None listed
Conditions
Brief summary
Osteoarthritis (OA) is the most common cause of chronic pain and disability in older adults and is associated with muscle weakness, functional limitations, psychological distress, fear of movement and reduced quality of life. Knee OA accounts for the majority of the burden of OA worldwide. Exercise can effectively reduce pain in knee OA and is universally recommended as a first-line treatment by international evidence based treatment guidelines. Exercise also produces immediate, short term reductions in pain sensitivity after a single bout of exercise, called exercise induced hypoalgesia (EIH). However, higher levels of EIH variability can be seen in chronic pain conditions such as knee OA, with some people experiencing no change or even an increase in pain after exercise. Recent evidence in a healthy pain-free population has shown that education about the pain relieving effects of exercise may enhance EIH The effects of such an intervention have not yet been examined in an OA population, where EIH is known to be more variable. We will therefore conduct a double blind randomised controlled trial examining the effect of education on EIH in people with OA. The intervention group will receive 2 x 30 minute education sessions designed to increase their knowledge of EIH and increase their expectations of a positive effect. The comparison group will receive 2 x 30 minute education sessions about different types of pain and the pathophysiology of OA. Immediately after the second education intervention, participants’ expectations regarding exercise and pain will be assessed by questionnaire. After this, EIH will be measured in response to a standardised bout of resistance exercise. All assessments will be performed by a blinded assessor. The study will test whether changing a person’s expectation of pain relief following exercise can modify the EIH response.
Interventions
The intervention will consist of two education sessions (one-on-one interactive style lectures), 24-72 hours apart (‘Session 1’ and ‘Session 2’) delivered by a postgraduate qualified physiotherapist. Each of the two education sessions will last approximately 30 minutes and will be closely matched in duration for the intervention and control groups. The same experimenter will provide the education (intervention or control) to all participants. Participant adherence will be monitored during both s
The intervention will consist of two education sessions (one-on-one interactive style lectures), 24-72 hours apart (‘Session 1’ and ‘Session 2’) delivered by a postgraduate qualified physiotherapist. Each of the two education sessions will last approximately 30 minutes and will be closely matched in duration for the intervention and control groups. The same experimenter will provide the education (intervention or control) to all participants. Participant adherence will be monitored during both sessions using a session attendance checklist. In the intervention group, the first education session shall include information specifically tailored to counter common misconceptions and beliefs regarding osteoarthritis pain and its management. During the second 30 minute session, the intervention group’s content shall include: education about exercise induced hypoalgesia (Jones et., 2017). Upon completion of the second education session participants will complete a bout of isometric exercise where they will be instructed to maintain a target force until failure, defined as unable to sustain 25% of their maximum voluntary contraction for greater than or equal to 5-s, or a maximum of 5 minutes.
Sponsors
Auckland University of Technology, North Shore Campus
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
45 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Participants will be included if they are males and females greater than or equal to 45 years of age, meet The National Institute for Health and Care Excellence clinical criteria for the diagnosis of knee OA, have ongoing knee pain for greater than or equal to 3 months, and have an average pain intensity of greater than or equal to 3/10 numerical rating scale (NRS) in the last week at the time of screening. In the instance where participants have bilateral knee OA, the most painful knee will become the index knee.
Exclusion criteria
Participants will be excluded if they have an inability to speak or write English; conditions preventing safe participation in physical activity (Failed Physical Activity Readiness Questionnaire (PAR-Q), are physically unable to climb 2 flights of stairs, have ever had a total knee replacement, had recent knee surgery (past 6 months), a history of lower limb resistance training (greater than or equal to 2 times per week for a minimum of 6 weeks within the past 6 months); any other form of arthritis (e.g. rheumatoid arthritis); a history of musculoskeletal pain or injury in the lower limb (other than osteoarthritis) in the past 6 months; any neurological condition; any unstable/uncontrolled cardiovascular condition; a current diagnosis of a major psychiatric disorder; any cognitive impairment.
Outcome results
None listed