Effect of 6-week retro or forward walking program on pain, functional disability, quadriceps muscle strength, and performance in individuals with knee osteoarthritis: a randomized controlled trial (retro-walking trial)

Effects of thumb-tack needling combined with sporting on older adult patients with knee osteoarthritis: A randomized active-control clinical trial

AIM

The aim of this clinical study was to explore the effects of thumb-tack needling combined with sporting (TTNS) therapy on the improvement of pain and joint function in older adult patients with knee osteoarthritis (KOA).

METHODS

A total of 120 older adult patients with KOA were randomly assigned to receive TTNS therapy or medicine treatment (Med group) only for 1 month. The patients were followed up for 3 months and clinical efficacies were evaluated using a visual analog scale to assess pain, the Lequesne scoring system to assess motor function, and the Western Ontario and McMaster University Osteoarthritis Index to assess KOA severity. Blood was collected to measure the levels of interleukin-6 and tumor necrotic factor-alpha using enzyme-linked immunosorbent assay.

RESULTS

The data suggested that TTNS therapy resulted in a significantly higher clinical efficacy (P = 0.012). Visual analog scale score, Lequesne index, and Western Ontario and McMaster University Osteoarthritis Index of the TTNS group at the time of post-treatment (1 month) and post-follow-up (3 months) were also lower compared with the Med group. Patients in the TTNS group also showed lower levels of serum tumor necrotic factor-alpha and interleukin-6.

CONCLUSIONS

TTNS therapy is more efficacious than pharmacological treatment in improving the clinical outcomes of patients with KOA, which suggests its clinical utility in the management of KOA. Geriatr Gerontol Int 2024; 24: 415-420.

Does Walking Have an Association with Osteoarthritis? A Two-Sample Mendelian Randomization Analysis

Objective

Osteoarthritis (OA) is one of the major disabling human diseases. The related studies indicate a potential correlation between walking and OA. However, there is still a lack of evidence in genetics to support the correlation between walking and OA. Therefore, this study aimed to explore the relationship between walking and OA at the genetic level.

Methods

The publicly available Genome Wide Association Study (GWAS) data were used, with inverse variance weighting (IVW, the random-effects model) as the main analysis method, whereas MR-Egger, Weighted median, Simple mode, and Weighted mode as the secondary analysis methods. In addition, Cochran's Q test, pleiotropy test, and MR-Egger intercept test were conducted to examine the heterogeneity and pleiotropy of the outcome.

Results

In the MR analysis, IVW results showed a negative correlation between types of physical activity in last 4 weeks: Walking for pleasure (not as a means of transport) and OA (KOA or HOA) (odds ratio (OR) = 0.3224, 95% confidence interval (CI): 0.1261 to 0.8243), and the difference was of statistical significance (P = 0.0181). Moreover, IVW results also revealed a negative correlation between types of physical activity in last 4 weeks: Walking for pleasure (not as a means of transport) and KOA (OR = 0.1396, 95% CI: 0.0484 to 0.4026), and the difference was statistically significant (P = 0.0003). However, IVW results did not demonstrate any statistical significance types of physical activity in last 4 weeks: Walking for pleasure (not as a means of transport) and HOA (OR = 1.2075, 95% CI: 0.1978 to 7.3727, P = 0.8381).

Conclusion

From genetic studies, types of physical activity in last 4 weeks: Walking for pleasure (not as a means of transport) is negatively correlated with knee osteoarthritis (KOA), but there is no clear evidence supporting its correlation with hip osteoarthritis (HOA).

Transcranial direct current stimulation facilitates backward walking training

Backward walking training presents a great challenge to the physical and neural systems, which may result in an improvement in gait performance. Transcranial direct current electrical stimulation (tDCS), which can non-invasively enhance cortical activity, has been reported to strengthen corticomotor plasticity. We investigated whether excitatory tDCS over the primary motor cortex (M1) or the dorsolateral prefrontal cortex (DLPFC) enhances the effects of backward walking training in healthy participants. Thirty-six healthy participants (16 men and 20 women, mean age 21.3 ± 1.4 years) participated in this study. The participants were randomly assigned to one of the three tDCS groups (M1, DLPFC, and sham). They performed 5 min of backward walking training during 15 min of tDCS. We evaluated dual-task forward and backward walking performance before and after training. Both tDCS groups increased walking speed in the backward condition, but the DLPFC group increased the dual-task backward walking speed more than the M1 group. The M1 group showed decreased gait variability in dual-task backward walking, whereas the DLPFC group showed increased gait variability. Backward walking training combined with M1 stimulation may increase the backward walking speed by reducing gait variability. Backward walking training combined with DLPFC stimulation may prioritize walking speed over gait stability. Our results indicate that backward walking training combined with tDCS may be extended to other rehabilitation methods to improve gait performance.

