The Immediate Effects of Conventional Physical Therapy on the Knee Joint Load in Subjects with Moderate Knee Osteoarthritis; A Preliminary Single Blinded Randomized Control Trial

Fattahi, Leila; Rezaeian, Zahra Sadat

doi:10.30476/jrsr.2015.41079

The Immediate Effects of Conventional Physical Therapy on the Knee Joint Load in Subjects with Moderate Knee Osteoarthritis; A Preliminary Single Blinded Randomized Control Trial

Document Type : Original Articles

Authors

Leila Fattahi ¹

Zahra Sadat Rezaeian ²

¹ M.Sc. Student of Physical Therapy, Musculoskeletal Research Center, Student Research Committee of Rehabilitation Students (Treata), Department of Physical Therapy, Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran P.O. Box: 81745-164 Email:m.f_tavanavar@yahoo.com Cellular: +989132809469

² Assistant Professor of Physical Therapy, Musculoskeletal Research Center, Department of Physical Therapy, Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran P.O.Box: 81745-164 Business phone: +9831-37925042; +9831-37925012, Fax: +9831-36687270, Cellular: +98913325707 Email: zrezaeian@rehab.mui.ac.ir; zrezaeian@yahoo.com

https://doi.org/10.30476/jrsr.2015.41079

Abstract

Background: Subjects with knee osteoarthritis typically have higher knee adduction moment. Current research efforts are mainly focused on therapeutic procedures that potentially may modify disease progression. This preliminary study was designed as a single blind (examiner) randomized control trial to investigate the impact of conventional physical therapy on pain, and knee joint load in subjects with moderate knee osteoarthritis.Methods: Twelve participants diagnosed with moderate knee OA were randomly assigned into control and intervention groups. Three-dimensional knee kinematic and kinetic data were recorded during the gait before and after 10 sessions of conventional physical therapy. In addition, pain intensity was evaluated by visual analog scale and pain subscale of KOOS questionnaire. The control group did not receive any intervention during the same period. Gait parameters were analyzed within and between groups using nonparametric tests.Results: There was a significant difference between groups in baseline KOOS-pain Score and ML knee force (P =0.048 and P=0.01). Immediately after ten sessions of physical therapy the initial (first) peak of knee adduction moment was significantly (P=0.03) lower than that of the control group while the first and second peak of knee AP velocity were significantly (P=0.02, P =0.01 respectively) higher. In the intervention group, the second peaks of vertical and anteroposterior (AP) knee forces were strongly correlated with the pretest KOOS-pain Score (r =0.99 and r =0.98, P<0.001). Therefore a multivariate general linear model was adopted with adjustment to baseline KOOS-pain. By this adjustment, 51% alleviation of VAS pain score and 81% decrement of first peak of knee adduction moment in comparison to control group was statistically significant (P=0.02, P=0.03 respectively).Conclusion: It seems that ten sessions of conventional physical therapy may modify knee joint load in subjects with moderate knee osteoarthritis. Further research is recommended.

