatory cytokines to osteoarthritis treatments. Molecular Medicine Reports. 2022;25(3):1–15
[13] Baran P, Hansen S, Waetzig GH, Akbarzadeh M, Lamertz L, Huber HJ, Ahmadian MR, Moll JM, & Scheller J. The balance of interleukin (IL)-6, IL-6·soluble IL-6 receptor (sIL-6R), and IL-6·sIL-6R·sgp130 complexes allows simultaneous classic and trans-signaling. Journal of Biological Chemistry. 2018;293(18):6762–6775
[14] Rose-John S. Interleukin-6 family cytokines. Cold Spring Harbor Perspectives in Biology. 2018;10(2):a028415
[15] Molnar V, Matišić V, Kodvanj I, Bjelica R, Jeleč Ž, Hudetz D, Rod E, Čukelj F, Vrdoljak T, & Vidović D. Cytokines and chemokines involved in osteoarthritis pathogenesis. International Journal of Molecular Sciences. 2021;22(17):9208
[16] Nees TA, Rosshirt N, Zhang JA, Reiner T, Sorbi R, Tripel E, Walker T, Schiltenwolf M, Hagmann S, & Moradi B. Synovial cytokines significantly correlate with osteoarthritis-related knee pain and disability: inflammatory mediators of potential clinical relevance. Journal of Clinical Medicine. 2019;8(9):1343
[17] Miller RE, et al. The role of interleukin-6 in pain and pain sensitization in osteoarthritis. Osteoarthritis and Cartilage. 2020; 28(10):1300–1310.
[18] Mun CJ, Letzen JE, Nance S, Smith MT, Khanuja HS, Sterling RS, Bicket MC, Haythornthwaite JA, Jamison RN, & Edwards RR. Sex differences in interleukin-6 responses over time following laboratory pain testing among patients with knee osteoarthritis. The Journal of Pain. 2020;21(5–6):731–741
[19] Wang Y, et al. The role of subchondral bone in the pathogenesis of osteoarthritis. Journal of Orthopaedic Surgery and Research. 2021;16(1):1-10
[20] Bruyère O, Honvo G, Veronese N, Arden NK, Branco J, Curtis EM, Al-Daghri NM, Herrero-Beaumont G, Martel-Pelletier J, & Pelletier J-P. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Seminars in Arthritis and Rheumatism. 2019;49(3):337–350.
[21] Allaeys C, Arnout N, Van Onsem S, Govaers K, & Victor J. Conservative treatment of knee osteoarthritis. Acta Orthop Belg. 2020;86(3):412–421.
[22] Lim WB, & Al-Dadah O. Conservative treatment of knee osteoarthritis: a review of the literature. World Journal of Orthopedics. 2022;13(3):212.
[23] Deveza LA, Hunter DJ, & Van Spil WE. Too much opioid, too much harm. Osteoarthritis and Cartilage. 2018;26(3):293–295
[24] Kloppenburg M, & Berenbaum F. Osteoarthritis year in review 2019: epidemiology and therapy. Osteoarthritis and Cartilage. 2020;28(3):242–248
[25] Henriksen M, Nielsen SM, Christensen R, Kristensen LE, Bliddal H, Bartholdy C, Boesen M, Ellegaard K, Hunter DJ, & Altman R. Who are likely to benefit from the Good Life with osteoarthritis in Denmark (GLAD) exercise and education program? An effect modifier analysis of a randomised controlled trial. Osteoarthritis and Cartilage. 2023;31(1):106–114
[26] Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, Callahan L, Copenhaver C, Dodge C, & Felson D. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis & Rheumatology. 2020;72(2):220–233.