Active Neurodynamics at Home in Patients with Knee Osteoarthritis: A Feasibility Study

The aim was to evaluate the feasibility of a home-based neurodynamic programme for patients with knee osteoarthritis (KO). Thirty participants (70% women) ≥ 50 years old with KO (Kellgren-Lawrence grades I-II) were included. Active mobilisation of the femoral nerve was performed at home over a period of 6-8 weeks. The feasibility of the programme was assessed using a survey that included questions related to understanding of the activity; adherence to the intervention; the burden caused by the intervention; self-perceived effects on the participant; follow-up; the barriers; and facilitators. Pain intensity, using the numerical rating scale (NRS); pressure pain thresholds (PPT); temporal assessment; pain modulation; Knee Injury and Osteoarthritis Outcome Score (KOOS), 12-item Short Form Survey questionnaire (SF-12), and the Central Sensitization Inventory questionnaire (CSI) were also collected, before and after the intervention. All patients performed the intervention, completed at least 42 days of activity, and considered the exercise adequate, with 28 participants (93.3%) reporting that the intervention was good for them. Statistically significant values (p < 0.05) were found for NRS, elbow PPT, external knee PPT, internal knee PPT, elbow CPM, CSI, and KOOS. Home-based active neurodynamic treatment has been shown to be a feasible and safe intervention for KO patients. In addition, this intervention has shown positive effects on pain and function.

Analysis of Postural Control in Patients Diagnosed with Unilateral Knee Osteoarthrosis and Its Relationship with the Risk of Falls

Introduction

Knee osteoarthrosis, whether subtle or marked, appears to alter the stability and performance of the knee joint in activities of daily living that prevent the maintenance of bipedal posture. However, there is still a gap in the literature as to how knee osteoarthritis can affect static balance.

Objective

To analyze the performance of postural control in elderly diagnosed with unilateral knee osteoarthrosis.

Materials and Methods

40 elderly people of both sexes participated in this study, divided into two groups containing 20 elderly each. Group 1 (G1) consists of elderly patients who have received a diagnosis of unilateral knee osteoarthritis. Despite undergoing conservative treatment, their condition has shown insufficient improvement, leading to a clinical recommendation for total knee arthroplasty (TKA). The G2 group was made up of 20 elderly with an average age of 71.09 years, considered active, who do not have a diagnosis of osteoarthritis in the knee joint and practice physical activity. With the aid of a Baroscan pressure platform, the center of pressure (COP) displacement in the anteroposterior (COPAP) direction and mediolateral direction (COPML) and the area of center of pressure displacement were evaluated during bipedal postural control with eyes open and eyes closed.

Results

During postural control with eyes open and eyes closed, the G1 group showed greater displacement of the COP in the anteroposterior direction-COPAP (p = 0.007)-and mediolateral direction-COPML (p = 0.033)-when compared to the G2 group. As for the area of displacement of the COP, group G1 presented a larger area of displacement (p = 0.002) than group G2 during bipedal postural control with open eyes. For the condition with eyes closed, both groups showed similar behaviors, which resulted in no present statistically significant differences.

Conclusion

The results suggest that unilateral knee osteoarthritis influences bipedal postural control and activities of daily living that require this static balance, since information from the somatosensory system is reduced, resulting in stability of tasks that require body control and promoting the risk of falls. From a clinical perspective, the results suggest that the assessment of bipedal postural control can assist orthopedic physicians in assessing joint stability in patients with unilateral knee osteoarthrosis.

Osteoarthritis and sarcopenia-related traits: the cross-sectional study from NHANES 2011-2014 and Mendelian randomization study

BACKGROUND

Osteoarthritis (OA) and sarcopenia are common musculoskeletal disorders in the aged population, and a growing body of evidence indicated that they mutually influence one another. Nevertheless, there was still substantial controversy and uncertainty about the causal relationship between sarcopenia and OA. We explored the complex association between sarcopenia-related traits and OA using cross-sectional analysis and Mendelian randomization (MR).

METHODS

The cross-sectional study used the data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Weighted multivariable-adjusted logistic regression and subgroup analyses were used to evaluate the correlation between sarcopenia, grip, appendicular lean mass (ALM) and the risk of OA. Then, we further performed MR analysis to examine the causal effect of sarcopenia-related traits (grip strength, ALM) on OA. Instrumental variables for grip strength and ALM were from the UK Biobank, and the summary-level data for OA was derived from the Genetics of Osteoarthritis (GO) Consortium GWAS (n = 826,690).

