Volume 15, Issue 2 (Summer 2020)
Salmand: Iranian Journal of Ageing 2020, 15(2): 160-175 |
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Ansari G, Delbari A, Karimi M, Akbari Kamrani A A, Mohammadi S, Sahaf R. Effect of Melilotus Officinalis Oil on Knee Joint Pain and Stiffness in the Elderly With Primary Knee Osteoarthritis. Salmand: Iranian Journal of Ageing 2020; 15 (2) :160-175
URL: http://salmandj.uswr.ac.ir/article-1-1536-en.html
URL: http://salmandj.uswr.ac.ir/article-1-1536-en.html
Gholamreza Ansari1 
, Ahmad Delbari2 , Mehrdad Karimi 3, Ahmad Ali Akbari Kamrani1 , Siran Mohammadi1 , Robab Sahaf1
, Ahmad Delbari2 , Mehrdad Karimi 3, Ahmad Ali Akbari Kamrani1 , Siran Mohammadi1 , Robab Sahaf1
1- Department of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
2- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
3- Department of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran. , mehrdadkarimi@yahoo.com
2- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
3- Department of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran. , mehrdadkarimi@yahoo.com
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Extended Abstract
1. Introduction
steoarthritis is the most common joint disease [1], which is even more prevalent than heart disease, hypertension and diabetes [2]. Knee Osteoarthritis (KO) is one of the five leading causes of physical disability in the elderly [3]. There are different methods to reduce its symptoms [4-6]. One of the main goals of treatment in osteoarthritis is pain relief. Analgesics usually have significant side effects [7] which are higher in the elderly, due to age-related physiological changes, comorbidities, drug interactions, changes in drug metabolism and polypharmacy [8]. Therefore, in old age, medications should be used with more caution [9, 10]. Due to the cheaper and more accessible and less complication of complementary medicine treatments and the tendency of the elderly to use them, the main purpose of this study was to evaluate the effect of topical melilotus officinalis oil on joint pain and stiffness in the elderly with primary KO.
2. Methods & Materials
This is a double-blind randomized controlled clinical trial (Registration Code: IRCT2016082129461N1) conducted on 62 older people aged <60 years living in a nursing home in Tehran with mild to moderate KO diagnosed by an orthopedic physician, who had signed a consent form. Demographic information and joint pain and stiffness were measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Participants were assigned to intervention and control groups using a randomization table based on balanced-block randomization receiving melilotus officinalis oil and diclofenac gel, respectively. The intervention group used 5 drops of melilotus officinalis oil in front of the knee, and the control group used diclofenac gel twice the day (morning and night).
Data were collected before the study and at the end of the 2nd and 4th weeks of intervention by a questioner who was not aware of the Objectives of the study, and then entered into SPSS V. 23 software for analysis. Frequency distribution, percentage, mean and standard deviation were used to describe the data, and inferential statistics (repeated measures ANOVA and Bonferroni post hoc test) were used to examine the research hypotheses regarding the effect of intervention on different pain intensities and WOMAC changes. Before performing statistical analyzes, the normality of data distribution was checked by calculating kurtosis and skewness, which due to the normal distribution, parametric tests were used. Significance level of all tests was considered as P<0.05. Effect size was calculated to measure the level of oil effect.
3. Results
The mean age of participants was 78±7.79 years (ranged 63-94 years). There were 19 women and 15 men in the intervention group and 16 women and 11 men in the control group. Most participants were illiterate or only able to read and write; had at least one chronic illness, and used at least one medication. There was no significant difference between the intervention and control groups at baseline in terms of age, education, marital status, employment status, smoking, level of physical activity, chronic illness, and medication use.
Right knee pain (F1,58=439.70, P<0.001) and left knee pain (F1,58=368.8, P<0.001) in both intervention and control groups significantly decreased from the first to the third stage of the study. Moreover, right knee pain intensity (F2,58=62.6, P<0.001) and left knee pain intensity (F2,58=85.1, P<0.001) in both groups significantly decreased from the first to the third stage of the study. Furthermore, the mean joint stiffness (F2,58=69.9, P<0.001) in both groups significantly decreased from the first to the third stage of the study. For all variables of pain, pain intensity and joint stiffness, considering the effect size, the amount of changes from the first to the third stage was higher in the intervention group. The results of Bonfrroni post hoc test showed that the difference between the first and second stages and between the first and third stages of the study were significant in both groups, while the difference between the second and third stages were significant only in the intervention group which may be due to the role of maintenance or the medication used in the intervention group.
