Volume 19, Issue 1 (Spring 2024)                   Salmand: Iranian Journal of Ageing 2024, 19(1): 70-83 | Back to browse issues page


XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Asadi E, Gholami M, Shirzadegan R, Mokhayeri Y, Beiranvand A. Comparing the Effects of Rosemary Ointment and Ginger Ointment on Pain and Physical Performance of Elderly People With Knee Osteoarthritis: A Randomized Controlled Clinical Trial. Salmand: Iranian Journal of Ageing 2024; 19 (1) :70-83
URL: http://salmandj.uswr.ac.ir/article-1-2598-en.html
1- Student Research Committee, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran.
2- Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran.
3- Department of Nursing, Faculty of Nursing, Dorud Branch, Islamic Azad University, Dorud, Iran.
4- Cardiovascular Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran.
5- Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran. , beyranvand.a@lums.ac.ir
Full-Text [PDF 5670 kb]   (743 Downloads)     |   Abstract (HTML)  (2069 Views)
Full-Text:   (646 Views)
Introduction
Osteoarthritis is one of the most common chronic diseases and one of the main causes of disability and pain in old age. Osteoarthritis puts a heavy economic and social burden on the elderly and the healthcare system [3, 4, 8]. Among the large joints of the body, the knee joint is one of the most common areas affected by osteoarthritis, which causes more disability and clinical symptoms than other joints [5]. There are various methods to reduce the pain in older patients with knee osteoarthritis (KO). One of the safe methods is the use of topical ointments, especially those made by medicinal plants, which the elderly are more intended to use due to their availability and cheapness. This study aims to compare the effect of rosemary ointment and ginger ointment on pain and physical performance of elderly people with KO.

Methods
This is an open-label randomized controlled clinical trial that was conducted on 111 elderly patients with KO referred to the orthopedic clinic affiliated to Lorestan University of Medical Sciences. The samples were diagnosed with grade 1 to 2 osteoarthritis and were selected based on the inclusion and exclusion criteria. Participants, after signing the informed consent form, were evaluated by using a demographic form, the WOMAC scale, and the VAS scale. By block randomization method, the samples were divided into two intervention groups of ginger (n=37), and rosemary (n=37) and one control group (n=37). The intervention groups were asked to use the ointments twice a day, morning and evening, while the control group used an ibuprofen 400 mg tablet once a day. The questionnaires were completed before and 14 days after the intervention, and the obtained data were analyzed in Stata software, version 17. To describe the data, central tendency and dispersion measures were calculated. To compare the pain intensity score and physical performance score between the three groups, analysis of covariance (ANCOVA) was used followed by Tukey’s test for pairwise comparison.

Results
Of 111 participants, 56 were female (50.45%) and 55(49.55%) were male. There were 37(33.33%) older people with grade 1 osteoarthritis and 74(66.67%) with grade 2 osteoarthritis. According to ANOVA results, there was no significant difference in age (P=0.78) between the study groups, but the difference in BMI was significant (P=0.005). Based on the results, there were significant differences in physical performance and pain before and after the intervention in the ginger and rosemary groups (P<0.001) and in the control group (P<0.001). The results showed that by controlling the confounding effect of BMI, the differences in physical performance and pain after the intervention in the study groups were significant (P<0.001). Tukey’s test was performed to compare the two groups. It was found that there was a significant difference between the ginger and control groups (P<0.001), and between the rosemary and control groups (P<0.001) in physical performance, but there was no significant difference between the ginger and rosemary groups (P=0.22). Also, the results of Tukey’s test showed a significant difference in pain intensity after the intervention between the ginger and control groups (P<0.001), and between the rosemary and control groups (P<0.001), but there was no significant difference between the ginger and rosemary groups (P=0.10).

Conclusion
The results of the present study showed that rosemary ointment and ginger ointment reduced the pain intensity of the elderly people with KO. These effects have been observed in some other studies. One of the mechanisms of ginger ointment’s analgesic effect is the inhibition of arachidonic acid metabolism through inhibition of cyclooxygenase and lipoxygenase pathways, similar to the mechanism of action of non-steroidal anti-inflammatory drugs. The simultaneous inhibition of these two enzymes may increase the anti-inflammatory effect and reduce the side effects of ginger ointment [15]. Also, researchers have attributed the analgesic effects of rosemary ointment to the anti-inflammatory effect of rosemary [31]. Our results also showed that rosemary and ginger ointment improved the physical performance of the elderly with KO. Both rosemary and ginger ointments had the same efficacy as ibuprofen. Therefore, using local treatments using rosemary and ginger ointments can be useful to reduce pain and improve physical performance of the elderly with KO.

