Eccentric resistance ergometry in knee osteoarthritis rehabilitation: a randomized clinical trial

Patients randomized to the intervention arm would receive standard physiotherapy treatment and they will exercise on an eccentric ergometer. Both Physiotherapy and ergometry training will be delivered individually. Standard physiotherapy treatment would be delivered by experienced Physiotherapists. Specifically, the standard Physiotherapy treatment comprises a combination of manual therapy and therapeutic exercises. For the manual therapy component, the techniques chosen comprise passive physiological and accessory movements, muscle stretching, and soft tissue mobilization. These techniques will be applied by the treating physiotherapists in accordance to their assessment findings. For the therapeutic-exercises component, the exercises will be supervised by the treating physiotherapists and the exercises consist of (i) active range-of-motion exercises, (ii) muscle strengthening exercises, and (iii) balance and functional training. All manual therapy techniques and therapeutic exercises would be progressed only if the symptoms and signs of OA (pain, knee effusion, and muscle soreness) are decreasing. Eccentric ergometry training involves cycling on an eccentric ergometer. Exercise intensity will be determined by the Borg’s rating of perceived exertion (RPE) scale. Dosage will be 15 minutes per session. In the absence of increased knee pain, effusion, or excessive fatigue, the patients are allowed to gradually progress from an initial RPE rating of "very very light intensity" on the first session to an RPE rating of “hard intensity" in the subsequent sessions. Physiotherapy treatment will be delivered twice weekly for the first 3 weeks and once weekly for the next 5 weeks. Each treatment session is 30mins in duration. Patients will train twice weekly on the eccentric ergometer and each session is 15mins in duration.