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Liu N, Liu G, Chang X, Xu Y, Hou Y, Zhang D, Wang L, Chen S. Combining various acupuncture therapies with multimodal analgesia to enhance postoperative pain management following total knee arthroplasty: a network meta-analysis of randomized controlled trials. Front Neurol 2024; 15:1361037. [PMID: 38562427 PMCID: PMC10984270 DOI: 10.3389/fneur.2024.1361037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/20/2024] [Indexed: 04/04/2024] Open
Abstract
Objective This study aims to evaluate the efficacy and safety of various acupuncture treatments in conjunction with multimodal analgesia (MA) for managing postoperative pain and improving knee function in patients undergoing total knee arthroplasty (TKA), based on the findings from clinical research indicating the potential benefits of acupuncture-related therapies in this context. Methods We searched Web of Science, PubMed, SCI-hub, Embase, Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data, and Chinese Scientific Journal Database (VIP) to collect randomized controlled trials of acupuncture-related therapies for post-TKA pain. After independent screening and data extraction, the quality of the included literature was evaluated. The potential for bias in the studies incorporated in the analysis was assessed according to the guidelines outlined in the Cochrane Handbook 5.1. Network meta-analysis (NMA) was conducted using RevMan 5.4 and Stata 16.0 software, with primary outcome measures including visual analog scale (VAS), pain pressure threshold (PPT), hospital for special surgery knee score (HSS), and knee joint range of motion (ROM). Furthermore, the interventions were ranked based on the SUCRA value. Results We conducted an analysis of 41 qualifying studies encompassing 3,003 patients, examining the efficacy of four acupuncture therapies (acupuncture ACU, electroacupuncture EA, transcutaneous electrical acupoint stimulation TEAS, and auricular acupoint therapy AAT) in conjunction with multimodal analgesia (MA) and MA alone. The VAS results showed no significant difference in efficacy among the five interventions for VAS-3 score. However, TEAS+MA (SMD: 0.67; 95%CI: 0.01, 1.32) was more effective than MA alone for VAS-7 score. There was no significant difference in PPT score among the three interventions. ACU + MA (SMD: 6.45; 95%CI: 3.30, 9.60), EA + MA (SMD: 4.89; 95%CI: 1.46, 8.32), and TEAS+MA (SMD: 5.31; 95%CI: 0.85, 9.78) were found to be more effective than MA alone for HSS score. For ROM score, ACU + MA was more efficacious than EA + MA, TEAS+MA, and AAT + MA, MA. Regarding the incidence of postoperative adverse reactions, nausea and vomiting were more prevalent after using only MA. Additionally, the incidence of postoperative dizziness and drowsiness following ACU + MA (OR = 4.98; 95%CI: 1.01, 24.42) was observed to be higher compared to that after AAT + MA intervention. Similarly, the occurrence of dizziness and drowsiness after MA was found to be significantly higher compared to the following interventions: TEAS+MA (OR = 0.36; 95%CI: 0.18, 0.70) and AAT + MA (OR = 0.20; 95%CI: 0.08, 0.50). The SUCRA ranking indicated that ACU + MA, EA + MA, TEAS+MA, and AAT + MA displayed superior SUCRA scores for each outcome index, respectively. Conclusion For the clinical treatment of post-TKA pain, acupuncture-related therapies can be selected as a complementary and alternative therapy. EA + MA and TEAS+MA demonstrate superior efficacy in alleviating postoperative pain among TKA patients. ACU + MA is the optimal choice for promoting postoperative knee joint function recovery in TKA patients. AAT + MA is recommended for preventing postoperative adverse reactions. Systematic review registration https://www.crd.york.ac.uk/, identifier (CRD42023492859).
