Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

First Advisor

Samuel Cheng

Date of original Performance / Presentation

January 2025

Publication Date / Copyright Date

1-1-2025

Abstract

Abstract Background Knee osteoarthritis (OA) is a degenerative joint disorder associated with chronic pain, reduced mobility, and diminished quality of life. Extracorporeal shockwave therapy (ESWT) has emerged as a promising non-invasive treatment, though its effectiveness and predictors of clinical outcomes remain uncertain. Objective This study aimed to assess the therapeutic efficiency of ESWT in patients with knee OA and identify baseline predictors of treatment outcomes. Methods A prospective interventional study was conducted on patients with radiographically and clinically confirmed knee OA. Participants underwent radial ESWT for four weeks alongside a standardized home-based exercise program. Outcome measures included pain (Visual Analog Scale), pressure pain threshold (PPT), knee range of motion (ROM), and isometric muscle strength. Functional outcomes were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Functional Reach Test (FRT), and Global Rating of Change (GROC). Biomechanical parameters like Q-angle, tibiofemoral alignment, and navicular drop were also recorded. Data were analyzed using repeated measures ANOVA and linear regression. Results Participants showed significant clinical improvement following the intervention. Pain scores decreased by over 80% by Week 6, with reductions evident from Week 2. PPT increased across multiple anatomical regions, reflecting reduced peripheral sensitivity. Functional outcomes, including WOMAC and FRT, improved significantly from Week 3 onward. Strength gains were observed in both quadriceps and hamstrings, accompanied by enhanced knee ROM in flexion and extension. Week-to-week improvements across all outcomes were statistically significant. Discussion The observed benefits appear to result from multiple mechanisms. ESWT likely influences nociceptive modulation, reduces inflammation, and enhances angiogenesis through vascular endothelial growth factor (VEGF) and nitric oxide pathways. Biomechanical measurements, especially in Q-angle and tibiofemoral alignment, predicted recovery specifically in female participants. Strength gains correlated with baseline functional reach and reciprocal muscle strength, suggesting a neuromuscular synergy. Conclusion ESWT is an effective adjunct to exercise-based rehabilitation in knee OA, leading to meaningful improvements in pain, strength, and function. Individual outcomes are influenced by baseline neuromuscular and biomechanical factors, highlighting the value of personalized treatment plans incorporating ESWT. Keywords Knee osteoarthritis, extracorporeal shockwave therapy, pain, biomechanics, functional outcome, physical therapy, rehabilitation.

Disciplines

Physical Therapy

Keywords

biomechanics rehabilitation; extracorporeal shockwave therapy; functional outcome; Knee osteoarthritis; pain; physical therapy

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