What is the evidence for cryotherapy in patients with knee osteoarthritis for pain reduction and functional improvement?
AMSTAR Rating
Summary
Patient Population:
This meta-analysis included five randomized controlled trials (RCTs) that focused on adults diagnosed with knee osteoarthritis (OA). A total of 201 participants were included in the study (Male=65, Female=136) with an average age of 61.
Intervention:
Intervention groups were treated with cryotherapy (CT) associated or not with kinesiotherapy and/or compression.
While there was no standardized duration or frequency of treatment, four studies applied ice for 20 minutes per application; the fifth study did not specify their period of application. Frequency of application varied from treatment twice a day for three weeks, up to three times a week over eight weeks.
- Clarke et al. (1974): 3 sessions a week for 3 weeks.
- Silva et al. (2007): 10 sessions, twice a week, for 5 weeks before kinesiotherapy.
- Aciksoz et al. (2017): 2 times a day, for 3 weeks.
- Dantas et al. (2019): 4 sessions were carried out over 4 consecutive days.
- MohammedSadiq and Rasool (2023): 8 weeks/3 sessions/week on non-consecutive days.
Comparison:
Various study comparison groups were treated with non-tuned short-wave diathermy, placebo (with sandbags), or exercise programs and education on knee OA.
Outcome:
Pain, functionality, and muscle strength were assessed. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS), Knee Injury and Osteoarthritis Outcome Score (KOOS), Lequesne, and scale of Pain intensity (0-3) were used to assess pain and function. One study also used a modified sphygmomanometer test to assess muscle strength.
- A pooled effect estimate of the studies showed statistically significant results for pain reduction compared to control groups (SMD = −0.57; 95% (95%) CI; [−0.97, −0.18]; p = 0.004; I2 = 42%).
- Assessing functional scores in four of the RCT’s included in this review, there was a slight trend in favour of CT, but without statistically significant results (SMD = −0.28; 95% (95%) CI; [−0.58, 0.02]; p = 0.07; I2 = 0%).
- Only one study assessed muscle strength and found insignificant improvement with the application of CT.
Guideline Recommendations
| Source | Recommendation |
|---|---|
| American College of Rheumatology (2019) | Conditionally Recommended |
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Pain
Short term (3-8 weeks)
Long term
Function
Short or Long term
Muscle strength
Short or Long term
Relevant Clinical Info
MohammedSadiq HA, Rasool MT. Effectiveness of home-based conventional exercise and cryotherapy on daily living activities in patients with knee osteoarthritis: A randomized controlled clinical trial. Medicine (Baltimore). 2023 May 5;102(18):e33678. doi: 10.1097/MD.0000000000033678. PMID: 37145013; PMCID: PMC10158910.
The study by MohammedSadiq and Rasool (2023) is the most recent RCT included in the meta-analysis, scoring an unclear risk of bias based on the Cochrane tool. This prospective, randomized, double-blind study examined 34 participants (Male=8, Female=26) living with a diagnosis of knee OA grade ≤3. Participants had an average age of 51.60 and were split into three groups. The intervention group received cryotherapy for 20 minutes at a time over three sessions a week for eight weeks, in combination with home exercise and education. The first control group received home exercise and education alone. The second control group received education and standard physiotherapeutic services. Based on WOMAC scores, the intervention (CT) group had statistically significant improvement compared to the control groups in pain (2.22 vs 4.81 and 12.7; P < .0001), stiffness (0.39 vs 1.56 and 4.33; P < .0001), physical function (5.72 vs 13.31 and 38.13; P < .0001), and the total score (8.33 vs 19.69 and 55.33; P < .0001) at 2 months.
Participant Information
of participants
were Female
The sample size was 201
Mean age of 61 years.
There were 5 studies used.