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Affiliation(s)
- Ningning Liu
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- School of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Gaihong Liu
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xiaoli Chang
- Research Institute of Acupuncture and Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yingxue Xu
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yi Hou
- School of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Dongbin Zhang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Lianzhu Wang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Shaozong Chen
- Research Institute of Acupuncture and Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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Wang H, Ma B, Wang G, Wang P, Long H, Niu S, Dong C, Zhang H, Zhao Z, Ma Q, Hsu CW, Yang Y, Wei J. Dose-Response Relationships of Resistance Training in Adults With Knee Osteoarthritis: A Systematic Review and Meta-analysis. J Geriatr Phys Ther 2023:00139143-990000000-00037. [PMID: 37774094 DOI: 10.1519/jpt.0000000000000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND AND PURPOSE To determine the effects of resistance training (RT) on symptoms, function, and lower limb muscle strength in patients with knee osteoarthritis (KOA), and to determine the optimal dose-response relationships. DATA SOURCES We searched the PubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and ClinicalTrials.gov databases from inception to January 23, 2022. ELIGIBILITY CRITERIA Randomized controlled trials that examined the effects of RT in KOA patients (mean age ≥50 years) were included. DATA SYNTHESIS We applied Hedges' g of the random-effects model to calculate the between-subject standardized mean difference (SMDbs). A random-effects metaregression was calculated to explain the influence of key training variables on the effectiveness of RT. We used the Grading of Recommendations Assessments, Development and Evaluation (GRADE) method to appraise the certainty of evidence. RESULTS A total of 46 studies with 4289 participants were included. The analysis revealed moderate effects of RT on symptoms and function (SMDbs =-0.52; 95% CI: -0.64 to -0.40), and lower limb muscle strength (SMDbs = 0.53; 95% CI: 0.42 to 0.64) in the intervention group compared with the control group. The results of the metaregression revealed that only the variable "training period" (P< .001) had significant effects on symptoms, function, and lower limb muscle strength, and the 4 to 8 weeks of training subgroup showed greater effects than other subgroups (SMDbs =-0.70, -0.91 to -0.48; SMDbs = 0.76, 0.56 to 0.96). CONCLUSIONS Compared with inactive treatments, RT is strongly recommended to improve symptoms, function, and muscle strength in individuals with KOA. Dose-response relationship analysis showed that 4 to 8 weeks of RT had more benefits.
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Affiliation(s)
- Huan Wang
- Department of Orthopedics, Tangdu Hospital of Air Force Military Medical University, Xi'ep, China
| | - Baoan Ma
- Department of Orthopedics, Tangdu Hospital of Air Force Military Medical University, Xi'ep, China
| | - Guotuan Wang
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Chaohu University, Hefei 238000, China
| | - Pu Wang
- Department of Orthopedics, Tangdu Hospital of Air Force Military Medical University, Xi'ep, China
| | - Hua Long
- Department of Orthopedics, Tangdu Hospital of Air Force Military Medical University, Xi'ep, China
| | - Shun Niu
- Department of Orthopedics, Tangdu Hospital of Air Force Military Medical University, Xi'ep, China
| | - Chuan Dong
- Department of Orthopedics, Tangdu Hospital of Air Force Military Medical University, Xi'ep, China
| | - Hongtao Zhang
- Department of Orthopedics, Tangdu Hospital of Air Force Military Medical University, Xi'ep, China
| | - Zhen Zhao
- Department of Orthopedics, Tangdu Hospital of Air Force Military Medical University, Xi'ep, China
| | - Qiong Ma
- Department of Orthopedics, Tangdu Hospital of Air Force Military Medical University, Xi'ep, China
| | - Chihw-Wen Hsu
- General Education Center, National Taiwan Sport University, Taoyuan, Taiwan
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Yong Yang
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Chaohu University, Hefei 238000, China
| | - Jianshe Wei
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Chaohu University, Hefei 238000, China
- Institute for Brain Sciences Research, School of Life Sciences, Henan University, Kaifeng, China
