EVALUATING THE EFFECTIVENESS OF LASER ACUPUNCTURE COMBINED WITH QIGONG IN THE TREATMENT OF KNEE OSTEOARTHRITIS

Summary

Objective: To evaluate the effectiveness of the treatment of knee osteoarthritis by the laser acupuncture combined with Qigong. Subjects and research methods: A controlled clinical intervention was conducted on 70 patients with knee osteoarthritis, were divided into 2 groups. The research group was treated with the laser acupuncture combined with Qigong. The control group was treated with electroacupuncture combined with Qigong during a 21- days course of treatment. Results: The laser acupuncture combined with Qigong is effective in reducing the pain level according to VAS scale, improving knee function according to the WOMAC scale and increasing the range of knee motion (p<0.01). The treatment results: the good results was 48.6%, quite good was 45.7%, average was 5.7%, there were no ineffective results; equivalent to the group treated with electroacupuncture combined with Qigong, (p>0.05). Conclution: laser acupuncture combined with Qigong have effective in treatment of knee osteoarthritis.

I. INTRODUCTION

            Knee osteoarthritis is a chronic disease, the second leading cause of disability for the elderly after cardiovascular disease, with the main symptoms being pain and limited movement. Regarding the treatment of osteoarthritis, modern medicine mainly uses pain-relieving drugs to reduce systemic inflammation or use drugs injected directly into the knee joint [1]. These groups of drugs have the effect of reducing pain and slowing down the process of knee osteoarthritis, but sometimes also cause some adverse effects, especially unwanted effects on the digestive tract.

According to traditional medicine knee osteoarthritis is a disease with the name Hạc Tất Phong and there are many effective treatment methods in Traditional Medicine such as acupuncture, acupuncture, acupressure, and nourishing qigong. ...[2]. Currently, in clinical practice laser acupuncture is a non-invasive treatment method, using low-power laser beams to target acupuncture points in the meridian system. The bio-stimulating effect of the laser has the effect of enhancing local metabolism, combined with the effect of clearing the meridians and qi, only when stimulating at acupuncture points according to traditional medicine theory, it is very suitable for applying this treatment. Treatment of musculoskeletal diseases including periarthritis humeroscapularis [3], [4], [5].

With the aim of providing clinicians with an option for treating a number of chronic diseases using a multi-therapy approach, combining the effectiveness of physician treatment with self-practice methods, we conducted research. Researched the topic with the goal of evaluating the clinical effectiveness of treating knee osteoarthritis by laser acupuncture combined with physical exercise.

II. RESEARCH SUBJECTS AND METHODS

1. Research subjects:

Patients diagnosed with knee osteoarthritis treated at the National Hospital of Acupuncture from May 2023 to November 2023, were selected for the study according to the following criteria:

- Selection criteria according to modern medicine: Patients diagnosed with knee osteoarthritis according to the standards of the American College of Rheumatology (ACR) (1991) with the following symptoms [1]:

1. Knee pain.
2. Bone spurs at the joint edge on X-ray.
3. Joint fluid is a degenerative fluid.
4. Age ≥ 35.
5. Morning stiffness for less than 30 minutes.
6. Creaking in joints when moving.

Diagnosis is determined when factors 1, 2 or 1, 3, 5, 6 or 1, 4, 5, 6 are present.

- Patients with VAS score ≤ 6.

- X-ray: Knee osteoarthritis stages I and II according to Kellgren and Lawrence 1987.

- Patients agree and voluntarily participate in the research after being clearly explained about the research objectives.

- Patient selection criteria according to Traditional Medicine: Patients are diagnosed with knee osteoarthritis according to Modern Medicine standards and are diagnosed with Kidney failure or Kidney failure with rheumatoid wind and cold with the following symptoms [6].

- Observation: difficulty walking, limited knee flexion, no swelling or redness. The tongue is pale, with thin white tongue coating

- Listening-Smell: there may be a crunching sound when moving the knee joint.

- Ask a question: Knee joints and limbs have severe pain and fatigue, increased pain in cold, like warm compresses, massage, weak back and knees, numb limbs.

- Touching: The place is not hot, the sentence is good, the vein is mysterious and clear.

- Exclusion criteria:

  + Osteoarthritis of the knee due to secondary causes

+ Co-morbidity with other medical diseases (heart failure, liver and kidney failure...)

           - Patients have been treated with non-steroidal anti-inflammatory drugs within the past 10 days or have had local corticosteroid injections within the last 3 months.

+ Pregnant and lactating women

          - The patient does not comply with the treatment course and regimen.

2.2. Research Methods

- Research design: Prospective research method, clinical intervention, controlled, comparison before and after treatment.

- Research sample size and implementation method: Select the sample purposefully until there are 70 patients who meet the research criteria, divided into 2 treatment groups according to the following treatment regimen:

+ Group 1 (research group): Includes 35 patients, treated with Including 35 patients, treated with laser acupuncture combined with self-practice of nourishing qigong 45 minutes/day according to Nguyễn Văn Hưởng method [7] .