4. Conclusion
The use of melilotus officinalis oil as a cheap, available and uncomplicated treatment on the extent and severity of knee pain and joint stiffness in the elderlies with mild to moderate KO is recommended. Further studies are recommended to investigate the mechanism of the effect of melilotus officinalis oil in reducing knee pain and joint stiffness in elderlies with mild to moderate KO and to determine the exact dose for its use.
Ethical Considerations
Compliance with ethical guidelines
All ethical principles were considered in this article. The participants were informed about the purpose of the research and its implementation stages; they were also assured about the confidentiality of their information; Moreover, They were allowed to leave the study whenever they wish, and if desired, the results of the research would be available to them.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors' contributions
All authors contributed equally in preparing all parts of the research.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The researchers of this project are grateful to all the participants of this research project of the staff and management of Kahrizak Charity Sanatorium and the Department of Traditional Medicine of Tehran University of Medical Sciences.
References
Halter JB, Ouslander JG, Studenski S, High KP, Asthana S, Supiano MA, et al. Hazzard’s geriatric medicine and gerontology, 7th Ed. New York: McGraw Hill Professional; 2017.
Martel-Pelletier J. Pathophysiology of osteoarthritis. Osteoarthritis and Cartilage. 1998; 6(6):374-6. [DOI:10.1053/joca.1998.0140] [PMID]
SaraeiPour S, Salavati M, Akhbari B, KazemNezhad A. [Translation and adaptation of Knee injury and Osteoarthritis Outcome Score (KOOS) in to Persian and testing persian version reliability among iranians with osteoarthritis (Persian)]. Archives of Rehabilitation. 2007; 8(1):42-6. http://rehabilitationj.uswr.ac.ir/article-1-10-en.html
Jordan JM, Linder GF, Renner JB, Fryer JG. The impact of arthritis in rural populations. Arthritis Care & Research. 1995; 8(4):242-50. [DOI:10.1002/art.1790080407] [PMID]
Mardani-Kivi M, Asadi K, Karimi-Mobarakeh M, Babaei Jandaghi A, Hashemi-Motlagh K, Saheb-Ekhtiari K. [Evaluating surgical outcomes of cementless total hip replacement in old patients (Persian)]. Journal of Guilan University of Medical Sciences. 2013; 22(87):15-21. http://journal.gums.ac.ir/article-1-39-en.html
Malekzadeh M, Ghasemi B, Mirnasuri R. [Effect of aquatic exercises on the motor performance and the quality of life in patients with knee joint osteoarthritis (Persian)]. Hormozgan Medical Journal. 2014; 18(3):194-200. https://sites.kowsarpub.com/hmj/articles/87760.html
Saboor M. [Elderly’s medical therapy status (Persian)]. Iranian Journal of Ageing. 2007; 2(1):216-22. http://salmandj.uswr.ac.ir/article-1-16-en.html
Nazem k, Bozari Poor – Boeeni B, Tavakoli A. Osteoarthrits: A revolution in treatment. Yafte. 2004; 6(3):3-13. http://yafte.lums.ac.ir/article-1-926-en.html
Naderi Z, Mozaffari-Khosravi H, Dehghan A, Fallah Hosseini H, Nadjarzadeh A. [The effect of Ginger (Zingiber Officinale) powder supplement on pain in patients with knee osteoarthritis: A double-blind randomized clinical trial (Persian)]. The Journal of Shahid Sadoughi University of Medical Sciences. 2013; 20(5):657-67. http://jssu.ssu.ac.ir/article-1-2232-en.html
Emad MR, Amanolahi A. [Comparison of Ibuprofen with acupuncture in reducing knee osteoarthritis pain (Persian)]. Armaghane Danesh. 2008; 12(4):35-43. http://armaghanj.yums.ac.ir/article-1-661-en.html
Emami Razavi Z, Karimi M, kamalinejad M. [The efficacy and safety of topical Oliban oil in relieving the symptoms of knee pain (vajaol-rakbe) (Persian)]. Journal of Islamic and Iranian Traditional Medicine. 2012; 3(2):183-90. http://jiitm.ir/article-1-139-en.html
Longo D, Fauci A, Kasper D, Hauser S. Harrison’s principles of internal medicine, 18th Ed. New York: McGraw Hill Professional; 2011.
