|Year : 2018 | Volume
| Issue : 2 | Page : 94-97
Efficacy of combined proprioceptive exercises and conventional physiotherapy in patients with knee osteoarthritis: A double-blinded two-group pretest–posttest design
Veena Kirthika1, S Sudhakar2, K Padmanabhan3, S Ramachandran4, Mohan Kumar3
1 Department of Neuro Physiotherapy, Faculty of Physiotherapy, Dr. MGR Educational and Research Institute University, Chennai, Tamil Nadu, India
2 Department of Sports Physiotherapy, Faculty of Physiotherapy, Dr. MGR Educational and Research Institute University, Chennai, Tamil Nadu, India
3 Department of Ortho Physiotherapy, Faculty of Physiotherapy, Dr. MGR Educational and Research Institute University, Chennai, Tamil Nadu, India
4 Department of Cardiopulmonary Physiotherapy, Faculty of Physiotherapy, Dr. MGR Educational and Research Institute University, Chennai, Tamil Nadu, India
|Date of Web Publication||22-Nov-2018|
Dr. S Sudhakar
Department of Sports Physiotherapy, Faculty of Physiotherapy, Dr. MGR Educational and Research Institute University, Maduravoyal, Chennai - 600 095, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: Osteoarthritis (OA) is a chronic degenerative condition of the joint. Current physiotherapy interventions for OA focus on pain reduction, improve knee range of motion, and muscle strength. OA of knee impairs quadriceps function which affects balance and gait reducing patient's mobility and function. Therefore, there is a need to find out the effect of combined proprioceptive exercises with conventional physiotherapy in Patient with knee osteoarthritis (PKOA). Aim: The aim of this study is to analyze the effect of combined proprioceptive exercises and conventional physiotherapy in PKOA. Methods: A total of 40 female POAK were recruited for the study and were divided into two groups as follows: Group A (conventional group) and Group B (experimental group). Group B in addition to the conventional treatment received proprioceptive exercises. Both the groups were instructed to perform exercises for 5 days in a week for 3 months. Visual analog scale (VAS) for pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were noted pre- and post-intervention. Results: On comparing the mean values of Group A and Group B on VAS and WOMAC scores, both the groups showed a significant decrease (P < 0.001) in the posttest mean, but Group B (experimental group) was more effective than Group A (conventional group). Conclusion: The present study concluded that 3 months duration of combining proprioceptive exercises with conventional physiotherapy is more effective than conventional physiotherapy alone in PKOA.
Keywords: Conventional physiotherapy, osteoarthritis, proprioceptive exercise, visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index
|How to cite this article:|
Kirthika V, Sudhakar S, Padmanabhan K, Ramachandran S, Kumar M. Efficacy of combined proprioceptive exercises and conventional physiotherapy in patients with knee osteoarthritis: A double-blinded two-group pretest–posttest design. J Orthop Traumatol Rehabil 2018;10:94-7
|How to cite this URL:|
Kirthika V, Sudhakar S, Padmanabhan K, Ramachandran S, Kumar M. Efficacy of combined proprioceptive exercises and conventional physiotherapy in patients with knee osteoarthritis: A double-blinded two-group pretest–posttest design. J Orthop Traumatol Rehabil [serial online] 2018 [cited 2019 Jan 21];10:94-7. Available from: http://www.jotr.in/text.asp?2018/10/2/94/245996
| Introduction|| |
Osteoarthritis (OA) is one of the most common musculoskeletal disorders in the world affecting 2693 of every 100,000 women and 1770 of every 100,000 men. The overall prevalence of knee OA was found to be (22%–39%) 28.7% in India. Knee OA is the most common type of arthritis. While it can occur even in young people, the chance of developing OA increases after the age of 45 years. With the knee being one of the most commonly affected joints, women (31.6%) are more likely to have OA than men. OA is a joint disease that causes the cushion layer between one's bones or cartilage to wear away. Symptoms include pain, tenderness in the knee, stiffness when standing or walking, loss of flexibility, and grating sensations that can be heard when the knee joint is used.,
Unilateral OA of knee has impaired proprioceptive accuracy in both the knees. Impaired proprioceptive accuracy could be a risk factor for progression of both knee pain and activity limitations in patients with knee osteoarthritis (PKOA). Proprioception is the process by which the body can vary muscle contraction in immediate response to incoming information regarding external force. Any pathology that adversely affects muscle function may impair force generation and proprioceptive activity system is essential for maintenance of balance, and production of smooth stable gait.
