Evaluation
The participants were evaluated in 3phases: at the initial evaluation (pretreatment), immediately after treatment,
and at a 12-month follow-up. An 11-point numerical pain rating scale (NPRS) was used to measure pain during the last 2 days of treatment, where 0 corresponded to “no pain” and 10 corresponded to “worst imaginable ain.” The NPRS has been shown to yield reliable and valid scores, with an MCID of 2 points.25,26 We administered a validated KOOS questionnaire as a functional measure. 27,28 The KOOS questionnaire is designed specifically for patients with knee injuries and OA. It consists of 5 subscales: symptoms, daily activities, pain, recreational function, and quality of life. The answers are based on reports from the previous week, where a score of 0 corresponds to “functional impairment” with exacerbated symptoms and a score of 100 corresponds to “normal function” without symptoms. Each subscale was normalized and analyzed individually. The MCID of the KOOS is not yet well defined, but may vary between 10% and 40% depending on the initial result.23,24 We did not perform a 12-month follow-up of the control group because after the first arm of the study, the participants in that group were referred for traditional physical therapy.