Bagheri SR, Fatemi E, Fazeli SH, Ghorbani R, Lashkari F. [Efficacy of low level laser on Knee Osteoarthritis treatment (Persian)]. Koomesh. 2011; 12(3):285-92. http://koomeshjournal.semums.ac.ir/article-1-1236-en.html
Hadipourjahromi M, Mozaffari Kermani R, Kadivar M, Safavi M. [Chondro-protective effects of pomegranate on experimental osteoarthritis (Persian)]. Medical Sciences Journal of Islamic Azad University, Tehran Medical Branch. 2007; 17(4):199-203. http://tmuj.iautmu.ac.ir/article-1-55-en.html
Moghadam Nia A, Heidari B, Pourhadi M, Baradaran M. [Comparison of the therapeutic effects of effective material of red pepper and Diclofenac gel in treatment of osteoarthritis (Persian)]. Journal of Babol University of Medical Sciences. 2003; 5(3):12-7. http://jbums.org/article-1-2756-en.html
Ramezani M, Nekozad N. [Comparison between the effectiveness of glucosamine sulfate and zintoma on clinical improvement of knee osteoarthritis (Persian)]. Ebnesina. 2011; 14(3):29-34. http://ebnesina.ajaums.ac.ir/article-1-119-en.html
Jastan Marani M, Pourfarzi F, Moharamzad Y. [The efficacy of two-drug regimen of glucosamine and chloroquine compared to one-drug regimen of glucosamine in treatment of knee osteoarthritis (Persian)]. Journal of Ardabil University of Medical Sciences. 2009; 9(2):157-63. http://jarums.arums.ac.ir/article-1-281-en.html
Hou PW, Fu PK, Hsu HC, Hsieh CL. Traditional Chinese medicine in patients with osteoarthritis of the knee. Journal of Traditional and Complementary Medicine. 2015: 5(4):182-96. https://doi.org/10.1016/j.jtcme.2015.06.002
Heidari MR, Najafi F, Asadipour A, Ansari m, Zahedi Mj, Vahedian M. [Analgesic and ulcerogenic effect of Methanolic extract of Melilotus Officinalis (Persian)]. Journal of Kerman University of Medical Sciences. 2001; 8(4):210-19. http://jkmu.kmu.ac.ir/article_34050.html
Zarban A, Malekaneh M, Hassanpour M, Najjari MT, Abad M. [Evaluation of antioxidant properties of 28 Iranian herbs (Persian)]. Journal of Birjand University of Medical Sciences. 2004; 11(1):9-15. http://journal.bums.ac.ir/article-1-175-fa.html
Khaki A. [Antioxidant activity, phytochemical and ethnopharmacology of melilotus officinalis l. As anti inflammatory to treat of diabetic sore (Persian)]. Eco-Phytochemical Journal of Medical Plants. 2015; 3(1):73-81. http://ecophytochemical.gorganiau.ac.ir/article_556322.html
Ansari GR, Delbari A, Karimi M, Akbari Kamrani AA, Abolfathi Momtaz Y, Mohamadi S, et al. [The effect of Melilotous Officinalis on physical function among older adults with mild to moderate primary knee osteoarthritis: A double blind randomized controlled trial (Persian)]. Iranian Journal of Aging. 2019; 14(2):132-43. [DOI: 10.32598/sija.13.10.510]
Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) subjective knee evaluation form, Knee injury and Osteoarthritis Outcome Score (KOOS), Knee injury and Osteoarthritis Outcome Score Physical Function Short form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care & Research. 2011; 63(S11):S208-28. [DOI:10.1002/acr.20632] [PMID] [PMCID]
Ebrahimzadeh MH, Makhmalbaf H, Birjandinejad A, Keshtan FG, Hoseini HA, Mazloumi SM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in Persian Speaking Patients with Knee Osteoarthritis. Archives of Bone and Joint Surgery. 2014; 2(1):57-62. [DOI: 10.22038/ABJS.2014.2373] [PMID] [PMCID]
1. Introduction
steoarthritis is the most common joint disease [1], which is even more prevalent than heart disease, hypertension and diabetes [2]. Knee Osteoarthritis (KO) is one of the five leading causes of physical disability in the elderly [3]. There are different methods to reduce its symptoms [4-6]. One of the main goals of treatment in osteoarthritis is pain relief. Analgesics usually have significant side effects [7] which are higher in the elderly, due to age-related physiological changes, comorbidities, drug interactions, changes in drug metabolism and polypharmacy [8]. Therefore, in old age, medications should be used with more caution [9, 10]. Due to the cheaper and more accessible and less complication of complementary medicine treatments and the tendency of the elderly to use them, the main purpose of this study was to evaluate the effect of topical melilotus officinalis oil on joint pain and stiffness in the elderly with primary KO.