OA of the knee impairs quadriceps functions which, in turn, impair the patient's balance and gait reducing their mobility and function. The intent of proprioceptive exercises is to expose people to activities that challenge the stability of the knee and balance in a controlled manner during rehabilitation. Current physical therapy interventions for knee OA focus on decreasing pain and improving knee range of motion, muscle strength, balance, and functional mobility., It is necessary to focus on proprioceptive accuracy of the knee which when neglected can have a deleterious effect during rehabilitation. The present study was intended to find the effectiveness of combining proprioceptive exercises with conventional treatment to reduce pain and improve functional ability in female PKOA.
| Methodology|| |
The study protocol was approved by the Institution Research and Ethics Committee, and the study was performed according to the guidelines laid by the Declaration of Helsinki, revised 2013. A total of 40 female PKOA were recruited for the two group's pretest–posttest experimental study by the simple random sampling method. Before the data collection, duly signed informed consent was obtained. They were randomly allocated into two even groups as follows: Group A (conventional group) and Group B (experimental group) by the block randomization (4 × 5 blocks).
Treatment protocol in Group A
Totally 20 PKOA were given isometric quadriceps exercises, high sitting knee extension, straight leg raise, hamstring stretching, hip abduction, hip extension, along with short-wave diathermy (crossfire method) wider spacing, and thermal dose for 15 min. All the exercises were performed once in a day, with 10 repetitions for each exercise.
Treatment protocol in Group B
Twenty PKOA were given proprioceptive exercises in addition to the conventional treatment. Pelvic tilts and knee flexion and extension using Swiss ball, sliding lunge, stepping lunge, step up and down in a footstool, stand up and sit down in a stool, squatting, and single leg squat were given as proprioceptive exercises. All the exercises were performed once in a day, with 10 repetitions for each exercise.
Both the groups followed the above-mentioned exercise protocol for 5 days/week for 3 months. Visual analog scale (VAS) for pain and the Western Ontario and McMaster Universities OA Index (WOMAC) score were noted pre- and post-intervention. The therapist who supervised the intervention and outcome assessor was blinded to the groups. Hence, the study was double-blinded. Detailed study layout was displayed in the standardized format, consolidated standards of reporting trials [Figure 1].
The collected data were assessed for their normality using Shapiro–Wilk test. As the data follow normal distribution, all the descriptive were expressed in mean ± standard deviation. Paired t-test was adopted to find out the effectiveness within Group A and Group B in participants with stress-induced asthma, and independent t-test (Student's t-test) was used to compare the changes in mean values of all parameters between Group A and Group B. The data were analyzed using statistical software, statistical package for the social science (SPSS), and IBM SPSS version 22.0 (IBM Corp. Armonk, NY, USA). Value of P ≤ 0.05 was considered to be statistically significant.
| Results|| |
A total of 40 female PKOA were recruited for this experimental study. The demographic characteristic of the patient recruited was given in [Table 1]. Three PKOA (one – Group A and two – Group B) who lost to follow-up were analyzed using intention to treat analysis. There exists significant difference between pretest and posttest in VAS and WOMAC scores among both the groups, which are displayed in [Table 2] and [Table 3]. Between group analysis revealed significant difference among the groups. PKOA in Group B demonstrated significant improvement (P < 0.001) in VAS and WOMAC scores when compared with Group A, [Figure 1], [Figure 2], [Figure 3].