+ Group 2 (control group): Includes 35 patients, treated with electro-acupuncture combined with self-training with nourishing qigong according to the same regimen as the research group.

Both study groups received a 21-days treatment course.

* Research targets and how to determine research targets

- General characteristics: including distribution by age group, gender, obesity status (BMI) and lesion location, assessed at the time of admission to the hospital by interview method.

- Evaluate the clinical effectiveness of treatment: by converting scores from indicators including pain level according to VAS scale, ability to move the knee joint according to the WOMAC scale and range of motion of the knee joint according to the method. Zero ears at times before and after treatment according to the formula:

Treatment results (K) = [( Score after treatment - Score before treatment) / Score before treatment ] × 100%

Table 2.1. How to evaluate treatment effectiveness

2.3. Data processing method: Research data were processed using SPSS 20.0 program. The difference is statistically significant with p < 0.05.

2.4. Research ethics:

Our research is conducted entirely for the purpose of caring for and protecting the health of patients and has research permission from the Ethics Council of the VietNam University of Traditional Medicine.

III. RESEARCH RESULTS

3.1. Characteristics of research subjects

Table 3.1. Distribution of study patients according to age and gender

Comment: Knee osteoarthritis is most common in people over the age of 60 (33/70 patients). The proportion of women with knee osteoarthritis is higher than that of men (p<0.05), with the average age of osteoarthritis being 57.12 ± 9.35. There was no difference in patient distribution by age group and gender between the 2 study groups (p>0.05).

Table 3.2. Distribution of study patients according to disease duration

Comment: The duration of illness of patients in the study ranged from the highest to >6 months, accounting for 35.7%; <1 month accounts for 27.1%; 3-6 months accounts for 21.4%, the lowest is the 1-3 month group accounting for 15.7%. The difference in disease duration between the two study groups was not statistically significant with p > 0.05.

3.2. Treatment effectiveness of laser acupuncture combined with exercise in the treatment of knee osteoarthritis.

Table 3.3. Changes in some clinical research indicators

Comment: There is no difference in the average value of pain level according to the VAS scale, knee range of motion according to the zero method and knee joint function according to the Womax scale between the 2 study groups (p>0.05 ). After 21 days of treatment, these indicators changed significantly compared to before treatment (p < 0.01). However, there was no significant difference in treatment effectiveness between the group treated with laser acupuncture combined with physical exercise compared to the group treated with electroacupuncture combined with physical exercise (p>0.05).

Table 3.4. General treatment results

Comment: After 21 days of treatment, good treatment results accounted for 48.6% in the control group and 40.0% in the control group; Good category accounts for 45.7% in the experimental group and 48.6% in the control group. Both research groups showed clear effectiveness, but no difference in treatment effectiveness was seen between the two research groups (p > 0.05).

IV. DISCUSS

1. Discuss some characteristics of research patients.

* Age and gender characteristics:

The research results in table 3.1 show that the average age of knee osteoarthritis patients in the study was 57.68 ± 10.17 years old in the control group and 56.56 ± 8.53 years old in the control group. The proportion of osteoarthritis patients aged 50-59 years old accounts for 20% and the group over 60 years old accounts for 67.1%, with no statistically significant difference in age between the study groups with p > 0.05. The proportion of female patients with knee osteoarthritis was greater than that of male patients in all study groups (p<0.05).

The results of studying the age and gender characteristics of patients in our study are similar to the research results of some other authors. Studies have concluded that the incidence of the disease in women is higher than in men and accounts for a high proportion in the age group over 50 [7], [8]. These conclusions may be due to the natural law that as age increases, cartilage cells become older, the ability to synthesize collagen and mucopolysaccharides is reduced and disturbed, and cartilage quality will be poor. Reduced elasticity and bearing capacity. Women over the age of 50 are more susceptible to knee osteoarthritis than men due to hormonal changes common in premenopause, the decline in female sex hormones reduces cartilage cells. Thus, it can be seen that age and gender are the highest risk factors for osteoarthritis in general and osteoarthritis in particular [1], [4].

- Characteristics of disease duration: Table 3.2 shows that disease duration over 6 months accounts for the highest proportion (37.1% in the researcher group and 35.7% in the control group), followed by disease duration illness from 3 to 6 months (accounting for 21.4% in both study groups), the lowest was in the group under 3 months. Thus, osteoarthritis in general and osteoarthritis in particular are chronic diseases, causing pain and joint deformity, often without signs of inflammation, caused by the aging process and prolonged overload of cartilage. joints, gradually affecting the joint's motor function [1]. In the early stages, the patient only needs to rest or take regular painkillers. Patients usually only go to the hospital when joint mobility is affected. This is also the reason why the time of illness until the time of research in our study was quite long.