2. Methods & Materials
This is a double-blind randomized controlled clinical trial (Registration Code: IRCT2016082129461N1) conducted on 62 older people aged <60 years living in a nursing home in Tehran with mild to moderate KO diagnosed by an orthopedic physician, who had signed a consent form. Demographic information and joint pain and stiffness were measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Participants were assigned to intervention and control groups using a randomization table based on balanced-block randomization receiving melilotus officinalis oil and diclofenac gel, respectively. The intervention group used 5 drops of melilotus officinalis oil in front of the knee, and the control group used diclofenac gel twice the day (morning and night).
Data were collected before the study and at the end of the 2nd and 4th weeks of intervention by a questioner who was not aware of the Objectives of the study, and then entered into SPSS V. 23 software for analysis. Frequency distribution, percentage, mean and standard deviation were used to describe the data, and inferential statistics (repeated measures ANOVA and Bonferroni post hoc test) were used to examine the research hypotheses regarding the effect of intervention on different pain intensities and WOMAC changes. Before performing statistical analyzes, the normality of data distribution was checked by calculating kurtosis and skewness, which due to the normal distribution, parametric tests were used. Significance level of all tests was considered as P<0.05. Effect size was calculated to measure the level of oil effect.
3. Results
The mean age of participants was 78±7.79 years (ranged 63-94 years). There were 19 women and 15 men in the intervention group and 16 women and 11 men in the control group. Most participants were illiterate or only able to read and write; had at least one chronic illness, and used at least one medication. There was no significant difference between the intervention and control groups at baseline in terms of age, education, marital status, employment status, smoking, level of physical activity, chronic illness, and medication use.
Right knee pain (F1,58=439.70, P<0.001) and left knee pain (F1,58=368.8, P<0.001) in both intervention and control groups significantly decreased from the first to the third stage of the study. Moreover, right knee pain intensity (F2,58=62.6, P<0.001) and left knee pain intensity (F2,58=85.1, P<0.001) in both groups significantly decreased from the first to the third stage of the study. Furthermore, the mean joint stiffness (F2,58=69.9, P<0.001) in both groups significantly decreased from the first to the third stage of the study. For all variables of pain, pain intensity and joint stiffness, considering the effect size, the amount of changes from the first to the third stage was higher in the intervention group. The results of Bonfrroni post hoc test showed that the difference between the first and second stages and between the first and third stages of the study were significant in both groups, while the difference between the second and third stages were significant only in the intervention group which may be due to the role of maintenance or the medication used in the intervention group.
4. Conclusion
The use of melilotus officinalis oil as a cheap, available and uncomplicated treatment on the extent and severity of knee pain and joint stiffness in the elderlies with mild to moderate KO is recommended. Further studies are recommended to investigate the mechanism of the effect of melilotus officinalis oil in reducing knee pain and joint stiffness in elderlies with mild to moderate KO and to determine the exact dose for its use.
