***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of this study was to investigate the effects of focused low-intensity pulsed ultrasound ( FLIPUS ) therapy on the functional and health status of patients with knee osteoarthritis ( KOA ) . A total of 106 subjects with bilateral KOA were r and omized sequentially into two groups . Group I received FLIPUS + diclofenac sodium , and group II received sham FLIPUS + diclofenac sodium . The therapeutic effects of the interventions were evaluated by measuring changes in VAS pain , the WOMAC scores , and the LI scores after 10 days of treatment as well as changes in LI and VAS at follow-up , 4 and 12 weeks later . In addition , changes in the range of motion , ambulation speed , and the SF-36 in each group were recorded after 10 days of treatment . Compared with those in group II , patients in group Ishowed significant improvements in VAS , WOMAC , LI , ambulation speed , and most items in the SF-36 after 10 days of treatment . In addition , patients in group I showed significant improvements in LI and VAS at follow-up . There were no FLIPUS-related  adverse events during and after the interventions . In conclusion , FLIPUS is a safe and effective treatment modality for relieving pain and improving the functions and quality of life of patients with KOA The present study aim ed to compare the efficacy of three different deep heating modalities : phonophoresis ( PH ) , short-wave diathermy ( SWD ) , and ultrasound ( US ) , in knee osteoarthritis . Patients who consented to participate in the study were r and omly divided into the following three groups . Group 1 ( n = 33 ) received PH , Group 2 ( n = 33 ) received US , and Group 3 ( n = 35 ) received SWD . These deep heating therapies were applied by the same therapist . Each therapy began with 20-min hot pack application . Each of the three physical therapy modalities was applied 5 days a week for 2 weeks ( a total of 10 sessions ) . The patients were evaluated using visual analogue scale ( VAS ) at rest , 15-m walking time , and the Western Ontario and McMaster Universities Arthritis Index ( WOMAC ) both before and after the treatment . Moreover , at the end of the treatment , both the physician and the patient made an overall evaluation , by rating the treatment efficacy . The results of the study showed that VAS , 15-m walking time , and WOMAC parameters were improved with all three deep heating modalities , and all the three modalities were effective . However , there was no significant difference between the three modalities in terms of efficacy . There was also no significant difference between the three groups in terms of post-treatment general evaluation of the physician and the patient . The present study is the first to suggest that choosing one of PH/US/SWD therapy options would provide effective results and none of them are superior to the others , and we believe that these findings will be a basis for further studies The index for hip disease ( ISH ) was established , vali date d and appraised as a new assessment test for the trial of new drugs as well as for long-term follow-up of patients , and to help with future indications for surgery . The ISH deals with pain , maximum walking distance , and some activities of daily living . Inter-observer reproducibility is good ( mean deviation 0.55 points ; p less than 0.05 ) . In a short-term , double-blind crossover trial , the ISH , judged according to its power to distinguish between the active drug period and the placebo period , appears as one of the best assessment tests . In the long term , total hip prosthesis is most often justified when the ISH score reaches 10 - 12 points . The index of severity for knee disease ( ISK ) was vali date d and appraised by the same statistical methods . Its value in non-steroidal anti-inflammatory drug ( NSAID ) or analgesic trials is lower than the value of the ISH . However , its use is still justified for that purpose , and for long-term follow-up of osteoarthritis of the knee BACKGROUND / AIM A r and omized , placebo-controlled , double-blind study was design ed to investigate the effectiveness of ultrasound therapy in primary knee osteoarthritis . MATERIAL S AND METHODS Ninety patients between 40 and 65 years of age having grade 2 and 3 bilateral knee osteoarthritis enrolled in the study were r and omly assigned into 3 groups : continuous ultrasound , pulsed ultrasound , and placebo ultrasound . All patients were given a home exercise program . Patients were evaluated at baseline , at the end of the treatment , and at the second month after the treatment by a range of motion measurement , visual analog scale , Lequesne index for knee osteoarthritis , and Short Form-36 quality of life scale . RESULTS The increase in the knee range of motion was similar in both ultrasound groups , while the change in the placebo group was not statistically significant . Visual analog scale scores and Lequesne scores of the placebo group at the second month were significantly greater than both ultrasound groups ' scores ( P < 0.01 and P < 0.05 , respectively ) . CONCLUSION Significant improvements in terms of pain , function , and quality of life scales were noted in both ultrasound groups in comparison with the placebo group . No statistically significant difference was found in terms of efficacy between the continuous and pulsed ultrasound Cetin N , Aytar A , Atalay A , Akman MN : Comparing hot pack , short-wave diathermy , ultrasound , and TENS on isokinetic strength , pain , and functional status of women with osteoarthritic knees : a single-blind , r and omized , controlled trial . Am J Phys Med Rehabil 2008;87:443–451 . Objective : To investigate the therapeutic effects of physical agents administered before isokinetic exercise in women with knee osteoarthritis . Design : One hundred patients with bilateral knee osteoarthritis were r and omized into five groups of 20 patients each : group 1 received short-wave diathermy + hot packs and isokinetic exercise ; group 2 received transcutaneous electrical nerve stimulation + hot packs and isokinetic exercise ; group 3 received ultrasound + hot packs and isokinetic exercise ; group 4 received hot packs and isokinetic exercise ; and group 5 served as controls and received only isokinetic exercise . Results : Pain and disability index scores were significantly reduced in each group . Patients in the study groups had significantly greater reductions in their visual analog scale scores and scores on the Lequesne index than did patients in the control group ( group 5 ) . They also showed greater increases than did controls in muscular strength at all angular velocities . In most parameters , improvements were greatest in groups 1 and 2 compared with groups 3 and 4 . Conclusions : Using physical agents before isokinetic exercises in women with knee osteoarthritis leads to augmented exercise performance , reduced pain , and improved function . Hot pack with a transcutaneous electrical nerve stimulator or short-wave diathermy has the best outcome Within the context of a double blind r and omized controlled parallel trial of 2 nonsteroidal antiinflammatory drugs , we vali date d WOMAC , a new multidimensional , self-administered health status instrument for patients with osteoarthritis of the hip or knee . The pain , stiffness and physical function subscales fulfil conventional criteria for face , content and construct validity , reliability , responsiveness and relative efficiency . WOMAC is a disease-specific purpose built high performance instrument for evaluative research in osteoarthritis clinical trials OBJECTIVE To determine the feasibility of conducting a r and omized controlled trial assessing the effect of low-intensity pulsed ultrasound ( US ) therapy on cartilage repair in patients with mild to moderate knee osteoarthritis ( OA ) . DESIGN Pilot , double-blinded , r and omized placebo-controlled trial with 2-months follow-up . SETTING Rehabilitation research facility . PARTICIPANTS Adults ( N=27 ; ≥45y ) with grade s 1 or 2 of medial joint space narrowing ( Osteoarthritis Research Society International atlas ) due to knee OA were r and omly allocated to receive active ( n=14 ) or sham ( n=13 ) US therapy .  Four participants withdrew for personal reasons . INTERVENTIONS Twenty-four sessions of active ( 20 % duty cycle , 1MHz , average temporal intensity : 0.2W/cm(2 ) , therapeutic dose : 112.5J/cm(2 ) ) or sham ( no sound-head crystal ) US therapy . MAIN OUTCOME MEASURES Success of recruitment and adherence rates were established by a priori criteria . Effect on cartilage repair was assessed by measuring cartilage volume and thickness and scoring cartilage injury , subchondral cyst formation , and bone marrow lesions on magnetic resonance images . RESULTS Patient recruitment and adherence rates were successful . No significant age-adjusted differences were seen between groups in the cartilage repair outcomes . Age-adjusted analyses , including only subjects who attended 20 sessions or more , showed an increase in medial tibia cartilage thickness in the active US therapy group ( 90μm ; 95 % confidence interval , 1 - 200 ; P=.05 ) . CONCLUSIONS Conducting a r and omized controlled trial to assess the effects of US therapy on the cartilage repair in people with mild to moderate knee