Knee osteoarthritis is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. We conducted a 3-arm, blinded (injector, assessor, injection group participants), randomized controlled trial to assess the efficacy of prolotherapy for knee osteoarthritis.
METHODS
Ninety adults with at least 3 months of painful knee osteoarthritis were randomized to blinded injection (dextrose prolotherapy or saline) or at-home exercise. Extra- and intra-articular injections were done at 1, 5, and 9 weeks with as-needed additional treatments at weeks 13 and 17. Exercise participants received an exercise manual and in-person instruction. Outcome measures included a composite score on the Western Ontario McMaster University Osteoarthritis Index (WOMAC; 100 points); knee pain scale (KPS; individual knee), post-procedure opioid medication use, and participant satisfaction. Intention-to-treat analysis using analysis of variance was used.
RESULTS
No baseline differences existed between groups. All groups reported improved composite WOMAC scores compared with baseline status (P <.01) at 52 weeks. Adjusted for sex, age, and body mass index, WOMAC scores for patients receiving dextrose prolotherapy improved more (P <.05) at 52 weeks than did scores for patients receiving saline and exercise (score change: 15.3 ± 3.5 vs 7.6 ± 3.4, and 8.2 ± 3.3 points, respectively) and exceeded the WOMAC-based minimal clinically important difference. Individual knee pain scores also improved more in the prolotherapy group (P = .05). Use of prescribed postprocedure opioid medication resulted in rapid diminution of injection-related pain. Satisfaction with prolotherapy was high. There were no adverse events.
CONCLUSIONS
Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises.
Accurate adult height prediction is of clinical importance in assessing the need for pharmacological intervention and in the evaluation of the outcome of therapy. The methods currently in use are subject to a wide range of error, one source of which is the use of bone age (BA) measurements. We have developed a computer model for predicting adult height in pubertal boys without using BA determinations. The model is based on the existing Infancy-Childhood-Puberty model and calculates the onset of the pubertal growth spurt. Predicted adult height was assessed using this new model and four others in a group of normal boys and in a group of short normal boys receiving growth hormone. Calculated final heights by all the methods were not significantly different. Incorporation of paternal height into the prediction equations increased the accuracy of the prediction. It was concluded that our new model is as accurate as existing methods of predicting final height that involve assessing BA.
SummaryMeasurement of changes in the physiological cycle-to-cycle variability in gait kinematics using the ELLIS approach holds promise as a new tool for quantitative evaluation of gait adaptabilit...