Ethical Considerations
Compliance with ethical guidelines
All ethical principles were considered in this article. The participants were informed about the purpose of the research and its implementation stages; they were also assured about the confidentiality of their information; Moreover, They were allowed to leave the study whenever they wish, and if desired, the results of the research would be available to them.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors' contributions
All authors contributed equally in preparing all parts of the research.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The researchers of this project are grateful to all the participants of this research project of the staff and management of Kahrizak Charity Sanatorium and the Department of Traditional Medicine of Tehran University of Medical Sciences.
References
Halter JB, Ouslander JG, Studenski S, High KP, Asthana S, Supiano MA, et al. Hazzard’s geriatric medicine and gerontology, 7th Ed. New York: McGraw Hill Professional; 2017.
Martel-Pelletier J. Pathophysiology of osteoarthritis. Osteoarthritis and Cartilage. 1998; 6(6):374-6. [DOI:10.1053/joca.1998.0140] [PMID]
SaraeiPour S, Salavati M, Akhbari B, KazemNezhad A. [Translation and adaptation of Knee injury and Osteoarthritis Outcome Score (KOOS) in to Persian and testing persian version reliability among iranians with osteoarthritis (Persian)]. Archives of Rehabilitation. 2007; 8(1):42-6. http://rehabilitationj.uswr.ac.ir/article-1-10-en.html
Jordan JM, Linder GF, Renner JB, Fryer JG. The impact of arthritis in rural populations. Arthritis Care & Research. 1995; 8(4):242-50. [DOI:10.1002/art.1790080407] [PMID]
Mardani-Kivi M, Asadi K, Karimi-Mobarakeh M, Babaei Jandaghi A, Hashemi-Motlagh K, Saheb-Ekhtiari K. [Evaluating surgical outcomes of cementless total hip replacement in old patients (Persian)]. Journal of Guilan University of Medical Sciences. 2013; 22(87):15-21. http://journal.gums.ac.ir/article-1-39-en.html
Malekzadeh M, Ghasemi B, Mirnasuri R. [Effect of aquatic exercises on the motor performance and the quality of life in patients with knee joint osteoarthritis (Persian)]. Hormozgan Medical Journal. 2014; 18(3):194-200. https://sites.kowsarpub.com/hmj/articles/87760.html
Saboor M. [Elderly’s medical therapy status (Persian)]. Iranian Journal of Ageing. 2007; 2(1):216-22. http://salmandj.uswr.ac.ir/article-1-16-en.html
Nazem k, Bozari Poor – Boeeni B, Tavakoli A. Osteoarthrits: A revolution in treatment. Yafte. 2004; 6(3):3-13. http://yafte.lums.ac.ir/article-1-926-en.html
Naderi Z, Mozaffari-Khosravi H, Dehghan A, Fallah Hosseini H, Nadjarzadeh A. [The effect of Ginger (Zingiber Officinale) powder supplement on pain in patients with knee osteoarthritis: A double-blind randomized clinical trial (Persian)]. The Journal of Shahid Sadoughi University of Medical Sciences. 2013; 20(5):657-67. http://jssu.ssu.ac.ir/article-1-2232-en.html
Emad MR, Amanolahi A. [Comparison of Ibuprofen with acupuncture in reducing knee osteoarthritis pain (Persian)]. Armaghane Danesh. 2008; 12(4):35-43. http://armaghanj.yums.ac.ir/article-1-661-en.html
Emami Razavi Z, Karimi M, kamalinejad M. [The efficacy and safety of topical Oliban oil in relieving the symptoms of knee pain (vajaol-rakbe) (Persian)]. Journal of Islamic and Iranian Traditional Medicine. 2012; 3(2):183-90. http://jiitm.ir/article-1-139-en.html
Longo D, Fauci A, Kasper D, Hauser S. Harrison’s principles of internal medicine, 18th Ed. New York: McGraw Hill Professional; 2011.