OA is feasible . However , further pilot studies are needed to determine the optimal US dose and application parameters before design ing a full trial OBJECTIVE To investigate the effect of acupotomy on knee osteoarthritis ( KOA ) , compared to electro- acupuncture ( EA ) . METHODS Sixty KOA patients were r and omly divided into 2 groups : ultrasound-guided acupotomy group and EA group ; each had 3 weeks ' therapy . After the treatment , by contrast before and after therapy , by comparing curative effects among groups , we looked into disease improvement degree through activities of daily living score ( ADL ) , hospital for special surgery index ( HSS ) , visual analogue scales score ( VAS ) and knee joint 's infrared thermal imaging detection . RESULTS Grade d by ADL , the excellent rate in acupotomy group was much higher than EA group ; both acupotomy group and EA group had obvious changes in HSS index before and after the therapy ( P < 0.01 ) . And there was remarkable difference in HSS index variation between the groups ( P < 0.01 ) . Acupotomy group and EA group showed big difference in pain index before and after treatment ( P < 0.01 ) . Apparent difference also existed in the comparison among groups ( P < 0.01 ) . Both acupotomy group and EA group had apparent changes in infrared thermal imaging detection before and after the treatment ( P < 0 . 01 ) . CONCLUSION Acupotomy and EA both have significant effects in KOA treatment ; the former is better than the latter in relieving pain and improving knee functions A r and omized double blind clinical trial was conducted to determine the effectiveness of ultrasound ( US ) therapy in knee osteoarthritis ( OA ) . Sixty-seven patients ( mean age 54.8 + /-7 ) were r and omized to receive either 1 MHz frequency or 1 watt/cm(2 ) power continuous ultrasound for 5 min ( n = 34 ) or sham US ( n = 33 ) as a placebo . Ten sessions of treatment were applied to the target knee of the patient . A blinded evaluation at baseline and after treatment was made . Primary outcome was pain on movement assessed by visual analog scale ( VAS ) . Secondary outcomes consisted of the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) scores and 50 meters walking time . Both groups showed significant improvements in knee pain on movement . In the treatment group , the improvement in VAS score was statistically and significantly higher ( p < 0.001 ) and more pronounced than in the placebo group . Pain reduction averaged 47.76 % in the treatment group ( p = 0.013 ) . Secondary outcomes improved in both groups but reached statistical significance only in the treatment group : p = 0.006 for the mean change in total WOMAC scores and p = 0.041 for 50 meters walking time . Results suggest that therapeutic US is safe and effective treatment modality in pain relief and improvement of functions in patients with knee OA This investigation assessed differences between the response of men and women with knee osteoarthritis to superficial heat , cold , or contrast therapy applied with a water-circulating system or a st and ard heating pad , and rest . We further analyzed data from a previous study to better underst and the influence of gender on the response to treatment based on Knee Injury and Osteoarthritis Outcome Score ( KOOS ) subscales and a visual analog pain scale ( VAS ) . Using a within-subject , r and omized order design , 34 patients received each treatment in 1-week blocks . A KOOS question naire and VAS were completed at baseline and twice each week . Women were more likely to report clinical ly meaningful improvement in pain and symptoms on the KOOS with the use of heat , cold , and a heating pad . There were no significant differences in response to treatment between men and women for the function-daily living and quality of life subscales or percent pain reduction on the VAS . Men and women reported improved quality of life with intervention . Women are more likely to report clinical ly meaningful improvement in pain and symptoms associated with knee OA following the use of superficial heat , cold , or a heating pad than men AIM OF STUDY To compare the effectiveness of ibuprofen phonophoresis ( PH ) with conventional ultrasound ( US ) therapy in knee osteoarthritis . METHOD Sixty patients with a 
    Output:
    
There was no evidence to suggest that ultrasound was unsafe treatment .
Conclusions : Therapeutic ultrasound is a safe treatment to relieve pain and improve physical function in patients with knee osteoarthritis .
However , phonophoresis does not produce additional benefits to functional improvement , but may relieve pain compared to conventional non-drug ultrasound