Secondary Knee Osteoarthritis - Pain Assessment and Functional Evolution after Rehabilitation

The strategies used to monitor adherence to the intervention the session attendance, the VAS scale for pain, the Lequesne index, and the WOMAC scale for functionality – initial, when all patients were included in study and final, after 3 months. We`ll performed the following interventions for all patients: 1. Ultrasound Exam of the Knee (initial and after 3 months) • Supervisor/Provider: The exam is conducted by a qualified sonographer. • Mode of Administration: The examination is carried out on a one-on-one basis in a private setting where only the patient and the sonographer are present. • CARTILAGE THICKNESS – is a study parameter 2. Pressure Pain Assessment with Algometer (bilaterally at the knee using an Algometer II - SBMedic Electronics, Sweden; the probe - 1 cm² will be applied perpendicularly with pressure increasing at ~1 N/s until pain was reported). • Supervisor/Provider: This procedure is supervised and administered by a physiotherapist specialized in pain assessment and treatment. • Mode of Administration: The procedure is performed individually, with the physiotherapist applying pressure directly to the affected knee area to assess the patient's pain level. For areas will be investigated (superior, inferior, medial and lateral knee area) 3. Imagistic X-ray of the Knee: • Supervisor/Provider: The X-ray is performed by a radiologic technician. • Mode of Administration: The procedure is conducted individually in an X-ray room, where the patient is positioned appropriately to obtain the clearest possible images of the knee structure. • KELLGREN-LAWRENCE GRADE will be used to assess the knee osteoarthritis grade 4. Physical procedures (TENS, laser, ultrasound) administered by a physiotherapist in a clinical setting. • Transcutaneous Electrical Nerve Stimulation (TENS) of the quadriceps muscles and calf muscles (Endomed 482, device series 42.400, Enraf-Nonius, Netherlands); 30 min daily session of TENS for 6 days each week using two pairs of 10 cm × 15 cm carbon rubber electrodes (150 cm2), one for each side, stimulated both muscle groups, 15 minutes each region. • Low-Level Laser Therapy (LLLT) 20 minutes, daily (ASTAR PhysioGo 500I/501I Poland, PhysioGo series) Wavelength of 808 nm, a power of 100 mW, and an energy dosage of 7 J / cm2 , energy per point of 0.003 J. Applied for knee girdle muscles, left and right. • Ultrasound (BTL 4000). The treatment is carried out on an individual basis, where the patient is comfortably seated, and the ultrasound head (0.6 W/cm2) is moved in a circular motion over the affected knee area, for 10 minutes, left and right. 5. In-patient kinetic program (stretching, strength, aerobic training) administered by a physiotherapist in a clinical setting. - stretching of adductor and hamstrings muscles, daily, 10 minutes - strength exercises (gluteus medium and quadriceps), daily, 15 minutes - aerobic training (endurance training) performed at 60%–80% of maximum heart rate, according to the equation ((220 – age) × 0.65), three times a week, 40 minutes In-patient kinetic program occurs daily for the duration of hospital stay, as it was mentioned bellow. 6. Out-patient 3 months home-training; occurs 3 days after hospital discharge Aerobic training, three times a week, 40 minutes - Warm-up (10 minutes): gentle stretching and slow walking or stationary cycling - Main Activity (20 minutes): walking on flat surface or treadmill - Cool-down (10 minutes): slow walking and stretching Flexibility training, three times a week, 40 minutes - Warm-up (10 minutes): light cardiovascular exercise like walking or stationary cycling at a very low intensity. - Main Activity (20 minutes): Dynamic stretches: leg swings and arm circles to improve range of motion. Static stretches: hold stretches for each major muscle group for 20-30 seconds, such as hamstring and quadriceps stretches, and arm stretches. - Cool-down (10 minutes): Deep breathing and relaxation techniques to enhance muscle relaxation.