Bagheri SR, Fatemi E, Fazeli SH, Ghorbani R, Lashkari F. [Efficacy of low level laser on Knee Osteoarthritis treatment (Persian)]. Koomesh. 2011; 12(3):285-92. http://koomeshjournal.semums.ac.ir/article-1-1236-en.html
Hadipourjahromi M, Mozaffari Kermani R, Kadivar M, Safavi M. [Chondro-protective effects of pomegranate on experimental osteoarthritis (Persian)]. Medical Sciences Journal of Islamic Azad University, Tehran Medical Branch. 2007; 17(4):199-203. http://tmuj.iautmu.ac.ir/article-1-55-en.html
Moghadam Nia A, Heidari B, Pourhadi M, Baradaran M. [Comparison of the therapeutic effects of effective material of red pepper and Diclofenac gel in treatment of osteoarthritis (Persian)]. Journal of Babol University of Medical Sciences. 2003; 5(3):12-7. http://jbums.org/article-1-2756-en.html
Ramezani M, Nekozad N. [Comparison between the effectiveness of glucosamine sulfate and zintoma on clinical improvement of knee osteoarthritis (Persian)]. Ebnesina. 2011; 14(3):29-34. http://ebnesina.ajaums.ac.ir/article-1-119-en.html
Jastan Marani M, Pourfarzi F, Moharamzad Y. [The efficacy of two-drug regimen of glucosamine and chloroquine compared to one-drug regimen of glucosamine in treatment of knee osteoarthritis (Persian)]. Journal of Ardabil University of Medical Sciences. 2009; 9(2):157-63. http://jarums.arums.ac.ir/article-1-281-en.html
Hou PW, Fu PK, Hsu HC, Hsieh CL. Traditional Chinese medicine in patients with osteoarthritis of the knee. Journal of Traditional and Complementary Medicine. 2015: 5(4):182-96. https://doi.org/10.1016/j.jtcme.2015.06.002
Heidari MR, Najafi F, Asadipour A, Ansari m, Zahedi Mj, Vahedian M. [Analgesic and ulcerogenic effect of Methanolic extract of Melilotus Officinalis (Persian)]. Journal of Kerman University of Medical Sciences. 2001; 8(4):210-19. http://jkmu.kmu.ac.ir/article_34050.html
Zarban A, Malekaneh M, Hassanpour M, Najjari MT, Abad M. [Evaluation of antioxidant properties of 28 Iranian herbs (Persian)]. Journal of Birjand University of Medical Sciences. 2004; 11(1):9-15. http://journal.bums.ac.ir/article-1-175-fa.html
Khaki A. [Antioxidant activity, phytochemical and ethnopharmacology of melilotus officinalis l. As anti inflammatory to treat of diabetic sore (Persian)]. Eco-Phytochemical Journal of Medical Plants. 2015; 3(1):73-81. http://ecophytochemical.gorganiau.ac.ir/article_556322.html
Ansari GR, Delbari A, Karimi M, Akbari Kamrani AA, Abolfathi Momtaz Y, Mohamadi S, et al. [The effect of Melilotous Officinalis on physical function among older adults with mild to moderate primary knee osteoarthritis: A double blind randomized controlled trial (Persian)]. Iranian Journal of Aging. 2019; 14(2):132-43. [DOI: 10.32598/sija.13.10.510]
Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) subjective knee evaluation form, Knee injury and Osteoarthritis Outcome Score (KOOS), Knee injury and Osteoarthritis Outcome Score Physical Function Short form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care & Research. 2011; 63(S11):S208-28. [DOI:10.1002/acr.20632] [PMID] [PMCID]
Ebrahimzadeh MH, Makhmalbaf H, Birjandinejad A, Keshtan FG, Hoseini HA, Mazloumi SM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in Persian Speaking Patients with Knee Osteoarthritis. Archives of Bone and Joint Surgery. 2014; 2(1):57-62. [DOI: 10.22038/ABJS.2014.2373] [PMID] [PMCID]
Type of Study: Research |
Subject:
gerontology
Received: 2018/05/07 | Accepted: 2018/07/24 | Published: 2020/07/01
Received: 2018/05/07 | Accepted: 2018/07/24 | Published: 2020/07/01
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