Muscle Weakness, Musculoskeletal Injury
Conditions
Keywords
Musculoskeletal rehabilitation, Blood flow restriction, Resistance training, knee pain, military
Brief summary
In 2018, the Academic Department of Military Rehabilitation (ADMR) published a pilot randomised controlled trial (RCT), demonstrating the feasibility and acceptability of integrating twice-daily blood flow restriction (BFR) training into a busy residential care setting. Following its publication was a guidance note written by the Directorate of Defence Rehabilitation restricting the implementation of BFR training until more evidence can be provided to support its efficacy. This research trial is a fully-powered, multi-centre RCT investigating the efficacy and biological mechanism underpinning BFR therapy in UK military personnel with lower-limb musculoskeletal injury (specifically, persistent anterior knee pain) during residential rehabilitation. This study will aim to optimise both the rehabilitation outcome and improve the time-and cost-effectiveness of the service delivered across UK Defence Rehabilitation and beyond. Results will provide insight and knowledge to the clinical and scientific community to not only those embedded within Defence Rehabilitation, but also those working in civilian sector organisations and professional sport in the UK and abroad.
Interventions
OTHERResistance Training
Comparing two different exercise-based treatment methodologies on the clinical outcomes of individuals with persistent knee pain.
Sponsors
University of Bath
Defence Medical Rehabilitation Centre, UK
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 55 Years
Healthy volunteers
No
Inclusion criteria
* mechanical knee pain for at least three months * present with clinical signs and symptoms of knee pain arising from the tibiofemoral or patellofemoral joint diagnosed by sport and exercise medicine physician and/or physiotherapist * have reduced occupational employability medical grade secondary to their knee pain * report progression of resistance training load within the patient's rehabilitation programme is limited by knee pain * aged between 18 and 55 years * available to attend for the entire duration of the RRU course and a review appointment 3-months following course.
Exclusion criteria
diagnosed tibial, femoral or patella fracture and/or dislocation; * present with instability in the knee resulting from ligament deficiency * present with clinical signs and symptoms of patellar tendinopathy * have planned surgery over the study period * restricted knee range of movement; clinical signs and symptoms of non-musculoskeletal or serious pathological condition (i.e. Inflammatory arthropathy, infection or tumour) or referred pain from non-local pain source * present with any physical impairment or co-morbidities (including cardio-vascular disease) precluding the safe participation in the rehabilitation programme and/or assessment procedures * Cortico-steroid or analgesic injection intervention within the previous 7-days or previous knee surgery within the last 12 months to the affected limb Medical
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Lower Extremity Functional Scale (LEFS) over time | Baseline, week 3 and week 15 | LEFS is a 20-question patient-reported outcome measure (PROM) that measures functional status in patients with lower limb musculoskeletal injury. Questions on activity vary in physical demand from walking to running on uneven ground. The LEFS is a validated tool and has demonstrated good test-retest reliability and responsiveness in individuals with persistent knee pain. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Patient Specific Functional Scale over time | Baseline, week 3 and week 15 | — |
| Change in Musculoskeletal Health Questionnaire (MSK-HQ) over time | Baseline, week 3 and week 15 | — |
| Change in Tampa Scale of Kinesiophobia (TSK) over time | Baseline, week 3 and week 15 | — |
| Health Anxiety Depression Scale (HADS) | Baseline | — |
| Change in International Physical Activity Questionnaire (IPAQ) over time | Baseline, week 3 and week 15 | — |
| Change in Numeric Pain Rating Scale (NPRS) over time | Baseline, week 3 and week 15 | — |
| Change in Sport Injury Rehabilitation Beliefs Survey (SIRBS) over time | Baseline, week 3 and week 15 | — |
| Change in functional Activity Assessment (FAA) over time | Baseline and week 15 | — |
| Change in five Repetition Maximum Leg Press over time | Baseline, week 3 and week 15 | — |
| Change in isometric muscle strength of hip and knee using hand-held dynamometer over time | Baseline, week 3 and week 15 | — |
| Change in single leg heel raises to fatigue over time | Baseline, week 3 and week 15 | — |
| Change in qualitative assessment of single leg squat (QASLS) over time | Baseline, week 3 and week 15 | — |
| Change in decline knee bend over time | Baseline, week 3 and week 15 | — |
| Change in isometric midthigh pull over time | Baseline, week 3 and week 15 | — |
| Change in Knee Injury and Osteoarthritis Outcome Score (KOOS) over time | Baseline, week 3 and week 15 | — |
| Change in knee extension and flexion - maximal isometric voluntary contraction over time | Baseline, week 3 and week 15 | — |
| Change in muscle volume and anatomical cross sectional area (CSA) using magnetic resonance imaging (MRI) over time | Baseline, week 3 and week 15 | — |
| Change in pennation angle over time using ultrasonography | Baseline, week 3 and week 15 | Pennation angle measured in degrees |
| Change in fascicle length over time using ultrasonography | Baseline, week 3 and week 15 | fascicle length measured in mm |
| Change in single leg squat over time - kinetic and kinematic analysis | Baseline, week 3 and week 15 | 3D motion capture and force plate data will be used to collect kinetic and kinematic data which will be later analysed using inverse dynamics. Force measured in Newtons, Moments measured in Newton/Metres/kg |
| Change in bilateral squat over time - kinetic and kinematic analysis | Baseline, week 3 and week 15 | 3D motion capture and force plate data will be used to collect kinetic and kinematic data which will be later analysed using inverse dynamics. Force measured in Newtons, Moments measured in Newton/Metres/kg |
| Change in markers of muscle damage over time | Baseline, week 3 and week 15 | Using fasted blood samples. E.g., Creatine Kinase (units/L) |
| Change in markers of oxidative stress over time | Baseline, week 3 and week 15 | Using fasted blood samples. E.g., Protein carbonyl (units/L) |
| Change in markers of inflammation over time | Baseline, week 3 and week 15 | Using fasted blood samples. E.g., Interleukin-6 (pg/ml) |
| Change in markers of endothelial function over time | Baseline, week 3 and week 15 | Using fasted blood samples. E.g., Vascular endothelial growth factor (µg/L) |
| Change in daily monitoring of wellness score over time | Daily for the 3 weeks of rehabilitation | Subjective patient reported outcome measure of 'wellness' scored using a 5-point likert scale. |
| Change in daily monitoring of session rate of perceived exertion (sRPE) over time | Daily for the 3 weeks of rehabilitation | Subjective patient reported outcome measure of exertion, scored 0 to 10 (0 = no exertion, 10= maximal exertion) |
| Change in daily monitoring of pain over time | Daily for the 3 weeks of rehabilitation | Subjective patient reported outcome measure of pain measured using a 0 to 100mm visual analog scale (VAS). 0= no pain, 100 = worst pain |
| Change in counter-movement jump over time | Baseline, week 3 and week 15 | — |
Countries
United Kingdom
Contacts
Primary ContactPeter Ladlow, PhD
Backup ContactRuss Coppack, PhD
Outcome results
None listed