Towards improved efficacy of exercise programmes in knee osteoarthritis

Knee osteoarthritis (OA) is a common musculoskeletal condition influenced by theload on the knee (i.e. External Knee Adduction Moment (EKAM)). Clinicalguidelines recommend exercise and education with knee OA. Open kinetic chainstrengthening exercises of the knee and/or hip muscles did not change the EKAM.In turn, neuromuscular training exercise programmes (including closed kineticchain strengthening exercises performed slowly) could be effective in decreasingthe EKAM. Two studies explored similar programmes and reported conflictingresults. Further, the effect of exercise on muscle co-contraction has never beeninvestigated despite the increased co-contraction in knee OA. Therefore, aneuromuscular training exercise programme combining hip and kneestrengthening and balance exercises integrated with education was developed,and its feasibility and effectiveness investigated in a pilot study (pre-post design).Clinical guidelines are not specific about exercise programme delivery. Therefore,a meta-analysis investigating the effectiveness of exercise in knee OA wasconducted and a questionnaire scoping current physiotherapy practice inmanaging knee OA was devised. These strategies aimed to identify the optimalexercise dosage, mode of delivery, and which muscles to exercise. Theinvestigator's test-retest reliability in assessing the outcome measures was alsoevaluated.Fourteen participants (twelve women and two men, mean age 61.79±10.42 years)completed a six-week exercise programme with good attendance rates. TheEKAM did not change significantly (p>0.05) on the affected side, whereas itincreased significantly on the contralateral side in late-stance (p=0.02). Pain,function, quality of life, self-efficacy, muscle strength, and balance significantlyimproved (p<0.05). Only co-contraction between vastus-lateralis and bicepsfemorisof the affected side significantly decreased in early and mid-stance(p=0.01 and 0.04, respectively). Kinematic and kinetic changes were highlyvariable. The preliminary findings from this thesis suggest this exerciseprogramme benefits individuals with knee OA, yet its effect should be evaluated ina larger randomised controlled trial.

Level dc:type.qualificationlevel

Doctoral (Level 8)

Year dc:date.issued

2012

Author dc:creator

• AI-Khlaifat, LS

Language dc:language

en

Identifier

oai:salford-repository.worktribe.com:1338078

OAI identifier oai:identifier

oai:salford-repository.worktribe.com:1338078