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Mahmood I, Zia Ur Rahman M, Dehghani-Sanij AA. Modelling and analysis of orthoses generated whole-body vertical vibrations impact on limb stability and compliant dynamics in a ramp gait. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Starkey S, Hinman R, Paterson K, Saxby D, Knox G, Hall M. Tibiofemoral contact force differences between flat flexible and stable supportive walking shoes in people with varus-malaligned medial knee osteoarthritis: A randomized cross-over study. PLoS One 2022; 17:e0269331. [PMID: 35653355 PMCID: PMC9162314 DOI: 10.1371/journal.pone.0269331] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the effect of stable supportive to flat flexible walking shoes on medial tibiofemoral contact force (MTCF) in people with medial knee osteoarthritis and varus malalignment. Design This was a randomized cross-over study. Twenty-eight participants aged ≥50 years with medial knee osteoarthritis and varus malalignment were recruited from the community. Three-dimensional full-body motion, ground reaction forces and surface electromyograms from twelve lower-limb muscles were acquired during six speed-matched walking trials for flat flexible and stable supportive shoes, tested in random order. An electromyogram-informed neuromusculoskeletal model with subject-specific geometry estimated bodyweight (BW) normalized MTCF. Waveforms were analyzed using statistical parametric mapping with a repeated measures analysis of variance model. Peak MTCF, MTCF impulse and MTCF loading rates (discrete outcomes) were evaluated using a repeated measures multivariate analysis of variance model. Results Statistical parametric mapping showed lower MTCF in stable supportive compared to flat flexible shoes during 5–18% of stance phase (p = 0.001). For the discrete outcomes, peak MTCF and MTCF impulse were not different between the shoe styles. However, mean differences [95%CI] in loading impulse (-0.02 BW·s [-0.02, 0.01], p<0.001), mean loading rate (-1.42 BW·s-1 [-2.39, -0.45], p = 0.01) and max loading rate (-3.26 BW·s-1 [-5.94, -0.59], p = 0.02) indicated lower measure of loading in stable supportive shoes compared to flexible shoes. Conclusions Stable supportive shoes reduced MTCF during loading stance and reduced loading impulse/rates compared to flat flexible shoes and therefore may be more suitable in people with medial knee osteoarthritis and varus malalignment. Trial registration Australian and New Zealand Clinical Trials Registry (12619000622101).
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Affiliation(s)
- Scott Starkey
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Rana Hinman
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Kade Paterson
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - David Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Gabrielle Knox
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle Hall
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
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Jafarnezhadgero AA, Hamlabadi MP, Sajedi H, Granacher U. Recreational runners who recovered from COVID-19 show different running kinetics and muscle activities compared with healthy controls. Gait Posture 2022; 91:260-265. [PMID: 34775229 PMCID: PMC8584715 DOI: 10.1016/j.gaitpost.2021.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/12/2021] [Accepted: 11/01/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Social isolation through quarantine represents an effective means to prevent COVID-19 infection. A negative side-effect of quarantine is low physical activity. RESEARCH QUESTION What are the differences of running kinetics and muscle activities of recreational runners with a history of COVID-19 versus healthy controls? METHODS Forty men and women aged 20-30 years participated in this study and were divided into two experimental groups. Group 1 (age: 24.1 ± 2.9) consisted of participants with a history of COVID-19 (COVID group) and group 2 (age: 24.2 ± 2.7) of healthy age and sex-matched controls (controls). Both groups were tested for their running kinetics using a force plate and electromyographic activities (i.e., tibialis anterior [TA], gastrocnemius medialis [Gas-M], biceps femoris [BF], semitendinosus [ST], vastus lateralis [VL], vastus medialis [VM], rectus femoris [RF], gluteus medius [Glut-M]). RESULTS Results demonstrated higher peak vertical (p = 0.029; d=0.788) and medial (p = 0.004; d=1.119) ground reaction forces (GRFs) during push-off in COVID individuals compared with controls. Moreover, higher peak lateral GRFs were found during heel contact (p = 0.001; d=1.536) in the COVID group. COVID-19 individuals showed a shorter time-to-reach the peak vertical (p = 0.001; d=3.779) and posterior GRFs (p = 0.005; d=1.099) during heel contact. Moreover, the COVID group showed higher Gas-M (p = 0.007; d=1.109) and lower VM activity (p = 0.026; d=0.811) at heel contact. SIGNIFICANCE Different running kinetics and muscle activities were found in COVID-19 individuals versus healthy controls. Therefore, practitioners and therapists are advised to implement balance and/or strength training to improve lower limbs alignment and mediolateral control during dynamic movements in runners who recovered from COVID-19.