[27] Wang W, Niu Y, & Jia Q. Physical therapy as a promising treatment for osteoarthritis: a narrative review. Frontiers in Physiology. 2022;13:1011407
[28] Saputra RW. Pengaruh kombinasi muscle energy technique dan traksi manual terhadap penurunan nyeri dan peningkatan kemampuan aktifitas fungsional pada penderita osteoartritis lutut di RS. PHC Surabaya. Kieraha Medical Journal. 2023;5(2):121–128
[29] Muthiah S, & Rini I. Efek traksi translasi dan contrax relax terhadap perubahan range of motion dan nyeri pada penderita osteoartritis. Media Kesehatan Politeknik Kesehatan Makassar. 2022;17(1):66–69.
[30] Wijianto W, Dewangga MW, & Choirunisa D. Pengaruh penambahan traksi pada intervensi Graston technique terhadap penurunan nyeri gerak pada lansia dengan osteoarthritis lutut. Prosiding University Research Colloquium. 2019;157–161
[31] Davis AM, King LK, Stanaitis I, & Hawker GA. Fundamentals of osteoarthritis: outcome evaluation with patient-reported measures and functional tests. Osteoarthritis and Cartilage. 2022;30(6):775–78.
[32] Mugada V, Kondru P, Manda SN, Vegi M, & Kakada S. Assessment of patient relevant outcomes in knee osteoarthritis patients using the Knee Injury and Osteoarthritis Outcome Score (KOOS) scale. Journal of Research in Pharmacy. 2020;24(5)
[33] Roos EM. 30 years with the Knee Injury and Osteoarthritis Outcome Score (KOOS). Osteoarthritis and Cartilage. 2023
[34] Fleisher IT, Thompson MC, Mensah CJ, Joseph AD, Mclawhorn AS, Padgett DE, & Lyman S. Development and validation of crosswalks between the Western Ontario & Mcmaster Universities Osteoarthritis Index and Hip Disability and Osteoarthritis Outcome Score Joint Replacement/Knee Injury and Osteoarthritis Outcome Score Joint Replacement. The Journal of Arthroplasty. 2022;37(6):1034–1039.
[35] Nugraha RW, Kurniati M, Detty AU, & Marlina D. Hubungan antara usia, pekerjaan dan jenis kelamin dengan kejadian osteoartritis di RSUD Dr. H. Abdul Moeloek Provinsi Lampung. Jurnal Ilmu Kedokteran Dan Kesehatan. 2023;10(10):3073–3082
[36] Contartese D, Tschon M, De Mattei M, & Fini M. Sex specific determinants in osteoarthritis: a systematic review of preclinical studies. International Journal of Molecular Sciences. 2020;21(10):3696
[37] Berampu S, Siahaan T, Jehaman I, Ginting S, & Mekarsari D. Pelaksanaan manual traksi dan isometrik exercise terhadap peningkatan aktivitas fungsional pada penderita osteoarthritis knee di Rumah Sakit Grandmed Lubuk Pakam. Jurnal Pengmas Kestra (Jpk). 2021;1(1):173–179
[38] [40] Mcdevitt AW, O’Halloran B, & Cook CE. Cracking the code: unveiling the specific and shared mechanisms behind musculoskeletal interventions. Archives of Physiotherapy. 2023;13(1):14
[39] Mabey T, Honsawek S, Tanavalee A, Yuktanandana P, Wilairatana V, & Poovorawan Y. Plasma and synovial fluid inflammatory cytokine profiles in primary knee osteoarthritis. Biomarkers. 2016;21(7):639–644
[40] Chen W, et al. Biomechanical unloading modulates synovial inflammation in knee osteoarthritis: a randomized trial. Journal of Orthopaedic Research. 2023;41(8):1789-1801.
[41] Patel S, et al. Kinetics of systemic cytokine responses to manual therapy in osteoarthritis: implications for trial design. Osteoarthritis and Cartilage. 2022;30(11):1456-1465.
[42] Rossi F, et al. Dual role of IL-6 in joint homeostasis and inflammation: implications for manual therapy. Arthritis Research & Therapy. 2023;25(1):78.
[43] Garcia A, et al. Adipose tissue-derived IL-6 limits the efficacy of mechanical interventions in obese osteoarthritis patients. Cells. 2022;11(21):3354.
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