RESULTS

In this cross-sectional analysis, we observed that sarcopenia, grip were significantly linked with the risk of OA (OR 1.607, 95% CI 1.233-2.094, P < 0.001), (OR 0.972, 95% CI 0.964-0.979, P < 0.001). According to subgroup analyses stratified by gender, body mass index (BMI), and age, the significant positive relationship between sarcopenia and OA remained in males, females, the age (46-59 years) group, and the BMI (18.5-24.9 kg/m²) group (P < 0.05). Furthermore, MR analysis and sensitivity analyses showed causal associations between right grip, left grip and KOA (OR 0.668; 95% CI 0.509 to 0.877; P = 0.004), (OR 0.786; 95% CI 0.608 to 0.915; P = 0.042). Consistent directional effects for all analyses were observed in both the MR-Egger and weighted median methods. Subsequently, sensitivity analyses revealed no heterogeneity, directional pleiotropy or outliers for the causal effect of grip strength on KOA (P > 0.05).

CONCLUSIONS

Our research provided evidence that sarcopenia is correlated with an increased risk of OA, and there was a protective impact of genetically predicted grip strength on OA. These findings needed to be verified in further prospective cohort studies with a large sample size.

Effects of backward walking exercise using lower body positive pressure treadmill on knee symptoms and physical function in individuals with knee osteoarthritis: a protocol for RCT

OBJECTIVES

The primary aim is to compare the effects of backward walking exercise to forward walking exercise on knee pain, knee functions, and thigh muscle strength in individuals with mild to moderate knee osteoarthritis using lower body positive pressure, in addition to mobility functions, balance, and self-reported health status.

METHODS

The study is a single blind randomized clinical trial with two independent groups. This study will enroll 26 participants with mild to moderate knee osteoarthritis. The participants will be randomized into either experimental group (backward walking exercise) or control group (forward walking exercise). Both groups will use lower body positive pressure treadmill for walking exercise. Both groups will perform regular conventional exercise and worm-up exercise before walking exercise. The treatment will be three times a week for six weeks. Walking session will be up to 30 min each session. Data collection will be collected during pre- and post- intervention including primary outcomes including numeric pain rating scale (NPRS), knee injury and osteoarthritis outcome score (KOOS), and thigh muscle strength test. The secondary outcomes include five times sit to stand test (FTSTS), 3-meter backward walk test (3MBWT), timed up and go test (TUG), four square step test (FSST), functional reach test (FRT), 10-meter walk test (10-MWT), six minute walk test (6MWT), medical outcomes study short form 12 (SF-12), patient health questionnaire -9 (PHQ-9), and rapid assessment of physical activity (RAPA). An independent t-test will be used to evaluate the effect of treatment on the outcome measures.

RESULTS

Not applicable.

CONCLUSION

Using lower body positive pressure may have promising results against knee osteoarthritis. Moreover, walking backward exercise using lower body positive pressure might add more benefits to individuals with knee osteoarthritis and help clinicians in decision making.

TRIAL REGISTRATION

This study was registered in ClinicalTrails.gov (ID: NCT05585099).

Recovery of Quadriceps Strength and Knee Function Using Adjuvant EMG-BF After Primary ACL Reconstruction

Introduction: Immobility and limited usage of operated limbs lead to weakness and atrophy of the muscle after anterior cruciate ligament (ACL) reconstruction. However, training programs for preventing biomechanical risk factors such as lower limb alignment and increased muscular contraction are very limited. Thus, the current study was carried out to evaluate the recovery of quadriceps muscle strength and the improvement of knee function using adjuvant electromyographic biofeedback (EMG-BF) after ACL reconstruction. Methods: This prospective randomized controlled trial was conducted among 40 patients (20=EMG-BF group, 20=Control group) with ACL reconstruction, who were referred to Akhtar Hospital from 2021 to 2022. In the EMG-BF group, EMG BFB was added to the standard rehabilitation protocol, and in the control group, the standard rehabilitation protocol with full postoperative weight-bearing, knee brace (zero degree of extension, 90 degrees of flexion), and electrical stimulation with maximal voluntary isometric knee extension was performed. Each group was intervened for 4 weeks and three sessions of 30 minutes per week. It should be noted that each patient participated in 16 outpatient physiotherapy sessions after surgery. Nicholas Hand-Held Dynamometer (HHD) was used for measuring quadriceps strength, and Knee Outcome Survey-Activities of Daily Living (KOS-ADLs) and Knee Outcome Survey Sports Activities Scale (KOS-SAS) questionnaires were used for assessing the knee function. Results: Four weeks after the treatment, the EMG-BF group showed a significant increase in quadriceps strength (P=0.0001). Quadriceps strength had a significant difference before and after 4 weeks of intervention (P=0.0001), but in the control group, no significant difference was observed (P=0.368). The EMG-BF group had a significant increase in KOS-ADLs and KOS-SAS scores after 4 weeks of intervention (P=0.0001). Conclusion: In our study, isometric strengthening of quadriceps with adjuvant EMG-BF significantly increased the strength of quadriceps and knee function during 4 weeks. EMG-BF is a low risk, low cost, and less invasive intervention and has high safety and adjustment ability. It is a valuable adjuvant method for achieving better functional recovery in a shorter time.