Keywords

Conventional Physical Therapy

Knee Osteoarthritis

Gait

Joint Load

References
Simic M, Hunt MA, Bennell KL, Hinman RS, Wrigley TV. Trunk lean gait modification and knee joint load in people with medial knee osteoarthritis: The effect of varying trunk lean angles. Arthritis & Rheumatism 2012;64(10):1545-53.
Lim BW, Hinman RS, Wrigley TV, Sharma L, Bennell KL. Does knee malalignment mediate the effects of quadriceps strengthening on knee adduction moment, pain, and function in medial knee osteoarthritis? A randomized controlled trial. Arthritis & Rheumatism 2008;59(7):943-51.
Thorstensson CA, Henriksson M, von Porat A, Sjodahl C, Roos EM. The effect of eight weeks of exercise on knee adduction moment in early knee osteoarthritis GÃÃ´ a pilot study. Osteoarthritis and Cartilage 2007 Oct;15(10):1163-70.
Astephen JL, Deluzio KJ, Caldwell GE, Dunbar MJ. Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity. J Orthop Res 2008;26(3):332-41.
Hunt MA, Hinman RS, Metcalf BR, Lim BW, Wrigley TV, Bowles KA, et al. Quadriceps strength is not related to gait impact loading in knee osteoarthritis. The Knee 2010 Aug;17(4):296-302.
Landry SC, McKean KA, Hubley-Kozey CL, Stanish WD, Deluzio KJ. Knee biomechanics of moderate OA patients measured during gait at a self-selected and fast walking speed. Journal of Biomechanics 2007;40(8):1754-61.
Heiden TL, Lloyd DG, Ackland TR. Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarthritis patient gait. Clinical Biomechanics 2009 ; 24 (10): 833-41.
Foroughi N, Smith RM, Lange AK, Baker MK, Fiatarone Singh MA, Vanwanseele B. Lower limb muscle strengthening does not change frontal plane moments in women with knee osteoarthritis: A randomized controlled trial. Clinical Biomechanics 2011 ;26(2):167-74.
Lim BW, Kemp G, Metcalf B, Wrigley TV, Bennell KL, Crossley KM, et al. The association of quadriceps strength with the knee adduction moment in medial knee osteoarthritis. Arthritis & Rheumatism 2009;61(4):451-8.
Simic M, Hinman RS, Wrigley TV, Bennell KL, Hunt MA. Gait modification strategies for altering medial knee joint load: A systematic review. Arthritis & Rheumatism 2011;63(3):405-26.
Hunt MA, Simic M, Hinman RS, Bennell KL, Wrigley TV. Feasibility of a gait retraining strategy for reducing knee joint loading: Increased trunk lean guided by real-time biofeedback. Journal of Biomechanics 2011 Mar 15;44(5):943-7.
Hunt MA, Birmingham TB, Bryant D, Jones I, Giffin JR, Jenkyn TR, et al. Lateral trunk lean explains variation in dynamic knee joint load in patients with medial compartment knee osteoarthritis. Osteoarthritis and Cartilage 2008 May;16(5):591-9.
Gaudreault N, Mezghani N, Turcot K, Hagemeister N, Boivin K, de Guise JA. Effects of physiotherapy treatment on knee osteoarthritis gait data using principal component analysis. Clinical Biomechanics 2011;26(3):284-91.
Turcot K, Aissaoui R, Boivin K, Pelletier M, Hagemeister N, de Guise JA. The responsiveness of three-dimensional knee accelerations used as an estimation of knee instability and loading transmission during gait in osteoarthritis patient's follow-up. Osteoarthritis and Cartilage.17(2):213-9.
Kerrigan DC, Lelas JL, Goggins J, Merriman GJ, Kaplan RJ, Felson DT. Effectiveness of a lateral-wedge insole on knee varus torque in patients with knee osteoarthritis. Arch Phys Med Rehabil 2002 ;83(7):889-93.
Pollo FE, Otis JC, Backus SI, Warren RF, Wickiewicz TL. Reduction of medial compartment loads with valgus bracing of the osteoarthritic knee. Am J Sports Med 2002;30(3):414-21.
Pietrosimone BG, Saliba SA, Hart JM, Hertel J, Kerrigan DC, Ingersoll CD. Effects of disinhibitory transcutaneous electrical nerve stimulation and therapeutic exercise on sagittal plane peak knee kinematics and kinetics in people with knee osteoarthritis during gait: a randomized controlled trial. Clinical Rehabilitation 2010 Dec 1;24(12):1091-101.
Hubley-Kozey CL, Deluzio KJ, Landry SC, McNutt JS, Stanish WD. Neuromuscular alterations during walking in persons with moderate knee osteoarthritis. Journal of Electromyography and Kinesiology 2006;16(4):365-78.
Altman RD, Gold GE. Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society 15, A1-A56. 1-1-2007. [ Abstract].
Altman RD, Hochberg M, Murphy WA, Jr., Wolfe F, Lequesne M. Atlas of individual radiographic features in osteoarthritis. Osteoarthritis Cartilage 1995 Sep;3 Suppl A:3-70.:3-70.
Kellgren JH FAU, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957; 16(4): 494â502.
McGibbon CA, Krebs DE, Scarborough DM. Rehabilitation effects on compensatory gait mechanics in people with arthritis and strength impairment. Arthritis & Rheumatism 2003;49(2):248-54.
Salavati M, Mazaheri M, Negahban H, Sohani SM, Ebrahimian MR, Ebrahimi I, et al. Validation of a Persian-version of Knee injury and Osteoarthritis Outcome Score (KOOS) in Iranians with knee injuries. Osteoarthritis and Cartilage 2008 ;16 (10): 1178-82.
Zohreh Shafizadegan. Evaluation Of Ground Reaction Forces In Patients With Various Severities Of Knee Osteoarthritis. Journal of Mechanics in Medicine and Biology 2015;16:1-15.
Brody LTHC. Therapeutic Exercise : moving toward function. Philadelphia: Lippincott Williams & Wilkins; 2005.
Roos EM, Toksvig-Larsen S. Knee injury and Osteoarthritis Outcome Score (KOOS) - validation and comparison to the WOMAC in total knee replacement.(1477-7525
Hertling D, Kessler RM. Management of common musculoskeletal disorders : physical therapy principles and methods. Philadelphia: J.B. Lippincott; 1996.
Cameron MH. Physical agents in rehabilitation : from research to practice. St. Louis, Mo.: Saunders/Elsevier; 2009.
Richards J. Biomechanics in clinic and research : an interactive teaching and learning course. Edinburgh; New York: Churchill Livingstone/Elsevier; 2008.
Thorp LE, Wimmer MA, Foucher KC, Sumner DR, Shakoor N, Block JA. The biomechanical effects of focused muscle training on medial knee loads in OA of the knee: a pilot, proof of concept study. J Musculoskelet Neuronal Interact 2010 ;10 (2): 166-73.
Wright GN, Trotter AB. Rehabilitation research. Madison: University of Wisconsin; 1968.