Dextrose Prolotherapy for Symptomatic Knee Osteoarthritis: Feasibility, Acceptability, and Patient-Oriented Outcomes in a Pilot-Level Quality Improvement Project
Bibliographic record
Abstract
OBJECTIVES: Knee osteoarthritis (KOA) is a growing health problem with limited nonsurgical treatment options. Prolotherapy is an injection-based technique for chronic KOA pain; health plan coverage is limited, presenting an access barrier. A local health plan recently included coverage for prolotherapy for KOA, but uptake and treatment response in routine care are unknown. The authors conducted a pilot-level quality improvement (QI) project to explore the feasibility, acceptability, and effects of prolotherapy for painful KOA in a primary care setting. DESIGN: QI prospective case series. SETTING/LOCATION: Outpatient: invitation letters were sent to symptomatic KOA patients with a primary care provider whose health plan covered prolotherapy. SUBJECTS: Primary care patients with KOA. INTERVENTION: Intra- and extra-articular prolotherapy injections: patients received up to six prolotherapy sessions. OUTCOME MEASURES: Primary: Feasibility: response rate to invitation to utilize prolotherapy. Acceptability: patient adherence to, and satisfaction with, three or more prolotherapy sessions. Secondary: Survey based (the Western Ontario McMaster University Osteoarthritis Index, WOMAC, 0-100; EuroQOL 5-D). Objectively assessed: function (30-sec chair stand, 4 × 10 m walk, 9-step stair-climb), overall activity (ActiGraph wGT3X accelerometer), treadmill gait analysis, and preferred walking speed. Outcome analysis (paired t-test) was per protocol, comparing follow-up and baseline outcome data at ∼8 months. RESULTS: Thirty-nine patients were invited, 11 responded, and 7 patients (59.6 ± 9.3 years, 6 female) received 5.0 ± 1.1 prolotherapy sessions. Satisfaction was high. Their WOMAC scores improved by 27.6 ± 19.5 points (p = 0.02) at 8.4 months. Functional testing improved by 8.0 ± 3.6 sec (p = 0.003) in the 4 × 10 m walk. There were no group differences between baseline and follow-up in chair stand, stair-climb, accelerometry, or gait outcomes. Five patients increased their preferred walking speed (p = 0.001). CONCLUSIONS: These data suggest that prolotherapy in this primary care clinic is feasible and acceptable. Self-reported improvement is similar to that of efficacy studies; office-based, objectively assessed functional assessment can be performed. Further evaluation is warranted.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".