Effectiveness of Radial Extracorporeal Shock Wave Therapy in Patients With Knee Osteoarthritis

The study was planned as a randomized controlled trial. Eligible patients who meet the inclusion criteria, will be invited to the study.

Patients who accepted to participate in the study by meeting the criteria will be randomly divided into two groups as the first group treatment ESWT + exercise, the second group sham ESWT + exercise. Computer-aided software will be used to assign patients to treatment groups.

The following evaluations will be made: Visual Analog Scale (VAS), Patient Global Assessment (PGA), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 6-minute walk test (6MWT).

VAS is widely used in the assessment of pain. In the present study, pain was assessed in three conditions: at rest, during movement, and at night.

PGA is an instrument used in clinical settings to capture the patient's subjective appraisal of overall health and disease-related well-being, serving as a concise indicator of disease activity.

WOMAC is widely used to evaluate the functional status of patients with knee osteoarthritis. High WOMAC values indicate increased pain and stiffness/stiffness, and impaired physical function.

6MWT will be done by the physician in the marked corridor of 30 meters in our clinic. At the end of 6 minutes, the total distance they walked will be determined and recorded in meters.

The exercises to be applied to each group are knee range of motion and strengthening exercises for the knee. It will be checked by phone on a weekly basis.

The first group will receive ESWT and exercise therapy. ESWT application will be given to the medial part of the knee region on the side where the pain is described, on the patellofemoral and tibiofemoral joint lines and once a week in a total of four sessions.

The second group will receive sham ESWT and exercise therapy. Sham ESWT application will be given to the medial part of the knee region on the side where the pain is described, on the patellofemoral and tibiofemoral joint lines and once a week in a total of four sessions.

Before starting the 4-session treatment program, at the end of the treatment program and at the twelfth, twenty-fourth weeks from the beginning of the treatment, the scales and tests under the heading of evaluations will be administered.

The sample calculation was made on the effect size. When the effect size of the difference between the two treatment groups in terms of change in VAS is taken as 0.8, when the sample is calculated using the Mann-Whitney U test with a significance level of 0.05 and a power of 0.85, the sample study is 36 patients per group and a total of 72 patients in total was found to be sufficient.

Inclusion criteria

• Being over 50-85 years old.
• Diagnosis of knee osteoarthritis according to ACR clinical/radiological diagnostic criteria
• Stage 2 and above according to Kellgren Lawrence (K-L)
• Completion of Informed Signed Consent Form

Exclusion criteria

• Gait disorders due to orthopedic or neuromuscular disease
• Participation in a structured physical rehabilitation program in the last 12 months before the study
• Those who have had an intra-articular injection of the knee in the last 6 months
• History of lower extremity surgery
• Those with mechanical instability in the knee, a history of infection, malignancy
• Inflammatory rheumatic diseases (rheumatoid arthritis, spondyloarthritis etc.)
• A medical diagnosis or self-reported cognitive impairment
• Presence of progressive cancer AND/OR other diseases that impair general condition
• Situations where ESWT application is contraindicated
• Having previously received ESWT treatment
• Patients with hip and/or ankle pathology