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Affiliation(s)
- Amir Ali Jafarnezhadgero
- Department of Sport Management and Biomechanics, Faculty of Education Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Milad Piran Hamlabadi
- Department of Sport Management and Biomechanics, Faculty of Education Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Heidar Sajedi
- Department of Sport Science, Farhangian University, Sanandaj, Iran
| | - Urs Granacher
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany,Corresponding author
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Nishino K, Koga H, Koga Y, Tanaka M, Nawata A, Endoh K, Arakawa M, Omori G. Association of isometric quadriceps strength with stride and knee kinematics during gait in community dwelling adults with normal knee or early radiographic knee osteoarthritis. Clin Biomech (Bristol, Avon) 2021; 84:105325. [PMID: 33770532 DOI: 10.1016/j.clinbiomech.2021.105325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/15/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Identifying indicators of early knee osteoarthritis is important for preventing the onset and/or progression of the disease. Although low quadriceps strength and changes in stride and knee kinematics during gait have been suggested as possible indicators, their relevance and relationships have not been fully examined. This study aimed to analyze the association of quadriceps strength with stride and knee kinematics during gait in adults with normal knee or early knee osteoarthritis. METHODS A total of 881 knees from 474 community dwelling adults (238 males and 236 females) were included. Radiographic images of the knee in standing position were obtained, and grading of knee osteoarthritis was classified. Isometric quadriceps strength was measured using a force detector device. Three-dimensional knee kinematics during gait was obtained by a motion capture system. Sex-based difference of quadriceps strength, stride and knee kinematics during gait was evaluated by multiple comparison among grades by sex and multiple regression of quadriceps strength was analyzed by stride and knee kinematics during gait. FINDINGS Stride length and quadriceps strength were significantly reduced with higher grade in both sexes, and changes in knee kinematics during gait differed by sex from early knee osteoarthritis. Quadriceps strength in both sexes was significantly correlated with changes in stride length and knee kinematics during gait. INTERPRETATION Improving quadriceps strength in early knee osteoarthritis was related with maintaining gait ability and restraining abnormal knee kinematics during gait. This may help to develop clinical approaches to prevent the onset and/or progression of knee osteoarthritis.
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Affiliation(s)
- Katsutoshi Nishino
- Niigata Institute for Health and Sports Medicine, 67-12 Seigorou, Chuoh-ku, Niigata city, Niigata, Japan.
| | - Hiroshi Koga
- Division of Musculoskeletal Science for Frailty, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuoh-ku, Niigata city, Niigata, Japan
| | - Yoshio Koga
- Department of Orthopedic Surgery, Ninohji Onsen Clinic, 452Toramaru, Shibata city, Niigata, Japan
| | - Masaei Tanaka
- Niigata Institute for Health and Sports Medicine, 67-12 Seigorou, Chuoh-ku, Niigata city, Niigata, Japan
| | - Atsushi Nawata
- Division of Musculoskeletal Science for Frailty, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuoh-ku, Niigata city, Niigata, Japan
| | - Kazuo Endoh
- Department of Health and Nutrition, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata city, Niigata, Japan
| | - Masaaki Arakawa
- Niigata Institute for Health and Sports Medicine, 67-12 Seigorou, Chuoh-ku, Niigata city, Niigata, Japan
| | - Go Omori
- Department of Health and Sports, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata city, Niigata, Japan
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Effect of 16-week corrective training program on three dimensional joint moments of the dominant and non-dominant lower limbs during gait in children with genu varus deformity. Sci Sports 2020. [DOI: 10.1016/j.scispo.2018.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Madadi-Shad M, Jafarnezhadgero A, Zago M, Granacher U. Effects of varus knee alignment on gait biomechanics and lower limb muscle activity in boys: A cross sectional study. Gait Posture 2019; 72:69-75. [PMID: 31173948 DOI: 10.1016/j.gaitpost.2019.