A Comparative Clinical Study to Evaluate the Efficacy of Janu Basti and Matra Basti with Shvadanstra Taila in the Management of Janu-Sandhigata Vata w.s.r. to Osteoarthritis of Knee Joint.â€

ØEffect of Therapy on Sandhishoola (Knee Joint Pain): -

In Group A, the meanbefore treatment was 5.286 which improved to 3.714 after treatment. It showedan improvement with Mean Difference of 1.571 ±0.7559 (S.D) with 29.72%. Thestatistical analysis showed very significant result at p value (< 0.0005).

In Group B, the meanscore before treatment was 4.867 which improved to 2.733 after treatment. Itshowed an improvement with Mean Difference of 2.133±0.5164 (S.D.) with43.82%.The statistical analysis showed extremely significant result at p value <0.0001.

Intergroup comparisonwas done to assess the comparative efficacy of both groups. When Group A wascompared with Group B on symptom of Sandhishoola, the two-tailed pvalue was 0.0327that was significant. it means that their statisticaldifference in the efficacy of both treatments on Sandhishoola.

Vitiation of Vata has an important role inthe arising ofJanu-Sandhigata Vata. Shooladoesn’t occur without Vata. The Rukshata of Vata is cured by Tailadueto Snigdha. The Virya of Tailla is Ushna. It has effect on VatikaShoola. Tilataila has Snehana, Vedanasthapana, Sandhaniya, ShoolaPrashamana,Balyakarma. Basti is the best medicament for Vatika disorders. The properties of Basti which is VatanulomanaandSrotoshodhakaremove the impacted stool mass in the body and pacifying Vata inPakvashayagives direct effect onJanu-Sandhigata Vata.Similarly, effect of Snehanaand Swedana is worth mentioning, as Snehana is said to be MardavakaraandSwedana is said to be Shoolaghna. Thus, irrespective of the materialused these two procedures will have a certain positive effect towards reducing Shoola.

Ø Effect ofTherapy on Sandhisotha (Swelling overjoints): -

In Group A, the mean score before treatment was1.833 which improved to 0.333 after treatment. It showed an improvement withMean Difference of 1.500 ±0.674 (S.D). with 81.83% change. The statisticalanalysis showed very significant result at p value < 0.0005.

In Group B, themean before treatment was 1.750 which improved to 0.2500 after treatment. Itshowed an improvement with Mean Difference of 1.500±0.674 (S.D.). with 85.71%change. The statistical analysis showed significant result at p value <0.0005. which 85.71% change.

Intergroupcomparison was done to assess the comparative efficacy of both groups. WhenGroup A was compared with Group B on symptom ofSandhisotha, the two-tailed p value was 0.7908that was insignificant.Its means there is no statistical difference in the efficacy of both treatmentsonSandhisotha.

TheUshnata applied by the Janu Basti procedure and UshnaVirya of drugs do the Pachana of the Dushya involved in the formation of Sotha. Due to this action the Sothamighthave reduced in Group B.

Ø Effect ofTherapy on Sandhigraha(Stiffness injoints): -

InGroup A, the mean score before treatment was 2.000 which improved to 1.000after treatment. It showed an improvement with Mean Difference of 1.000 ±0.6030(S.D). with50% change. The statistical analysis showed very significant resultat p value < 0.0020.

In Group B, themean before treatment was 2.000 which improved to 0.6667 after treatment. Itshowed an improvement with Mean Difference of 1.333 ±0.4880 (S.D.). with 66.65%change. The statistical analysis showed extremely significant result at p value< 0.0001.

Intergroupcomparison was done to assess the comparative efficacy of both groups. WhenGroup A was compared with Group B on symptom ofSandhigraha,the two-tailed p value was 0.0459that was insignificant.

Joint stiffness is feature of JanuSandhigataVatawhich is caused by Rooksha and SheetaGuna of Vata.

The heat applied through the JanuBasti(retentionof oil on knee joint)with *ShvadanstraTaila,*retention of Taila and UshnaVeerya of Taila along with its Snigdhata decreases the Rooksha and SheetaGuna and reduce the stiffness.

Janu**Basti being successful in relieving the stiffness because ofitsSnehanaand Swedana effects simultaneously.Due to its SnehanaGuna,Vata gets pacified and Swedana causes relief inStabdhata, GauravaandSheeta dueto its inherent qualities.

Ø Effect ofTherapy on Sandhisphutana (Crepitus):-

In Group A, the mean before treatment was 1.929which improved to 1.714 after treatment. It showed an improvement with MeanDifference of 0.214 ±0.4258 (S.D). with 50% change. The statistical analysisshowed insignificant result at p value < 0.2500.

