None listed
Conditions
Brief summary
Knee osteoarthritis (OA) is a major public health problem. To reduce the burden of this disease, factors that increase the likelihood of disease progression need to be identified and treatments that slow progression need to be developed and tested. This is an emerging area and is the focus of this study because presently there are no established disease-modifying treatments for knee OA. One way to slow progression of the disease may be to reduce knee loading as this is one of only a few modifiable factors currently known to predict disease progression. This study will evaluate whether neuromuscular exercise, which aims to improve balance, alignment of the lower limb and trunk and muscle activity, reduces knee joint loading and thus has the potential to slow disease progression in people with knee OA, compared with the current standard physiotherapy treatment of strengthening the thigh muscles. If shown to be effective, recommendations can then be made to incorporate neuromuscular exercises into rehabilitation programs for knee OA.
Interventions
The participant will be randomised into one of two groups: (i) neuromuscular training; (ii) quadriceps strengthening.
(i) Neuromuscular training group
This intervention will comprise individual visits (up to twice weekly) to a physiotherapist located around Melbourne over 12 weeks, plus home exercises to be performed up to 5 times a week. Each physiotherapy session will last approximately 40 minutes. The exercises include closed kinetic chain, functional and balance exercises which aim to impr
The participant will be randomised into one of two groups: (i) neuromuscular training; (ii) quadriceps strengthening. (i) Neuromuscular training group This intervention will comprise individual visits (up to twice weekly) to a physiotherapist located around Melbourne over 12 weeks, plus home exercises to be performed up to 5 times a week. Each physiotherapy session will last approximately 40 minutes. The exercises include closed kinetic chain, functional and balance exercises which aim to improve dynamic stability, functional alignment and muscle activation patterns. A comprehensive exercise manual will be produced. Various equipment, including elastic bands will be used for some of the exercises. Progression of the exercises will be determined by the quality of the exercise performance and partly on participants' pain levels. (ii) Quadriceps strengthening group This intervention will comprise individual visits (up to twice weekly) to a physiotherapist located around Melbourne over 12 weeks, plus home exercises to be performed up to 5 times a week. Each physiotherapy session will last approximately 30 minutes. A comprehensive exercise manual will be produced. Open kinetic chain quadriceps strengthening exercises will be performed with resistance provided by ankle weights or elastic bands. Progression will be determined by the therapist taking into account the participant’s strength gain and pain levels.
Sponsors
The University of Melbourne, Department of Physiotherapy
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
A cohort of 100 men and women aged over 50 years with painful medial knee osteoarthritis (OA) will be recruited from the community, via notices in local and major newspapers, University of Melbourne Staff News, community club (such as RSL and bowls clubs) newsletters and posters which will be placed in medical, radiology or physiotherapy waiting rooms and advertisements placed in Facebook on the internet. Interested volunteers will telephone study personnel in order to establish initial eligibility for the project. Eligibility will subsequently be confirmed by radiographic and clinical examination. People with medial tibiofemoral joint OA (fulfilling the American College of Rheumatology classification criteria (Altman et al., 1986; Kellgren et al., 1963), a knee alignment of at least 181 degrees varus for women and 183 degrees varus for men and reporting average knee pain >39mm on an 100mm scale will be included.
Exclusion criteria
Exclusion criteria will include: a history of a lower limb joint replacement, high tibial osteotomy, spinal or hip surgery, any physiotherapy, lower limb exercises (including strengthening, pilates, yoga or balance components) or knee surgery or knee injections in the past 6 months, any condition that may affect walking, any systemic arthritic condition, any major medical conditions, such as cancer or major heart trouble, inability to walk unassisted and the inability to understand written or spoken English.
Outcome results
None listed