Ethical Considerations

Compliance with ethical guidelines

This study was approved by the Ethics Committee of Lorestan University of Medical Sciences (Code: IR.LUMS.REC.1400.002) and was registered by the Iranian Registry of Clinical Trials (IRCT) (ID: IRCT20210521051354N1).

Funding
This study was extracted from the master’s thesis of Ehsan Asadi, approved by School of Nursing and Midwifery, Lorestan University of Medical Sciences.

Authors' contributions
Conceptualization: Ehsan Asadi, Afsaneh Biranvand, Mohammad Gholami, and Razieh Shirzadegan; Data analysis: Yaser Mokhayeri, Afsaneh Biranvand and Mohammad Gholami; Writing: All authors.

Conflicts of interest
The authors declared no conflict of interest. 


 
References
  1. Wagg E, Blyth FM, Cumming RG, Khalatbari-Soltani S. Socioeconomic position and healthy ageing: A systematic review of cross-sectional and longitudinal studies. Ageing Research Reviews. 2021; 69:101365. [DOI:10.1016/j.arr.2021.101365] [PMID]
  2. Haber D. Health promotion and aging: Practical applications for health professionals. New York: Springer Publishing Company; 2013. [Link]
  3. Rafanan BS Jr, Valdecañas BF, Lim BP, Malairungsakul A, Tassanawipas W, Shiyi C, et al. Consensus recommendations for managing osteoarthritic pain with topical NSAIDs in Asia-Pacific. Pain Management. 2018; 8(2):115-28. [DOI:10.2217/pmt-2017-0047] [PMID]
  4. Hawker GA, King LK. The burden of osteoarthritis in older adults. Clinics in Geriatric Medicine. 2022; 38(2):181-92. [DOI:10.1016/j.cger.2021.11.005] [PMID]
  5. Hsu H, Siwiec RM. Knee osteoarthritis. Treasure Island: StatPearls Publishing; 2024. [PMID]
  6. Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis and Cartilage. 2013; 21(9):1145-53. [DOI:10.1016/j.joca.2013.03.018] [PMID] [PMCID]
  7. Kim DJ. A study on the physical activities, mental health, and health-related quality of life of osteoarthritis patients. Osong Public Health and Research Perspectives. 2019; 10(6):368-75. [DOI:10.24171/j.phrp.2019.10.6.07] [PMID] [PMCID]
  8. Zamri NAA, Harith S, Yusoff NAM, Hassan NM, Ong YQ. Prevalence, risk factors and primary prevention of osteoarthritis in Asia: A scoping review. Elderly Health Journal. 2019; 5(1):19-31. [DOI:10.18502/ehj.v5i1.1196]
  9. Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: A review. JAMA. 2021; 325(6):568-78. [DOI:10.1001/jama.2020.22171] [PMID] [PMCID]
  10. Scarpignato C, Lanas A, Blandizzi C, Lems WF, Hermann M, Hunt RH, et al. Safe prescribing of non-steroidal anti-inflammatory drugs in patients with osteoarthritis--An expert consensus addressing benefits as well as gastrointestinal and cardiovascular risks. BMC Medicine. 2015; 13:55. [DOI:10.1186/s12916-015-0285-8] [PMID] [PMCID]
  11. Saboor M. [Elderly’s medical therapy status (Persian)]. Salmand. 2007; 2(1):216-22. [Link]
  12. Cameron C. Non-Steroidal anti-inflammatory drugs (NSAIDs): Making safer treatment choices. Best Practice Journal. 2013; 55:8-19. [Link]
  13. Nadeem M, Imran M, Aslam Gondal T, Imran A, Shahbaz M, Muhammad Amir R, et al. Therapeutic potential of rosmarinic acid: A comprehensive review. Applied Sciences. 2019; 9(15):3139. [DOI:10.3390/app9153139]
  14. Keshavarzian S, Shahgholian N. Comparison of the effect of topical application of rosemary and menthol for musculoskeletal pain in hemodialysis patients. Iranian Journal of Nursing and Midwifery Research. 2017; 22(6):436-41. [DOI:10.4103/ijnmr.IJNMR_163_16] [PMID] [PMCID]
  15. Ballester P, Cerdá B, Arcusa R, Marhuenda J, Yamedjeu K, Zafrilla P. Effect of ginger on inflammatory diseases. Molecules. 2022; 27(21):7223. [DOI:10.3390/molecules27217223] [PMID] [PMCID]
