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- Page navigation anchor for RE: Commentary on "Efficacy of Intra-Articular Hypertonic Dextrose (Prolotherapy) for Knee Osteoarthritis: A Randomized Controlled Trial"RE: Commentary on "Efficacy of Intra-Articular Hypertonic Dextrose (Prolotherapy) for Knee Osteoarthritis: A Randomized Controlled Trial"
First of all, I am very happy to be able to communicate with you and appreciate your efforts to explore effective treatments for osteoarthritis.We are very fortunate to read the article titled "Efficacy of Intra-Articular Hypertonic Dextrose (Prolotherapy) for Knee Osteoarthritis: A Randomized Controlled Trial". We are very interested in your article.The study concluded that hypertonic glucose is an effective treatment for osteoarthritis.Recently, our team is doing an evidence-based medical study on the treatment of osteoarthritis.Your excellent research has been incorporated into our research.Through reading the article, we found that some important information and data were not reported.We would be grateful if you could provide us with data on the specific values of the scores of the experimental and control groups after treatment.Let us work together to cure osteoarthritis in humans.
We are looking forward to hearing from you.
Kindest regards,
Dong ZhiqiangCompeting Interests: None declared. - Page navigation anchor for RE: A reply to commentary on "Efficacy of Intra-Articular Hypertonic Dextrose (Prolotherapy) for Knee Osteoarthritis: A Randomized Controlled Trial"RE: A reply to commentary on "Efficacy of Intra-Articular Hypertonic Dextrose (Prolotherapy) for Knee Osteoarthritis: A Randomized Controlled Trial"
We thank Mr. Choudary, Mr. van Doorn, and Dr. Elshout for your interest in our article; active discussion of the medical literature is a cornerstone of medical education. Here are our responses to your remarks.
The decision to use a score ≥ 3 out of an ordinal scale 0-6 was not arbitrary; rather it was intended to include participants with moderate to severe knee pain with three specific considerations. 1) We aimed to detect a difference between groups based on our clinical and research experience while working within practical limitations of time and money. As for all such RCTs, this is an informed estimate that weighs potential effect at a given level of disease severity; we were pleased that our severity estimate was correct and we were able to detect differences between groups. 2) Patients with low or intermittent levels of pain may not be as adherent to an injection protocol, even one as minimally invasive as this one. Here again, our judgement proved correct; adherence was very high. 3) The 3/6 eligibility pain criterion allowed comparison to a prior benchmark study, facilitating comparison to the prolotherapy literature.1 In general, we suspect that prolotherapy with dextrose would also be effective for patients with lower levels of pain and would welcome efforts, necessarily larger to detect smaller differences, to test this hypothesis.
We selected eligibility criteria to best detect differences between groups in this efficacy trial, including the ex...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Commentary on "Efficacy of Intra-Articular Hypertonic Dextrose (Prolotherapy) for Knee Osteoarthritis: A Randomized Controlled Trial"RE: Commentary on "Efficacy of Intra-Articular Hypertonic Dextrose (Prolotherapy) for Knee Osteoarthritis: A Randomized Controlled Trial"
Rahim Choudary, Medical Student, Erasmus MC Rotterdam
Other contributors:
Pieter van Doorn, doctoral candidate musculoskeletal diseases at the Department of General Practice, Erasmus MC Rotterdam
Dr. G. Elshout, General Practitioner, assistant professor at the Department of General Practice, Erasmus MC RotterdamWith great interest, we have read the article "Efficacy of Intra-Articular Hypertonic Dextrose (Prolotherapy) for Knee Osteoarthritis: A Randomized Controlled Trial". We want to compliment the authors for seeking a safer and more effective therapy for the treatment of knee osteoarthritis. However, we had some discussion about the design of the study and interpretation of the results and would like to share them with the authors.
First, as the authors have described in the study, patients were included if they had a score of ≥3 (on an ordinal scale from 0-6) in response to the question: What is the average level of your left/ right knee pain in the past 3 months? We would like to know what the rationale was for the chosen scale, because the chosen scale of 0-6 seems arbitrary.
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Second, patients were also excluded if they had a BMI ≥35. A moderation analysis was done and showed no effect of BMI on pain outcome in this study population. But we wondered what the reason was for the exclusion of this group? We would also like to know the specific comorbidities and lifestyle factors of the excluded patients, so that the reade...Competing Interests: None declared.