4.2. On the treatment effectiveness of laser acupuncture combined with exercise in the treatment of knee osteoarthritis.

According to modern medicine, osteoarthritis is the result of mechanical and biological processes that cause an imbalance between synthesis and destruction of cartilage and subchondral bone. The final manifestations of osteoarthritis are morphological, biochemical, molecular and biomechanical changes in the cells and basic substances of cartilage leading to ossification, cracking and loss of articular cartilage, subchondral bone fibrosis, and formation of articular cartilage. bone spurs and subchondral bone cavities, reduced viscosity of fluid in the knee joint, and inflamed knee synovium, leading to pain and limited movement [3].

According to Traditional Medicine, pain is called "Thống", the book Tố Vấn, the book "Âm dương ứng tượng đại luận" writes “Thông tắc bất thống, thống tắc bất thông” (Thống is not unified, Thống is not clear), which can be understood as blood circulation smoothly in the body. There is no pain in the body, but when the meridians are blocked and the blood does not circulate, it causes pain [2], [8]. Therefore, in this study we evaluate the level of pain based on the patient's subjective feelings according to the VAS scale, evaluate the improvement in knee range of motion according to the zero method and evaluate the function of the knee joint according to the Womax scale, these are the evaluation scales used by many authors in studies to evaluate the treatment effectiveness of laser acupuncture combined with exercise in the treatment of knee osteoarthritis. Treatment results are calculated based on the above 3 indicators and divided into 4 levels: very good, good, average, poor results.

Table 3.3 shows that after a 21-day treatment course, all 3 research indicators including pain level, knee joint function and knee joint range of motion increased compared to before treatment in both research groups treated with electroacupuncture combined with physical therapy and in the group of patients treated with laser acupuncture combined with physical therapy (p<0.01), there was no difference in the values of these indices between the two research groups (p> 0.05) with good treatment results in the control group accounting for 48.6%, good for 45.7% and average for 5.7%, equivalent to the control group with good treatment results of 40%; 0% %; good accounts for 48.6% and average accounts for 11.4% (p>0.05). No patient had poor results in both research groups (table 3.4), the electroacupuncture group combined with exercise training also showed similar results. From the above data, it can be seen that for patients with knee osteoarthritis, whether treated with laser acupuncture combined with physical exercise or with electroacupuncture combined with physical exercise, the treatment results are very positive.

The results of our study are similar to the results of some other authors when studying the effectiveness of osteoarthritis treatment using electroacupuncture combined with shock waves or electroacupuncture combined with conditioning exercises [9], [10]. In this study, we have chosen a regimen that includes acupoints located on the meridians related to the diseased area based on the anatomical location of the nerve segment of Traditional Medicine and according to the method of “tuần kinh thủ huyệt” (circulating the acupuncture meridians) of Traditional Medicine, using laser beam technique to target acupuncture points in the selected regimen. Laser acupuncture is a non-invasive treatment method, combining physical therapy and traditional medicine. Laser acupuncture causes biological stimulation to acupuncture points, from which cell tissue in that acupuncture point area absorbs the energy of the laser beam, creating positive responses such as pain relief, muscle relaxation, edema reduction, and anti-inflammation. The effects of laser acupuncture according to the theory of Traditional Medicine can be seen: cellular respiration depends on qi, improving cellular respiration is the process of regulating qi; Circulation belongs to blood, improving microcirculation is the process of blood mixing [4], [5], [8], [11]. Thus, laser has the effect of regulating qi and blood, restoring the balance of yin and yang, which is also the ultimate goal of acupuncture treatment. In addition to using laser acupuncture, osteoarthritis patients in the study were also combined with nutrition exercises according to Nguyễn Văn Hưởng exercises with relaxation exercises that have both physical and mental effects, helping to relax the mind, the practitioner can control the senses, helping to gradually eliminate harmful reflexes for the body. Appropriate anti-sclerosis exercise movements and good effects on the musculoskeletal system help combine with self-massage movements. Acupressure massage helps the patient self-regulate the balance in the body, the meridians and blood circulation are regulated, thereby reducing pain and increasing the range of motion of the joints [7].

V. CONCLUSION

Research on 70 patients with primary knee osteoarthritis, of which 35 patients were treated with laser acupuncture combined with physical therapy, compared with 35 patients treated with electroacupuncture combined with physical therapy in the course of treatment. After 21 days of treatment, we concluded that laser acupuncture combined with exercise is effective in treating primary knee osteoarthritis, specifically:

- Reduced the average value of pain level according to the VAS scale from 5.35 ± 1.08 points before treatment to 1.56 ± 1.14 points after treatment (p < 0.01);

- Reduced WOMAC index from 35.74 ± 10.49 to 18.80 ± 7.70 (points), p<0.01;

- Increases knee joint range of motion from 98.51 ± 12.23 points before treatment to 134.80 ± 5.60 points after treatment (p<0.01)

- General treatment results: Good treatment results account for 48.6%, good treatment results account for 45.7%, average treatment results account for 5.7%, no patient has poor treatment results, equivalent equivalent to the group treated with electroacupuncture combined with exercise, (p >0.05).

Keyword

Knee osteoarthritis,laser acupuncture,Qigong