Towards improved efficacy of exercise programmes in knee osteoarthritis

AI-Khlaifat, LS

Abstract

Knee osteoarthritis (OA) is a common musculoskeletal condition influenced by the
load on the knee (i.e. External Knee Adduction Moment (EKAM)). Clinical
guidelines recommend exercise and education with knee OA. Open kinetic chain
strengthening exercises of the knee and/or hip muscles did not change the EKAM.
In turn, neuromuscular training exercise programmes (including closed kinetic
chain strengthening exercises performed slowly) could be effective in decreasing
the EKAM. Two studies explored similar programmes and reported conflicting
results. Further, the effect of exercise on muscle co-contraction has never been
investigated despite the increased co-contraction in knee OA. Therefore, a
neuromuscular training exercise programme combining hip and knee
strengthening 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 was
conducted and a questionnaire scoping current physiotherapy practice in
managing knee OA was devised. These strategies aimed to identify the optimal
exercise dosage, mode of delivery, and which muscles to exercise. The
investigator's test-retest reliability in assessing the outcome measures was also
evaluated.
Fourteen participants (twelve women and two men, mean age 61.79±10.42 years)
completed a six-week exercise programme with good attendance rates. The
EKAM did not change significantly (p>0.05) on the affected side, whereas it
increased significantly on the contralateral side in late-stance (p=0.02). Pain,
function, quality of life, self-efficacy, muscle strength, and balance significantly
improved (p<0.05). Only co-contraction between vastus-lateralis and bicepsfemoris
of the affected side significantly decreased in early and mid-stance
(p=0.01 and 0.04, respectively). Kinematic and kinetic changes were highly
variable. The preliminary findings from this thesis suggest this exercise
programme benefits individuals with knee OA, yet its effect should be evaluated in
a larger randomised controlled trial.

Citation

AI-Khlaifat, L. Towards improved efficacy of exercise programmes in knee osteoarthritis. (Thesis). University of Salford

• Thesis Type: Thesis
• Deposit Date: Jul 30, 2021
• Award Date: Jul 1, 2012