People with knee osteoarthritis (OA) frequently complain of knee instability. This study will test whether certain exercises can improve knee stability, reduce pain, and improve physical function in people with knee OA.
Study hypotheses: 1) Participants in the stability training group will demonstrate less pain and higher levels of physical function, based on self-report measures of pain and function (WOMAC, Lower Extremity Function Scale), and less time to complete the Get Up and Go test, a physical performance measure of function. 2) During walking and the step down task, participants in the stability training group will demonstrate greater knee motion during weight bearing, greater vertical ground reaction forces and loading rates, and reduced ratios of co-contraction between quadriceps/hamsting and tibialis anterior/gastrocnemius muscle pairs compared to the standard group. Participants in the stability group will also demonstrate greater step lengths, single limb support times, and average walking velocity compared to the standard group.
Primary Outcome Measures:
- Western Ontario and McMaster OA index (WOMAC) [ Time Frame: Measured at baseline, 2 months, 6 months, 1 year ] [ Designated as safety issue: No ]
- Lower Extremity Function Scale [ Time Frame: Measured at baseline, 2 months, 6 months, 1 year ] [ Designated as safety issue: No ]
- Get Up and Go test (a physical performance measure of function) [ Time Frame: Measured at baseline, 2 months, 6 months ] [ Designated as safety issue: No ]
- Knee Outcome Survey - Activities of Daily Living Scale [ Time Frame: Measured at baseline, 2 months, 6 months, 1 year ] [ Designated as safety issue: No ]
Secondary Outcome Measures:
- Cartilage morphology changes as measured by MRI [ Time Frame: Measured at baseline, 1 year ] [ Designated as safety issue: No ]
- Physical Activity Scale for the Elderly [ Time Frame: Measured at baseline, 2 months, 6 months, 1 year ] [ Designated as safety issue: No ]
- Quadriceps strength and activation [ Time Frame: Measured at baseline, 2 months, 6 months ] [ Designated as safety issue: No ]
- Radiographic severity of OA [ Time Frame: Measured at baseline, 1 year ] [ Designated as safety issue: Yes ]
- Fear Avoidance questionnaire for the knee [ Time Frame: Measured at baseline, 2months, 6 months, 1 year ] [ Designated as safety issue: No ]
- Beck Anxiety Index [ Time Frame: Measured at baseline, 2 months, 6 months, 1 year ] [ Designated as safety issue: No ]
- Center for Epidemiological Studies Depression Scale [ Time Frame: Measured at baseline, 2 months, 6 months, 1 year ] [ Designated as safety issue: No ]
- Motion analysis variables (knee motion, vertical ground reaction force, loading rates, knee adduction/abduction moment, and lower extremity muscle co-contractions during walking and a step-down task) [ Time Frame: Measured at baseline, 2 months, 6 months ] [ Designated as safety issue: No ]
| Estimated Enrollment: |
240 |
| Study Start Date: |
April 2004 |
| Estimated Study Completion Date: |
March 2009 |
| Estimated Primary Completion Date: |
November 2008 (Final data collection date for primary outcome measure) |
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1: Experimental
Traditional exercise program supplemented with knee stability training activities
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Other: Knee stability training
The addition of agility and perturbation training techniques to the traditional exercise program
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2: Active Comparator
Traditional exercise program
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Other: Traditional exercise therapy for knee osteoarthritis
Exercises include stretching, strengthening, and aerobic exercise
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Traditional exercise therapy for knee OA primarily focuses on lower limb strength and joint motion deficits. Recent evidence has suggested that changes in lower limb biomechanical factors during weight bearing activities may have substantial impact on physical function and disease progression in individuals with knee OA. The effectiveness of exercise therapy programs might be improved by incorporating balance and agility training techniques (knee stability training). The aim of this trial is to test the effectiveness of supplementing traditional exercise therapy with knee stability training techniques tailored for individuals with knee OA.
Participants will be randomly assigned to one of two groups. The first group will participate in a standard rehabilitation program of traditional exercise therapy for knee OA. The second group will participate in a standard rehabilitation program supplemented with a knee stability program. Study visits will occur at study entry, 2 months, 6 months, and 1 year. At each study visit, changes in pain, physical function, and biomechanical factors will be assessed. This study will last for one year.
Purpose