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 05/21/2019] [Accepted: 05/30/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is evidence that frontal plane lower limb malalignment (e.g., genu varus) is a risk factor for knee osteoarthritis development. However, only scarce information is available on gait biomechanics and muscle activity in boys with genu varus. RESEARCH QUESTION To examine the effects of knee varus alignment on lower limb kinematics, kinetics and muscular activity during walking at self-selected speed in boys with genu varus versus healthy age-matched controls. METHODS Thirty-six boys were enrolled in this study and divided into a group of boys with genu varus (n = 18; age: 11.66 ± 1.64 years) and healthy controls (n = 18; age: 11.44 ± 1.78 years). Three-dimensional kinematics, ground reaction forces, loading rates, impulses and free moments of both limbs were recorded during five walking trials at self-selected speed. Surface electromyography was recorded for rectus femoris and vastus lateralis/medialis muscles. RESULTS No significant between-group differences were found for gait speed. Participants in the genu varus group versus controls showed larger peak knee flexion (p = 0.030; d = 0.77), peak knee adduction (p < 0.001; d = 1.63), and peak ankle eversion angles (p < 0.001; d = 2.06). Significantly higher peak ground reaction forces were found at heel contact (vertical [p = 0.002; d = 1.16] and posterior [p < 0.001; d = 1.63] components) and at push off (vertical [p = 0.010; d = 0.93] and anterior [p < 0.001; d = 1.34] components) for genu varus versus controls. Peak medial ground reaction force (p = 0.032; d = 0.76), vertical loading rate (p < 0.001; d = 1.52), anterior-posterior impulse (p = 0.011; d = 0.92), and peak negative free moment (p = 0.030; d = 0.77) were significantly higher in genu varus. Finally, time to reach peak forces was significantly shorter in genu varus boys compared with healthy controls (p < 0.01; d = 0.73-1.60). The genu varus group showed higher activities in vastus lateralis (p < 0.001; d = 1.82) and vastus medialis (p = 0.013; d = 0.90) during the loading phase of walking. SIGNIFICANCE Our study revealed genu varus specific gait characteristics and muscle activities. Greater knee adduction angle in genu varus boys may increase the load on the medial compartment of the knee joint. The observed characteristics in lower limb biomechanics and muscle activity could play a role in the early development of knee osteoarthritis in genu varus boys.
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Affiliation(s)
| | - AmirAli Jafarnezhadgero
- Department of Physical Education and Sport Sciences, University of Mohaghegh Ardabili, Ardabil, Iran.
| | - Matteo Zago
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.
| | - Urs Granacher
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany.
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Rehabilitation before regenerative cartilage knee surgery: a new prehabilitation guideline based on the best available evidence. Arch Orthop Trauma Surg 2019; 139:217-230. [PMID: 30132073 DOI: 10.1007/s00402-018-3026-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Focal cartilage defects are an increasingly relevant clinical problem especially in athletes. Cartilage regenerative surgery (CRS) including microfracture and autologous chondrocyte implantation (ACI) to treat such isolated cartilage defects in the knee joint has been well established in the last two decades. In contradiction to high-level evidence concerning the surgical technique, cell-related issues, and clinical results, the knowledge about the optimal rehabilitation process is still sparse although the importance of optimizing the rehabilitation process has recently led to new research focus in this field. The preoperative time frame may be used to start rehabilitation which may fasten the postoperative recovery and optimize clinical outcome ("Prehabilitation"-PREHAB). The aim of this article, therefore, was to review the available literature on prehabilitation concepts and to present a prehabilitation guideline for CRS patients based on the best evidence available. METHODS A systemic literature research was conducted on rehabilitation for cartilage regenerative surgery as well as prehabilitation in knee joint procedures. From the available literature a prehabilitation concept was generated and tested in 10 ACI patients. RESULTS As the literature search found no studies addressing prehabilitation in CRS patients, an evidence-based PREHAB program has been compiled based on the available evidence from (a) studies addressing postoperative rehabilitation in CRS patients and (b) PREHAB studies on other knee procedures including TKA. This presented prehabilitation guideline has been tested in > 50 CRS patients and was found to be feasible as all of the patients showed a good compliance and were able to perform the protocol as suggested. CONCLUSION The presented PREHAB regimen may serve clinicians as a guideline for early rehabilitation of their CRS patients. Obviously, further research is mandatory to quantify its clinical effect and to demonstrate its cost-effectiveness and benefits in surgically treated patients.
