الفهرس 
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Abstract
Osteoarthritis (OA) is one of the most common diseases of the skeletal system, and can be defined as a degenerative condition affecting synovial joints, being the most prevalent form of joint disease, which does not lead to systemic involvement, without associated mortality. Knee OA is a disease of inflammatory and degenerative nature causing joint cartilage destruction, leading to joint deformity. Pain and stiffness is typically the early impairing factors for knee OA, subsequently leading to joint changes and progressive dysfunction. Physical agents can fight the painful process when correctly indicated and used. Among these agents were cryotherapy which can lower nerve impulse and produce local anesthetic effect over affected joint and various forms of exercises program which aims to increase muscle strengths around affected joints and hence increase physical function (Silva, et al., 2007).
The aim of this study was to determine effect of combining cryotherapy with knee exercises program versus conventional therapy on the clinical outcomes of patients with knee osteoarthritis.
Setting
The study was carried out in physical medicine and rehabilitation department of University hospital at Menoufia Governorate.
Subjects:
A purposive sample of 100 patients with rheumatoid arthritis assigned randomly and alternatively into two equal groups (study group I and study group II), 50 patients for each group. 9 patients (2 from study group I and 7 from study group II) did not completed the study.
Study group I: - performed knee exercise program for 30 min followed by cryotherapy for 20 min 3 times weekly for 8 weeks Study group II: - received routine hospital care (TENS for 10 min followed by SWD for 10 min and exercise on quad chair for 5 min
Tools of the study: 4 tools were utilized for data collection.
Tool I : Biosociodemographic data assessment sheet.
Tool II : WOMAC Knee Osteoarthritis Scale.
Tool III: Knee Range of Motion Measurement Test.
Tool IV: Knee Swelling Measurement Test.
The main findings of the present study were
There was significant improvement in the mean total knowledge score in study group I than study group II after 4 and 8 weeks of the program than before.
There was significant improvement in knee ROM (flexion and extension) in both studied groups (I & II) after 4 and 8 weeks of the programs than before.
There was significant improvement in mean total WOMAC score in both studied groups (I & II) after 4 and 8 weeks of the programs than before.
There was significant improvement in knee swelling in study group I after 4 and 8 weeks of the program than before.
Conclusion
Knee ROM, pain, joint stiffness, and physical function improved among knee osteoarthritis patients who performed knee exercise program followed by cryotherapy and in those who received conventional therapy (TENS followed by SWD and quad chair exercises.
Knee swelling decreased in patients who performed knee exercise program followed by cryotherapy.
Patients with grade I and II knee osteoarthritis who received combined cryotherapy with exercise program or received conventional therapy reported improvement in knee flexion, pain, stiffness and physical function than patients with grade III knee osteoarthritis.
Patients with BMI < 30 who received combined cryotherapy with exercise program or received conventional therapy reported improvement in knee flexion, pain, stiffness and physical function than those with BMI > 30
Recommendation
Cryotherapy and knee exercises program can be used as an alternative for managing patients with knee osteoarthritis as it is cheaper, readily available and has no contraindications in addition it can be used independently by patient with follow up only which saves patient time and effort.
Supervised rehabilitative health teaching program should be carried out for patient’s knee osteoarthritis about importance of combining cryotherapy with knee exercises in reducing pain, stiffness, swelling and improving ROM and physical functions.
Supervised health teaching program should be carried out to obese patients with knee osteoarthritis about the importance of weight reduction and ways of achieving it to help them to reduce pain, stiffness, and swelling and improve ROM and physical functions.
Manual worker patients with knee osteoarthritis should receive supervised health teaching program about the effective use of body mechanics to avoid overloading knee joints.