  16. Leach MJ, Kumar S. The clinical effectiveness of Ginger (Zingiber officinale) in adults with osteoarthritis. International Journal of Evidence-Based Healthcare. 2008; 6(3):311-20. [DOI:10.1111/j.1744-1609.2008.00106.x]
  17. Dehghan M, Abdoli-Tafti A, Ganji F, Ghaedi R. [Comparison the effects of ginger (Zingiber officinale) jelly and piroxicam jelly on pain of knee osteoarthritis (Persian)]. Scientific Journal of Kurdistan University of Medical Sciences. 2018; 23(1):8-17. [DOI:10.52547/sjku.23.1.8]
  18. Cimmino MA, Ferrone C, Cutolo M. Epidemiology of chronic musculoskeletal pain. Best Practice & Research. Clinical Rheumatology. 2011; 25(2):173-83. [DOI:10.1016/j.berh.2010.01.012] [PMID]
  19. Wandel S, Jüni P, Tendal B, Nüesch E, Villiger PM, Welton NJ, et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: Network meta-analysis. BMJ. 2010; 341:c4675. [DOI:10.1136/bmj.c4675] [PMID] [PMCID]
  20. Yang W, Sun C, He SQ, Chen JY, Wang Y, Zhuo Q. The efficacy and safety of disease-modifying osteoarthritis drugs for knee and hip osteoarthritis-A systematic review and network meta-analysis. Journal of General Internal Medicine. 2021; 36(7):2085-93. [DOI:10.1007/s11606-021-06755-z] [PMID] [PMCID]
  21. Gandek B. Measurement properties of the Western Ontario and McMaster Universities osteoarthritis index: A systematic review. Arthritis Care & Research. 2015; 67(2):216-29. [DOI:10.1002/acr.22415] [PMID]
  22. Xie F, Pullenayegum EM, Li SC, Hopkins R, Thumboo J, Lo NN. Use of a disease-specific instrument in economic evaluations: Mapping WOMAC onto the EQ-5D utility index. Value in Health. 2010; 13(8):873-8. [DOI:10.1111/j.1524-4733.2010.00770.x] [PMID]
  23. Bilbao A, Quintana JM, Escobar A, Las Hayas C, Orive M. Validation of a proposed WOMAC short form for patients with hip osteoarthritis. Health and Quality of Life Outcomes. 2011; 9:75. [DOI:10.1186/1477-7525-9-75] [PMID] [PMCID]
  24. 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. The Archives of Bone and Joint Surgery. 2014; 2(1):57-62. [PMID] [PMCID]
  25. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual analog scale for pain (VAS Pain), numeric rating scale for pain (NRS Pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care & Research. 2011; 63(Suppl 11):S240-52. [DOI:10.1002/acr.20543] [PMID]
  26. Heller GZ, Manuguerra M, Chow R. How to analyze the visual analogue scale: Myths, truths and clinical relevance. Scandinavian Journal of Pain. 2016; 13:67-75. [DOI:10.1016/j.sjpain.2016.06.012] [PMID]
  27. Alghadir AH, Anwer S, Iqbal A, Iqbal ZA. Test-retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. Journal of Pain Research. 2018; 11:851-6. [DOI:10.2147/JPR.S158847] [PMID] [PMCID]
  28. Rezvani AM, Siratinayer M, Abadi A, Moradyan T. [Correlation between visual analogue scale and short form of McGill questionnaire in patients with chronic low back pain (Persian)]. Qom University of Medical Sciences Journal. 2012; 6(1):31-4. [Link]
  29. 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)]. Journal of Shahid Sadoughi University of Medical Sciences. 2013; 20(5):657-67. [Link]
  30. Heydari Z, Ansari Jaberi A, Seyed Bagheri SH, Negahban Bonabi T. Effects of rosemary oil on osteoarthritis symptoms in the elderly: A double-blind randomized control. Journal of Occupational Health and Epidemiology. 2022; 11(3):171-9. [DOI:10.61186/johe.11.3.171]
  31. Elbahnasawy AS, Valeeva ER, El-Sayed EM, Rakhimov II. The impact of thyme and rosemary on prevention of osteoporosis in rats. Journal of Nutrition and Metabolism. 2019; 2019:1431384. [DOI:10.1155/2019/1431384] [PMID] [PMCID]