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Abstract
PURPOSE OF REVIEW This review focuses on studies published during July 2001 to August 2017 of exercise as an intervention in knee and hip osteoarthritis, including its influence on an array of patient outcomes. RECENT FINDINGS Studies continue to illustrate the efficacy of exercise in treating and managing osteoarthritis, with current literature more focused on the knee compared with the hip joint. Both traditional (e.g. strength, aerobic, flexibility) and more nontraditional (e.g. yoga, Tai Chi, aquatic) training modes improve patient outcomes related to joint symptoms, mobility, quality of life, psychological health, musculoskeletal properties, body composition, sleep, and fatigue. Exercise that is adequately dosed (e.g. frequency, intensity) and progressive in nature demonstrated the greatest improvements in patient outcomes. Supervised, partially supervised, and nonsupervised interventions can be successful in the treatment of osteoarthritis, but patient preference regarding level of supervision and mode of exercise may be key predictors in exercise adherence and degree of outcome improvement. A topic of increasing interest in osteoarthritis is the supplementary role of behavior training in exercise interventions. SUMMARY Osteoarthritis is a complex, multifactorial disease that can be successfully managed and treated through exercise, with minimal risk for negative consequences. However, to have greatest impact, appropriate exercise prescription is needed. Efforts to achieve correct exercise doses and mitigate patient nonadherence are needed to lessen the lifelong burden of osteoarthritis.
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Kus G, Yeldan I. Strengthening the quadriceps femoris muscle versus other knee training programs for the treatment of knee osteoarthritis. Rheumatol Int 2018; 39:203-218. [PMID: 30430202 DOI: 10.1007/s00296-018-4199-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/02/2018] [Indexed: 12/14/2022]
Abstract
People with knee osteoarthritis have atrophy of the muscles surrounding the knee joint. Therefore, exercise programs primarily have been focused on the strengthening of quadriceps femoris muscle (QFM). Primary aim of this systematic review was to determine which exercise increases strength of the QFM and describe the details of the training programs. Secondary aim was to determine effectiveness of strengthening of the QFM alone on pain and dysfunction in patient with knee osteoarthritis. PubMed, PEDro, and Cochrane were searched. PEDro for methodological quality of randomized controlled trials and Cochrane Collaborations' tool for risk of bias were used. A total of 1128 articles were identified from the database searches. Ten studies which were moderate-to-high level of evidence were included. In the comparison of different strengthening exercises of the QFM, significant difference was not found between training groups. However, strengthening of the QFM exercise training was superior to proprioceptive training. Additional hot packs plus shortwave diathermy or ultrasound or transcutaneous electrical nerve stimulation had superiority to isokinetic strengthening of the QFM alone. Only additional Russian electrical stimulation showed the significant difference compared with strengthening of the QFM exercise. Most of the included studies showed that strengthening of the QFM exercises has an effect on pain reduction and improvement of function. This review indicated that the strengthening of QFM training compared with other knee exercises provided muscle strengthening, pain reduction, and improved function while combination with other electrotherapy modalities or combination with Russian electrical stimulation had superiority to alone strengthening QFM training.
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Affiliation(s)
- Gamze Kus
- Department of Physiotherapy and Rehabilitation, Institute of Postgraduate Education, Istanbul University-Cerrahpasa, Istanbul, Turkey
- School of Physiotherapy and Rehabilitation, Mustafa Kemal University, Antakya, Turkey
| | - Ipek Yeldan
- Division of Physiotherapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Demirkapı Cad. Karabal, Sk., Bakirkoy, 34740, Istanbul, Turkey.
