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Objective: Randomized and open-label studies assessing prolotherapy for knee osteoarthritis have found quantitative improvement on the validated Western Ontario McMaster University Osteoarthritis Index (WOMAC) compared with baseline status and control therapies. This study assessed the qualitative response of participants receiving prolotherapy, an injection-based complementary treatment for symptomatic knee osteoarthritis (OA). Design: Qualitative study using semi-structured in-depth interviews at 52 weeks after enrollment; transcribed responses were discussed by coauthors to identify themes; disagreement was resolved by consensus. Setting: Outpatient. Participants: Twenty-two participants treated with prolotherapy for symptomatic knee OA who were exited from three randomized and open-label studies. Interventions: Intra- and extra-articular hypertonic dextrose injection (prolotherapy). Main outcome measures: Patient narrative and composite WOMAC questionnaire (0-100 points) scores. Results: Participants had baseline demographic and knee OA severity similar to those of participants in three prior intervention trials, as well as similar robust follow-up WOMAC score change (19.9 ± 12.6 points), suggesting a representative subsample. Seven themes were identified from participant narratives: (1) improvement in knee-specific quality of life ( n = 18), (2) safety and comfort, (3) pretreatment counseling enhanced treatment adherence and optimism, (4) overall positive experience with prolotherapy, (5) limited response to prolotherapy ( n = 4), (6) consistency with anecdotal clinical prolotherapy experience; and (7) functional improvement without pain reduction. Conclusions: Most participants reported substantially improved knee-specific effects, resulting in improved quality of life and activities of daily living; four participants reported minimal or no effect. Clear, complete description of procedural rationale may enhance optimism about and adherence to treatment appointments. [ABSTRACT FROM AUTHOR]

Objectives: This study determined whether injection with hypertonic dextrose and morrhuate sodium (prolotherapy) using a pragmatic, clinically determined injection schedule for knee osteoarthritis (KOA) results in improved knee pain, function, and stiffness compared to baseline status. Design: This was a prospective three-arm uncontrolled study with 1-year follow-up. Setting: The setting was outpatient. Participants: The participants were 38 adults who had at least 3 months of symptomatic KOA and who were in the control groups of a prior prolotherapy randomized controlled trial (RCT) (Prior-Control), were ineligible for the RCT (Prior-Ineligible), or were eligible but declined the RCT (Prior-Declined). Intervention: The injection sessions at occurred at 1, 5, and 9 weeks with as-needed treatment at weeks 13 and 17. Extra-articular injections of 15% dextrose and 5% morrhuate sodium were done at peri-articular tendon and ligament insertions. A single intra-articular injection of 6 mL 25% dextrose was performed through an inferomedial approach. Outcome measures: The primary outcome measure was the validated Western Ontario McMaster University Osteoarthritis Index (WOMAC). The secondary outcome measure was the Knee Pain Scale and postprocedure opioid medication use and participant satisfaction. Results: The Prior-Declined group reported the most severe baseline WOMAC score ( p=0.02). Compared to baseline status, participants in the Prior-Control group reported a score change of 12.4±3.5 points (19.5%, p=0.002). Prior-Decline and Prior-Ineligible groups improved by 19.4±7.0 (42.9%, p=0.05) and 17.8±3.9 (28.4%, p=0.008) points, respectively; 55.6% of Prior-Control, 75% of Prior-Decline, and 50% of Prior-Ineligible participants reported score improvement in excess of the 12-point minimal clinical important difference on the WOMAC measure. Postprocedure opioid medication resulted in rapid diminution of prolotherapy injection pain. Satisfaction was high and there were no adverse events. Conclusions: Prolotherapy using dextrose and morrhuate sodium injections for participants with mild-to-severe KOA resulted in safe, significant, sustained improvement of WOMAC-based knee pain, function, and stiffness scores compared to baseline status. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Single-cohort descriptive and correlational study. OBJECTIVES: To investigate the relationships between tendon pathology, biomechanical measures, and self-reported pain and function in individuals with chronic lateral epicondylosis. BACKGROUND: Lateral epicondylosis has a multifactorlal etiology and its pathophysiology is not well understood. Consequently, treatment remains challenging, and lateral epicondylosis is prone to recurrence. While tendon pathology, pain system changes, and motor impairments due to lateral epicondylosis are considered related, their relationships have not been thoroughly investigated METHODS: Twenty-six participants with either unilateral (n = 11) or bilateral (n = 15) chronic lateral epicondylosis participated in this study. Biomechanical measures (grip strength, rate of force development, and electromechanical delay) and measures of tendon pathology (magnetic resonance imaging and ultrasound) and self-reported pain and function (Patient-Rated Tennis Elbow Evaluation) were performed. Partial Spearman correlations, adjusting for covariates (age, gender, weight, and height), were used to evaluate the relationship between self-reported pain, function, and biomechanical and tendon pathology measures. RESULTS: Statistically significant correlations between biomechanical measures and the Patient-Rated Tennis Elbow Evaluation ranged in magnitude from 0.44 to 0.68 (P<.05); however, no significant correlation was observed between tendon pathology (magnetic resonance imaging and ultrasound) measures and the Patient-Rated Tennis Elbow Evaluation (r = -0.02 to 0.31, P>.05). Rate of force development had a stronger correlation (r = 0.54-0.68, P<.05) with self-reported function score than with grip strength (r = 0.35- 0.47 P<.05) or electromechanical delay (r = 0.5, P<.05). CONCLUSION: Biomechanical measures (pain-free grip strength, rate of force development, electromechanical delay) have the potential to be used as outcome measures to monitor progress in lateral epicondylosis. In comparison, the imaging measures (magnetic resonance imaging and ultrasound) were useful for visualizing the pathophysiology of lateral epicondylosis. However, the severity of the pathophysiology was not related to pain and function, indicating that imaging measures may not provide the best clinical assessment. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine whether prolotherapy, an injection-based complementary treatment for chronic musculoskeletal conditions, improves pain, stiffness, and function in adults with symptomatic knee osteoarthritis (KOA) compared to baseline status. Design: This was a prospective, uncontrolled study with 1-year follow-up. Setting: The study was conducted in an outpatient setting. Participants: Adults with at least 3 months of symptomatic KOA, recruited from clinical and community settings, participated in the study. Interventions: Participants received extra-articular injections of 15% dextrose and intra-articular prolotherapy injections of 25% dextrose at 1, 5, and 9 weeks, with as-needed treatments at weeks 13 and 17. Outcome measures: Primary outcome measure was the validated Western Ontario McMaster University Osteoarthritis Index (WOMAC). Secondary outcome measure was the validated Knee Pain Scale (KPS). Tertiary outcome measure was procedure-related pain severity and participant satisfaction. Results: Thirty-six (36) participants (60±8.7 years old, 21 female) with moderate-to-severe KOA received an average of 4.3±0.7 prolotherapy injection sessions over a 17-week treatment period and reported progressively improved scores during the 52-week study on WOMAC and KPS measures. Participants reported overall WOMAC score improvement 4 weeks after the first injection session (7.6±2.4 points, 17.2%), and continued to improve through the 52-week follow-up (15.9±2.5 points, p<0.001, 36.1%). KPS scores improved in both injected ( p<0.001) and uninjected knees ( p<0.05). Prescribed low-dose opioid analgesia effectively treated procedure-related pain. Satisfaction was high and there were no adverse events. Female gender, age 46-65 years old, and body-mass index of 25 kg/m2 or less were associated with greater improvement on the WOMAC instrument. Conclusions: In adults with moderate to severe KOA, dextrose prolotherapy may result in safe, significant, sustained improvement of knee pain, function, and stiffness scores. Randomized multidisciplinary effectiveness trials including evaluation of potential disease modification are warranted to further assess the effects of prolotherapy for KOA. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis is common and debilitating. Evidence-based care exists; there is a gap between recommended and received are. Multimodal treatment is recommended, with unknown effectiveness. We report pilot feasibility data for a new university-based clinic providing multimodal care for knee and hip osteoarthritis (KHOA)., Methods: Quality-improvement case series with the first 50 patients. A multidisciplinary team provided care. Feasibility outcomes included treatment duration, patient adherence, provision of guideline-recommended care, and satisfaction. Secondary outcomes included self-reported and objectively assessed patient measures., Results: Fifty patients (59±10.5 years, 32 female) received guideline-recommended care; 40 adhered to 3.83±2.21 follow-up visits over 12.24±7.79 months; satisfaction was high. Objectively assessed outcomes improved, but self-reported outcomes did not., Discussion: Early data suggest multimodal care for knee and hip osteoarthritis is feasible and may be associated with improved outcomes., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

Context: Upper respiratory conditions are common and have a significant impact on patient quality of life, medical resource expenditure, and antibiotic use. Saline nasal irrigation (SNI) is an adjunctive therapy for upper respiratory conditions; clinical studies suggest that use of SNI may be effective for symptoms of upper respiratory conditions, and its popularity seems to be growing. The prescribing patterns of physicians regarding SNI have not yet been studied., Objective: To assess the use among family physicians in Wisconsin of SNI, determine how and for which conditions they recommend SNI, and the degree to which they experience clinical success with SNI., Method: This was assessed by an electronic questionnaire of 330 practicing family physicians in the Wisconsin Academy of Family Physicians and Wisconsin Research and Education Network., Results: Analysis showed 286 of 330 respondents (87%) have used SNI as adjunctive care for a variety of upper respiratory conditions including chronic rhinosinusitis (91%), acute bacterial rhinosinusitis (67%), seasonal allergic rhinitis (66%), viral upper respiratory infection (59%), other allergic rhinitis (48%), irritant-based congestion (48%), and rhinitis of pregnancy (17%). Respondents also reported having used SNI prior to antibiotics for acute bacterial rhinosinusitis (77%). Use patterns varied regarding type of SNI administration, dosing frequency, saline concentration, and patient education., Conclusions: This questionnaire-based study suggests that SNI is used by family physicians for a variety of upper respiratory conditions though recommendation and patient education styles, dosing schedules, and solution types vary.