  32. Ghannadi A, Karimzadeh H, Tavakoli N, Darafsh M, Ramezanloo P. Efficacy of a combined rosemary and lavender topical ointment in the treatment of patients with osteoarthritis of the knee. Zahedan Journal of Research in Medical Sciences. 2013; 15(6):29-33. [Link]
  33. Araya-Quintanilla F, Gutierrez-Espinoza H, Munoz-Yanez MJ, Sanchez-Montoya U, Lopez-Jeldes J. Effectiveness of ginger on pain and function in knee osteoarthritis: A PRISMA systematic review and meta-analysis. Pain Physician. 2020; 23(2):E151-61. [DOI:10.36076/ppj.2020/23/E151]
  34. Al-Suhaimi EA, Al-Riziza NA, Al-Essa RA. Physiological and therapeutical roles of ginger and turmeric on endocrine functions. The American Journal of Chinese Medicine. 2011; 39(2):215-31. [DOI:10.1142/S0192415X11008762] [PMID]
  35. Young HY, Luo YL, Cheng HY, Hsieh WC, Liao JC, Peng WH. Analgesic and anti-inflammatory activities of [6]-gingerol. Journal of Ethnopharmacology. 2005; 96(1-2):207-10. [DOI:10.1016/j.jep.2004.09.009] [PMID]
  36. Chrubasik S, Pittler MH, Roufogalis BD. Zingiberis rhizoma: A comprehensive review on the ginger effect and efficacy profiles. Phytomedicine. 2005; 12(9):684-701. [DOI:10.1016/j.phymed.2004.07.009] [PMID]
  37. Scalfo F, Davis S, Lai A, Karsdal M, Offord E, Ameye L. Rosemary extract slows down cartilage degeneration in bovine articular cartilage explants. Journal of Human Nutrition and Dietetics. 2009; 22(3):270. [DOI:10.1111/j.1365-277X.2009.00952_19.x]
  38. Mohammadifar M, Talaei SA, Vakili Z, Bahmani F, Memarzadeh MR, Aarabi MH. [Eavaluating antinociceptic effect of nano-emulsion gel conataining rosemary and peppermint essential oils in a rat model of osteoarthritis (Persian)]. Scientific Journal of Kurdistan University of Medical Sciences. 2018; 23(4):100-9. [DOI:10.52547/sjku.23.4.100]
  39. Yip YB, Tam AC. An experimental study on the effectiveness of massage with aromatic ginger and orange essential oil for moderate-to-severe knee pain among the elderly in Hong Kong. Complementary Therapies in Medicine. 2008; 16(3):131-8. [DOI:10.1016/j.ctim.2007.12.003] [PMID]
  40. Zakeri Z, Izadi S, Bari Z, Soltani F, Narouie B, Ghasemi-Rad M. Evaluating the effects of ginger extract on knee pain, stiffness and difficulty in patients with knee osteoarthritis. Journal of Medicinal Plants Research. 2011; 5(15):3375-9. [Link]
  41. Niempoog S, Pawa KK, Amatyakul C. The efficacy of powdered ginger in osteoarthritis of the knee. Journal of the Medical Association of Thailand. 2012; 95(Suppl 1):S59-64. [Link]
  42. Jung MY, Lee MK, Park HJ, Oh EB, Shin JY, Park JS, et al. Heat-induced conversion of gingerols to shogaols in ginger as affected by heat type (dry or moist heat), sample type (fresh or dried), temperature and time. Food Science and Biotechnology. 2017; 27(3):687-93. [DOI:10.1007/s10068-017-0301-1] [PMID] [PMCID]
  43. Nurtjahja-Tjendraputra E, Ammit AJ, Roufogalis BD, Tran VH, Duke CC. Effective anti-platelet and COX-1 enzyme inhibitors from pungent constituents of ginger. Thrombosis Research. 2003; 111(4-5):259-65. [DOI:10.1016/j.thromres.2003.09.009] [PMID]
  44. Lantz RC, Chen GJ, Sarihan M, Sólyom AM, Jolad SD, Timmermann BN. The effect of extracts from ginger rhizome on inflammatory mediator production. Phytomedicine. 2007; 14(2-3):123-8. [DOI:10.1016/j.phymed.2006.03.003] [PMID]
Type of Study: Research | Subject: Clinical
Received: 2023/03/11 | Accepted: 2023/07/24 | Published: 2024/04/01

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | Iranian Journal of Ageing

Designed & Developed by : Yektaweb