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Effects of Corrective Training on Drop Landing Ground Reaction Force Characteristics and Lower Limb Kinematics in Older Adults With Genu Valgus: A Randomized Controlled Trial. J Aging Phys Act 2018; 27:9-17. [PMID: 29485356 DOI: 10.1123/japa.2017-0315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to identify the effects of a corrective exercise program on landing ground reaction force characteristics and lower limb kinematics in older adults with genu valgus. A total of 26 older male adults with genu valgus were randomized into two groups. An experimental group conducted a 14-week corrective exercise program, whereas a control group did not perform any exercise. The experimental group displayed lower peak vertical, peak anterior and posterior, and peak medial ground reaction force components during the posttest compared with the pretest. The vertical loading rate, impulses, and free moment amplitudes were not statistically different between groups. In the experimental group, the peak knee abduction during the posttest was significantly smaller and the peak hip flexion angle was significantly greater than during the pretest. The authors suggest that this corrective exercise program may be a suitable intervention to improve landing ground reaction forces and lower limb kinematics in older male adults with genu valgus.
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Spinoso DH, Bellei NC, Marques NR, Navega MT. Quadriceps muscle weakness influences the gait pattern in women with knee osteoarthritis. Adv Rheumatol 2018; 58:26. [DOI: 10.1186/s42358-018-0027-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/03/2018] [Indexed: 11/10/2022] Open
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Jafarnezhadgero AA, Majlesi M, Etemadi H, Robertson DGE. Rehabilitation improves walking kinematics in children with a knee varus: Randomized controlled trial. Ann Phys Rehabil Med 2018; 61:125-134. [PMID: 29476933 DOI: 10.1016/j.rehab.2018.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/16/2018] [Accepted: 01/30/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies have demonstrated increased medial stresses in knee varus alignment. Selecting a suitable treatment strategy for individuals with knee malalignment should be a priority. OBJECTIVES We aimed to investigate the effects of a 16-week corrective exercise continuum (CEC) program on 3-D joint angles of the dominant and non-dominant lower limbs in children with genu varus during walking. METHODS Overall, 28 male children with genu varus (age range 9-14 years) volunteered to participate in this study. They were randomly divided into 2 equal groups (experimental and control). The participants of the experimental group received CEC for 16 weeks. 3-D gait analysis involved using a Vicon Motion System. Paired and independent sample t-tests were used for within- and between-group comparisons, respectively. RESULTS For the experimental group, comparison of pre- and post-test joint kinematics of the dominant lower limb revealed that CEC decreased the peak ankle dorsiflexion angle by 26% (P=0.020), peak foot internal rotation angle by 53% (P=0.001), peak knee internal rotation angle by 40% (P=0.011), peak hip abduction by 47% (P=0.010), and peak hip external rotation angle by 60% (P=0.001). In contrast, peak knee external rotation angle of the dominant limb was increased after the training program by 46% (P=0.044). For the non-dominant lower limb, CEC decreased the peak ankle inversion by 63% (P<0.01), peak ankle eversion by 91% (P<0.01), peak foot internal rotation by 50% (P<0.01), peak knee internal rotation by 29%; P=0.042), peak hip abduction angle by 38% (P<0.01), and peak hip external rotation angle by 60% (P<0.01). CONCLUSIONS CEC therapy reduced excessive foot and knee internal rotations as well as excessive hip external rotation during walking in children with genu varus.
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Affiliation(s)
- Amir Ali Jafarnezhadgero
- Department of Physical Education and Sport Sciences, Faculty of Educational Science and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran.
| | - Mahdi Majlesi
- Department of Sport Biomechanics, Faculty of Humanities, Islamic Azad University, Hamedan Branch, Hamedan, Iran
| | - Hojat Etemadi
- Department of Sport Biomechanics, Faculty of Humanities, Islamic Azad University, Hamedan Branch, Hamedan, Iran
| | - D G E Robertson
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
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