|Table 2: Comparison of visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index scores of pre- and post-intervention in Group A|
Click here to view
|Table 3: Comparison of visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index scores of pre- and post-intervention in Group B|
Click here to view
|Figure 2: Pre-post-visual analog scale changes between Group A and Group B|
Click here to view
|Figure 3: Pre-post-Western Ontario and McMaster Universities Osteoarthritis Index score changes between Group A and Group B|
Click here to view
| Discussion|| |
PKOA faces problems with reduced quadriceps muscle strength and a decline in balance and proprioception. Reduced proprioception in participants with OA knee weakens their thigh muscles and may limit their walking ability and dynamic balance. Joint pain associated with knee OA also has a direct impact on the muscle activation and strength of the thigh muscles and proprioception. Therefore while treating PKOA, an exercise program that could concentrate on strengthening exercise of the muscles in and around knee joint and proprioceptive exercise which could have an effect in improving joint proprioception should be considered.
Current therapy for rehabilitation of PKOA focuses on reducing pain and improving knee joint range of motion. Proprioception which could be gradually affected during the disease in PKOA has to be given importance during rehabilitation. Proprioception responses allow compensatory adjustments in the lengths of various muscles, muscle tension, and joint position to facilitate joint movements. Proprioceptive activation exercises have a direct effect on mobility and pain, and restoration of proprioception is essential during the rehabilitation of PKOA.
Diminished knee proprioception highly correlates with the level of pain and the relationship between proprioception and muscle strength is closely related to functional movements. The intention of this study was to combine proprioceptive exercises with conventional physiotherapy in participants suffering from knee OA. This study shows that proprioceptive exercises are helpful in reducing pain and improving physical function related to knee joint.
Thus, the study demonstrates that combining proprioceptive exercises with conventional physiotherapy program are an effective treatment protocol to enhance knee joint functions and improve pain control in PKOA.
| Conclusion|| |
Three months combined proprioceptive exercises with conventional physiotherapy program might be an effective rehabilitation option over the convention physiotherapy program alone.
The authors are very thankful to Dr. Asir John Samuel, MPT, (PhD), Associate Professor, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar University, Mullana, India, for providing logistic and technical support in manuscript editing.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Pal CP, Singh P, Chaturvedi S, Pruthi KK, Vij A. Epidemiology of knee osteoarthritis in India and related factors. Indian J Orthop 2016;50:518-22.
] [Full text]
Sun HB. Mechanical loading, cartilage degradation, and arthritis. Ann N
Y Acad Sci 2010;1211:37-50.
Sellam J, Berenbaum F. The role of synovitis in pathophysiology and clinical symptoms of osteoarthritis. Nat Rev Rheumatol 2010;6:625-35.
Felson DT, Gross KD, Nevitt MC, Yang M, Lane NE, Torner JC, et al.
The effects of impaired joint position sense on the development and progression of pain and structural damage in knee osteoarthritis. Arthritis Rheum 2009;61:1070-6.
Sekir U, Gür H. A multi-station proprioceptive exercise program in patients with bilateral knee osteoarthrosis: Functional capacity, pain and sensoriomotor function. A randomized controlled trial. J Sports Sci Med 2005;4:590-603.
Pinto D, Robertson MC, Abbott JH, Hansen P, Campbell AJ, MOA Trial Team. et al.
Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee 2: Economic evaluation alongside a randomized controlled trial. Osteoarthritis Cartilage 2013;21:1504-13.
Nam CW, Kim K, Lee HY. The influence of exercise on an unstable surface on the physical function and muscle strength of patients with osteoarthritis of the knee. J Phys Ther Sci 2014;26:1609-12.
Knobloch K, Martin-Schmitt S, Gösling T, Jagodzinski M, Zeichen J, Krettek C, et al.
Prospective proprioceptive and coordinative training for injury reduction in elite female soccer. Sportverletz Sportschaden 2005;19:123-9.
Kramer M, Hohl K, Bockholt U, Schneider F, Dehner C. Training effects of combined resistance and proprioceptive neck muscle exercising. J Back Musculoskelet Rehabil 2013;26:189-97.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]