{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T22:47:03Z","timestamp":1785883623232,"version":"3.56.0"},"reference-count":39,"publisher":"Wiley","license":[{"start":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T00:00:00Z","timestamp":1627948800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004320","name":"Shiraz University of Medical Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004320","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Evidence-Based Complementary and Alternative Medicine"],"published-print":{"date-parts":[[2021,8,3]]},"abstract":"<jats:p>Background. Knee osteoarthritis is a common disease that is associated with chronic pain and disability in patients. Prolotherapy is a complementary therapeutic approach for improving pain and function in patients with osteoarthritis. We aimed to compare the effect of hypertonic saline with ozone plus hypertonic saline in improving the symptoms of osteoarthritis in the patients. Materials and Method. In this clinical trial, thirty-four adults with painful primary knee osteoarthritis for at least three months were randomized to two groups: ozone plus hypertonic saline 5% and hypertonic saline 5% alone. Prolotherapy and thrice follow-up with two-week intervals were done. The outcome measures included Oxford Knee Scale (OKS), Western Ontario McMaster University Osteoarthritis Index (WOMAC), and Visual Analog Scale (VAS), which were obtained from the patients before the injection and after the 2nd and 4th weeks after the start of the study. Results. The mean age of the participants was 60.12\u2009\u00b1\u20097.54 years. There were no statistically significant differences between demographic characteristics before the injection between the two groups (<jats:inline-formula>\n                     <a:math xmlns:a=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\">\n                        <a:mi>p<\/a:mi>\n                     <\/a:math>\n                  <\/jats:inline-formula>\u2009&gt;\u20090.05). The results showed that VAS and OKS values decreased over time (<jats:inline-formula>\n                     <c:math xmlns:c=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\">\n                        <c:mi>p<\/c:mi>\n                     <\/c:math>\n                  <\/jats:inline-formula>\u2009&lt;\u20090.001) in each group, but there was no significant difference in the reduction of those between the two treatment groups (<jats:inline-formula>\n                     <e:math xmlns:e=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\">\n                        <e:mi>p<\/e:mi>\n                     <\/e:math>\n                  <\/jats:inline-formula>\u2009=\u20090.734 and <jats:inline-formula>\n                     <g:math xmlns:g=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M4\">\n                        <g:mi>p<\/g:mi>\n                     <\/g:math>\n                  <\/jats:inline-formula>\u2009=\u20090.734, respectively). Both interventions improved the mean values of WOMAC pain, WOMAC stiffness, WOMAC act, and WOMAC total. However, there was no significant difference in WOMAC pain reduction rate (<jats:inline-formula>\n                     <i:math xmlns:i=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M5\">\n                        <i:mi>p<\/i:mi>\n                     <\/i:math>\n                  <\/jats:inline-formula>\u2009=\u20090.465), WOMAC stiffness rate (<jats:inline-formula>\n                     <k:math xmlns:k=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M6\">\n                        <k:mi>p<\/k:mi>\n                     <\/k:math>\n                  <\/jats:inline-formula>\u2009=\u20090.656), WOMAC act rate (<jats:inline-formula>\n                     <m:math xmlns:m=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M7\">\n                        <m:mi>p<\/m:mi>\n                     <\/m:math>\n                  <\/jats:inline-formula>\u2009=\u20090.376), and WOMAC total rate between the two methods (<jats:inline-formula>\n                     <o:math xmlns:o=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M8\">\n                        <o:mi>p<\/o:mi>\n                     <\/o:math>\n                  <\/jats:inline-formula>\u2009=\u20090.528). Conclusion. The results showed that intra-articular prolozone therapy and hypertonic saline injection can lead to improvement of pain and function in patients with knee osteoarthritis at the same status without any significant difference.<\/jats:p>","DOI":"10.1155\/2021\/5579944","type":"journal-article","created":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T00:50:09Z","timestamp":1628038209000},"page":"1-7","source":"Crossref","is-referenced-by-count":5,"title":["The Efficacy of Ozone Prolotherapy Compared to Intra-Articular Hypertonic Saline Injection in Reducing Pain and Improving the Function of Patients with Knee Osteoarthritis: A Randomized Clinical Trial"],"prefix":"10.1155","volume":"2021","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8867-3928","authenticated-orcid":true,"given":"Hamid reza","family":"Farpour","sequence":"first","affiliation":[{"name":"Shiraz Geriatric Research Center, Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran"},{"name":"Bone and Joint Diseases Research Center, Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3796-1062","authenticated-orcid":true,"given":"Alireza","family":"Ashraf","sequence":"additional","affiliation":[{"name":"Shiraz Geriatric Research Center, Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2002-8444","authenticated-orcid":true,"given":"Seyed Saeed","family":"Hosseini","sequence":"additional","affiliation":[{"name":"Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/41.s1.3"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1007\/s00223-020-00670-x"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2019.10.007"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2020.01.002"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-098099"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-016-0424-x"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctcp.2015.06.003"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/6940741"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9041167"},{"key":"10","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20180828-08"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.12809\/hkmj187600"},{"key":"12","doi-asserted-by":"publisher","DOI":"10.1007\/s11926-018-0794-5"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldx006"},{"key":"14","doi-asserted-by":"publisher","DOI":"10.19082\/5663"},{"key":"15","doi-asserted-by":"publisher","DOI":"10.1097\/01.phm.0000124443.31707.74"},{"key":"16","doi-asserted-by":"publisher","DOI":"10.1089\/wound.2018.0866"},{"key":"17","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2011.04.003"},{"key":"18","doi-asserted-by":"publisher","DOI":"10.2174\/0929867323666151221150420"},{"key":"19","doi-asserted-by":"publisher","DOI":"10.1016\/j.arcmed.2005.08.006"},{"issue":"4","key":"20","first-page":"553","article-title":"Painkilling effect of ozone-oxygen injection on spine and joint osteoarthritis","volume":"29","author":"A. 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