In Group B, the mean beforetreatment was 1.5333 which improved to 1.333 after treatment. It showed animprovement with Mean Difference of 0.2000 ±0.4140 (S.D.). with 13.346% change.The statistical analysis showed insignificant result at p value < 0.2500.

Intergroup comparison was done to assess thecomparative efficacy of both groups. When Group A was compared with Group B onsymptom ofSandhisphutana, thetwo-tailed p value was 0.2500that was insignificant. Its means there is nostatistical difference in the efficacy of both treatments onSandhisphutana.

Effect of Therapy on Sparshasahyata (Tenderness): -

In Group A, themean before treatment was 1.60 which improved to 0.2000 after treatment. Itshowed an improvement with Mean Difference of 1.400 ±0.547 (S.D). with 87.5%change. The statistical analysis showed insignificant result at p value <0.0625.

In Group B, themean before treatment was 1.66 which improved to 0.2000 after treatment. Itshowed an improvement with Mean Difference of 1.400 ±0.5477 (S.D.). with 87.5%change. The statistical analysis showed insignificant result at p value <0.0625.

Intergroupcomparison was done to assess the comparative efficacy of both groups. WhenGroup A was compared with Group B on symptom ofSparshasahyata,the two-tailed p value was 0.2154that was insignificant.Its means there is no statistical difference in theefficacy of both treatments onSparsaasahyata.

Tenderness is advanced stage of pain. Skin is thelodging place for Vata. Thus this can be said that tenderness is felt atdifferent dermatomes when the nerve is compressed. MatraBastiwith ShvadanstraTailahasanti-inflammatory, analgesic properties, due to anti- inflammatory effects of Shvadanstra. It may help in reducing thecompression of nerve by reducing inflammation of articular cartilages. Taila soothes the joints and also helpstreating levels of synovial fluid making the entire structure lubricated andeasy to rotate or to move. Tailaimproves blood supply to joints and restores integrity of vessels obliteratedby spasm of internal damage. Thus reduction of Tenderness was seen in both thegroups.

Ø  Effect of Therapyon WOMAC Index Score: -

In Group A, the mean beforetreatment was 55.21 which improved to 37.14 after treatment. It showed animprovement with Mean Difference of 18.071 ±8.453(S.D). with 32.729 % change.The statistical analysis showed insignificant result at p value < 0.0625.

In Group B, themean before treatment was 50.467 which improved to 29.467 after treatment. Itshowed an improvement with Mean Difference of 21.000 ±4.781 (S.D.). with41.611% change. The statistical analysis showed significant result at p value< 0.0001.

Intergroupcomparison was done to assess the comparative efficacy of both groups. WhenGroup A was compared with Group B on symptom ofWOMAC Index Score, the two-tailed p value was 0.8955 thatwas insignificant.Its means there is no statistical difference in the efficacyof both treatments on WOMAC IndexScore.

WOMAC index score includes pain, stiffness and physical function.Percentage of relief in Pain and stiffness was more in Group B than Group A, asdiscussed above. By improvement in pain and stiffness, the physical functionalso improves.

Ø Effect ofTherapy on X-Ray: - No anysignificant radiological changes were found after treatment in both groups. Maybe due to the short course of treatment and follow-up, changes in X-Ray werenot found.

Knee joint rangeof movements

·       **Knee Joint Extension -**InGroup A, the mean before treatment was 11.667 which is same 11.667 aftertreatment. It showed an improvement with Mean Difference is zero. In group B SDis zero.

·      KneeJoint Flexion- In Group A, the mean before treatmentwas 104.62 which improved to 116.15 after treatment. It showed an improvementwith Mean Difference of 11.538±5.911 (S.D.). with 9.93% change. The statisticalanalysis showed significant result at p value < 0.0001.

In Group B, the meanbefore treatment was 109.29 which improved to 119.29 aftertreatment. It showedan improvement with Mean Difference of -9.649±7.95 (S.D.). with9.643% change.The statistical analysis showed significant result at p value < 0.0006.

No any significantchanges were found on extension of knee joint after treatment in both groups.Intergroupcomparison was done to assess the comparative efficacy of both groups. WhenGroup A was compared with Group B on symptom ofrange of movements (flexion)the two-tailed p value was 0.1829& 0.2458 that was insignificant respectively right and left knee joint.Theseimprovement in range of motion might be due to the improvement in othersymptoms of the diseases such as pain, stiffness etc. Reduction in Pain,stiffness in turn might have overcome the restriction thus increasing the rangeof movements at knee joint.