Skip to main content

Research Repository

Advanced Search

A new integrated behavioural intervention for knee osteoarthritis : development and pilot study

Preece, SJ; Brookes, N; Williams, AE; Jones, R; Starbuck, C; Jones, A; Walsh, NE

A new integrated behavioural intervention for knee osteoarthritis : development and pilot study Thumbnail


Authors

N Brookes

AE Williams

C Starbuck

A Jones

NE Walsh



Abstract

Background: Exercise-based approaches have been a cornerstone of physiotherapy management of knee osteoarthritis for many years. However, clinical effects are considered small to modest and the need for continued adherence identified as a barrier to clinical efficacy. While exercise-based approaches focus on muscle strengthening, biomechanical research has identified that people with knee osteoarthritis over activate their muscles during functional tasks. Therefore, we aimed to create a new behavioural intervention, which integrated psychologically informed practice with biofeedback training to reduce muscle overactivity, and which was suitable for delivery by a physiotherapist.
Methods: Through literature review, we created a framework linking theory from pain science with emerging biomechanical concepts related to overactivity of the knee muscles. Using recognised behaviour change theory, we then mapped a set of intervention components which were iteratively developed through ongoing testing and consultation with patients and physiotherapists.
Results: The underlying framework incorporated ideas related to central sensitisation, motor responses to pain and also focused on the idea that increased knee muscle overactivity could result from postural compensation. Building on these ideas, we created an intervention with five components: making sense of pain, general relaxation, postural deconstruction, responding differently to pain and functional muscle retraining. The intervention incorporated a range of animated instructional videos to communicate concepts related to pain and biomechanical theory and also used EMG biofeedback to facilitate visualization of muscle patterns. User feedback was positive with patients describing the intervention as enabling them to “create a new normal” and to be “in control of their own treatment.” Furthermore, large reductions in pain were observed from 11 patients who received a prototype version of the intervention.
Conclusion: We have created a new intervention for knee osteoarthritis, designed to empower individuals with capability and motivation to change muscle activation patterns and beliefs associated with pain. We refer to this intervention as Cognitive Muscular Therapy. Preliminary feedback and clinical indications are positive, motivating future large-scale trials to understand potential efficacy. It is possible that this new approach could bring about improvements in the pain associated with knee osteoarthritis without the need for continued adherence to muscle strengthening programmes.

Citation

Preece, S., Brookes, N., Williams, A., Jones, R., Starbuck, C., Jones, A., & Walsh, N. (2021). A new integrated behavioural intervention for knee osteoarthritis : development and pilot study. BMC Musculoskeletal Disorders, 22(1), 526. https://doi.org/10.1186/s12891-021-04389-0

Journal Article Type Article
Publication Date Jun 8, 2021
Deposit Date Jun 9, 2021
Publicly Available Date Jun 9, 2021
Journal BMC Musculoskeletal Disorders
Publisher Springer Verlag
Volume 22
Issue 1
Pages 526
DOI https://doi.org/10.1186/s12891-021-04389-0
Publisher URL https://doi.org/10.1186/s12891-021-04389-0
Related Public URLs https://hub.salford.ac.uk/cognitive-muscular-therapy/
https://bmcmusculoskeletdisord.biomedcentral.com/
Additional Information Projects : The feasibility of using BiofEedback to reduce Pain in people with Knee Osteoarthritis (BEPKO)

Files






You might also like



Downloadable Citations