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Protocol-optimizing study of combining Tuina and horse-riding squat exercise for knee osteoarthritis

推拿结合马裆势练习治疗膝骨关节炎的优化方案研究

  • Clinical Study
  • Published:
Journal of Acupuncture and Tuina Science Aims and scope Submit manuscript

Abstract

Objective

To evaluate the efficacy of Tuina (Chinese therapeutic massage) manipulation plus horse-riding squat exercise in treating knee osteoarthritis (KOA) and optimize the combining protocol.

Methods

Based on a 2×2 factorial design, 120 eligible KOA patients were randomized into a manipulation group (group A1B2), a manipulation plus horse-riding squat group (group A1B1), a sitting knee-adjustment group (group A2B2 group), and a sitting knee-adjustment plus horse-riding squat group (group A2B1), with 30 cases in each group. The intervention was conducted three times a week, lasting for four weeks. The Western Ontario and McMaster Universities osteoarthritis index (WOMAC) was taken as the major measure for efficacy evaluation (including three component scores, pain, stiffness, and daily function, and total score).

Results

The three component scores (pain, stiffness, and daily function) and the total score of WOMAC showed significant differences after the intervention in the four groups (P<0.05). There were significant inter-group differences in the WOMAC stiffness score amongst the four groups after the intervention (P<0.05). In group A1B1, the step length, stride, walking speed, and knee joint flexion angle changed significantly after treatment (P<0.05). After the intervention, the step length changed significantly in group A1B2 (P<0.05), and the walking speed changed significantly in group A2B1 (P<0.05). There were no significant differences in the step length, stride, walking speed, or knee joint flexion angle among the four groups (P>0.05). The extensor peak torque at 180 °/s changed significantly in group A1B2 after treatment (P<0.05). Neither the intra-group nor the inter-group comparisons of the four groups revealed significant differences in the other isokinetic muscle strength parameters (P>0.05). The main effect of manipulation showed significant in affecting the WOMAC pain and total scores (P<0.05). The main effect of horse-riding squat exercise showed significant in affecting the WOMAC pain and stiffness scores (P<0.05).

Conclusion

The four treatment protocols all can improve the symptoms of KOA, for instance, relieving pain and stiffness, and enhancing daily function. Group A2B1 produces the most eminent effect in relieving joint stiffness. The main effects of both manipulation and horse-riding squat exercise are significant in reducing pain. Besides, the main effect of horse-riding squat exercise is significant in relieving joint stiffness.

【摘要】

目的

评价推拿手法结合马裆势练习治疗膝骨关节炎(KOA)的疗效, 以优化组合方案。

方法

采用2×2析因设计, 将120例符合纳入标准的KOA患者随机分为手法组(A1B2组), 手法结合马裆势组(A1B1组), 坐位调膝组(A2B2组)和坐位调膝结合马裆势组(A2B1组), 每组30例。患者每周干预3次, 持续4周。主要疗效评价指标为西安大略与麦克马斯特大学骨关节炎指数(WOMAC)评分(包括疼痛、僵硬、日常功能3项评分和总分), 次要疗效评价指标为步态分析(包括步长、步幅、步速和膝关节屈曲角度)和等速肌力测试(60 °/s和180 °/s角速度下的屈肌和伸肌峰力矩)。

结果

四组WOMAC疼痛、僵硬、日常功能3项评分和总分治疗前后组内差异均具有统计学意义(P<0.05)。四组治疗后WOMAC僵硬评分有统计学差异(P<0.05)。A1B1组治疗前后步长、步幅、步速及膝关节屈曲角度的差异有统计学意义(P<0.05); A1B2组治疗前后步长具有统计学差异(P<0.05), A2B1组治疗前后步速具有统计学差异(P<0.05)。四组步长、步幅、步速和膝关节屈 曲角度组间差异均无统计学意义(P>0.05)。A1B2组治疗前后180 °/s角速度伸肌峰力矩有统计学差异(P>0.05)。等速肌力 测试的其余指标四组组内及组间差异均无统计学意义(P>0.05)。手法主效应对于WOMAC疼痛评分及总分的改变有统 计学意义(P>0.05); 马裆势练习主效应对WOMAC疼痛和僵硬评分的改变具有统计学意义(P>0.05)。

结论

四种治疗方 案均可以改善KOA症状, 如缓解疼痛和僵硬, 增强日常功能。A2B1组关节僵硬减轻效果最佳。手法治疗和马裆势练习 在缓解疼痛方面都起主效应作用。马裆势练习在减轻关节僵硬方面起主效应作用。

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Acknowledgments

This work was supported by National Natural Science Foundation of China (国家自然科学基金项目, No. 8197151584); Shanghai Sailing Program (上海市“科技创 新行动计划”启明星培育杨帆专项, No. 22YF1444300); Three-year Development Project for Traditional Chinese Medicine of Shanghai [上海市进一步加快中医药事业发 展三年行动计划, No. ZY(2018–2020)-ZWB-1001-FWB-08]; Project of Non-drug Therapy Clinical Research Center (非药物疗法临床研究中心项目); Project Within the Budget of Shanghai University of Traditional Chinese Medicine (上海中医药大学预算内项目, No. 2021LK091).

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Authors and Affiliations

  1. Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China

    Hua Xing  (邢华), Li Gong  (龚利), Jianhua Li  (李建华), Sheng Shao  (邵盛), Yuzhou Chu  (储宇舟), Pengfei He  (何鹏飞), Hao Chen  (陈浩), Zhiran Kang  (康知然) & Dacheng Dai  (戴大城)

  2. Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, China

    Jiayun Shen  (沈佳韵)

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  1. Hua Xing  (邢华)
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  3. Li Gong  (龚利)
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  5. Sheng Shao  (邵盛)
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  6. Yuzhou Chu  (储宇舟)
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  7. Pengfei He  (何鹏飞)
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  8. Hao Chen  (陈浩)
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  9. Zhiran Kang  (康知然)
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  10. Dacheng Dai  (戴大城)
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Corresponding authors

Correspondence to Li Gong  (龚利) or Jianhua Li  (李建华).

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Co-first Authors

XING Hua, doctoral candidate, resident physician; SHEN Jiayun, master degree, resident physician

Conflict of Interest

There is no potential conflict of interest in this article.

Statement of Informed Consent

The protocol and informed consent were approved by the Medical Ethics Committee of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine (Approval No. 2015034). This trial was registered in Chinese Clinical Trial Registry (No. ChiCTR-INR-17011916). Informed consent was obtained from all individual participants.

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Xing, H., Shen, J., Gong, L. et al. Protocol-optimizing study of combining Tuina and horse-riding squat exercise for knee osteoarthritis. J. Acupunct. Tuina. Sci. 20, 139–151 (2022). https://doi.org/10.1007/s11726-022-1305-9

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  • DOI: https://doi.org/10.1007/s11726-022-1305-9

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