TYPE Original Research PUBLISHED 09 November 2022 DOI 10.3389/fmed.2022.1029140 OPEN ACCESS EDITED BY Tzvi Dwolatzky, Technion Israel Institute of Technology, Israel REVIEWED BY Farzaneh Gandomi, Razi University, Iran Cíntia Freitas, Federal University of Santa Catarina, Brazil *CORRESPONDENCE Marta Imamura marta.imamura@fm.usp.br SPECIALTY SECTION This article was submitted to Geriatric Medicine, a section of the journal Frontiers in Medicine RECEIVED 26 August 2022 ACCEPTED 10 October 2022 PUBLISHED 09 November 2022 CITATION Imamura M, Shinzato GT, Sugawara AT, Uchiyama SST, Matheus D, Simis M, Ayres DVM, dos Santos ACA, Assone T, Ramos VD, Fregni F and Battistella LR (2022) The Institute of Physical Medicine and Rehabilitation, Hospital das Clínicas University of São Paulo School of Medicine comprehensive rehabilitation program for elderly people with knee osteoarthritis. Front. Med. 9:1029140. doi: 10.3389/fmed.2022.1029140 COPYRIGHT © 2022 Imamura, Shinzato, Sugawara, Uchiyama, Matheus, Simis, Ayres, dos Santos, Assone, Ramos, Fregni and Battistella. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. The Institute of Physical Medicine and Rehabilitation, Hospital das Clínicas University of São Paulo School of Medicine comprehensive rehabilitation program for elderly people with knee osteoarthritis Marta Imamura 1,2 *, Gilson T. Shinzato 1 , André T. Sugawara 1 , Sabrina Saemy Tome Uchiyama 1 , Denise Matheus 1 , Marcel Simis 1,2 , Denise Vianna Machado Ayres 1 , Artur C. A. dos Santos 1 , Tatiane Assone 1,3 , Vinícius Delgado Ramos 1 , Felipe Fregni 4,5 and Linamara R. Battistella 1,2 1 Instituto de Medicina Física e Reabilitação, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil, 2 Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 3 Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 4 Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, United States, 5 Harvard Medical School, Boston, MA, United States Background: Knee osteoarthritis (OA) is a leading cause of disability in the elderly population. Chronic disabling pain is associated with maladaptive neuroplastic changes in brain networks, commonly associated with central sensitization. The main clinical features of nociplastic pain conditions include combined peripheral and central sensitization, and it is crucial to recognize this type of pain, as it responds to different therapies than nociceptive and neuropathic pain. Objective: To report the effect of the Institute of Physical Medicine and Rehabilitation (IMREA) comprehensive rehabilitation program to reduce pain and to improve functioning in elderly people with knee OA, under the DEFINE cohort. Methods: This is a retrospective observational cohort of 96 patients with knee OA, recruited from October 2018 to December 2019. All patients were evaluated by a trained multidisciplinary team using the Kellgren Lawrence classification, bilateral knee ultrasonography, the visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain, rigidity and difficulty scores, the Timed Up and Go Test (TUG), 10-m and 6-min walking test (10 and 6 MWT), Berg Balance Scale, isokinetic dynamometry for knee extension and flexion strength, and pain pressure thresholds. The rehabilitation program included paraspinous lidocaine blocks, focal extracorporeal shockwaves combined with radial pressure waves and Frontiers in Medicine 01 frontiersin.org