Effects of mat Pilates on older adult women with knee osteoarthritis: A randomized controlled trial

INTRODUCTION

Osteoarthritis is the most common joint disorder in the world and its incidence is rising, and one of the most frequent causes of pain, loss of function and disability in adults.

AIM

The aim of this study was to evaluate the effects of Mat Pilates on health status, pain, stiffness, and functionality of older adult women with knee osteoarthritis (KOA).

METHODS

A randomized-controlled trial to preliminarily test an intervention protocol of Mat Pilates in older women with KOA on health status, pain, stiffness, and functionality. This study included 41 volunteers with age over 40 years, which mean was 52.1 ± 8.9 years, and were allocated into Mat Pilates and control groups. The protocol was developed to be performed in 60 min, twice a week; the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Medical Outcomes Study 36 (SF-36) were used to assess pain, to evaluate functionality and stiffness.

RESULTS

The Mat Pilates group significantly improved the functional capacity assessed by SF-36 (33.12 ± 22.03 to 69.37 ± 22.43, p < 0.05), and by WOMAC (29.75 ± 6.92 to 9.75 ± 9.35, p < 0.05). The pain domain also improved in Mat Pilates group assessed by SF-36 (39.50 ± 12.89 to 71.75 ± 18.66, p < 0.05) and by WOMAC (8.00 ± 2.56 to 2.75 ± 3.01, p < 0.05). The total score of WOMAC (41.75 ± 10.39 to 14.25 ± 13.88, p < 0.05), and the general health status assessed by SF-36 (59.44 ± 18.07 to 82.75 ± 12.03, p < 0.05) only improved for Mat Pilates group. No differences were observed in outcomes for the control group in both questionnaires.

CONCLUSION

Our results show that Mat Pilates protocol can improve the health status, pain, and functionality of older women with KOA.

Effectiveness of three exercise programs and intensive follow-up in improving quality of life, pain, and lymphedema among breast cancer survivors: a randomized, controlled 6-month trial

PURPOSE

Postoperative complications of breast cancer (BC) seriously affect the quality of life (QOL) of survivors. Physical activity is related to prevention of complications and improvement of QOL. Follow-up can keep patients motivated to exercise. This study aimed to (1) compare the effect of three exercise programs on lymphedema, pain, and QOL in BC patients and (2) explore the effect of intensive follow-up on the outcomes of exercise programs.

METHODS

A single-blind randomized parallel controlled trial with a 6-month intervention was carried out in China in 2021. The study sample included 200 women with BC. The patients were randomly divided into 4 groups. G₀ (control group) was joint mobility exercise (JME) group; G₁ was joint mobility exercise + intensive follow-up (IF) group; G₂ was JME + aerobic exercise (AE) + IF group; and G₃ was JME + progressive resistance exercise (PRE) + IF group. Outcome measures were evaluated at baseline (T₁), 3 months post-intervention (T₂), and 6 months post-intervention (T₃). The following instruments and measurements were administered before and after the intervention: the Functional Assessment of Cancer Therapy-Breast (FACT-B) instrument, the numerical rating scale (NRS), and the relative volume change (RVC). Verificating aim 1 is by comparing the results of G₁, G₂, and G₃, and verificating aim 2 is achieved by comparing G₀ and G₁. Differences before and after the intervention were determined by analysis of variance of repeated measures and Kruskal-Wallis nonparametric analysis of variance.

RESULTS

Among the exercise programs, JME + PRE + IF resulted in the best improvement in QOL (T2: ΔG₃-G₀ = 13.032, P = 0.008; T2: ΔG₃-G₁ = 13.066, P < 0.001; ΔG₃-G₀ = 17.379, P < 0.001). For pain relief, JME + AE + IF had the best improvement (T3: ΔG₂-G₁ =  - 0.931, P = 0.010; ΔG₂-G₀ =  - 1.577, P < 0.001). For the prevention of lymphedema, JME + AE + IF (Z = 2.651, P = 0.048) and JME + PRE + IF (Z = 3.277, P = 0.006) had the similar effect, but JME + PRE + IF is better than JME + AE + IF.

CONCLUSION

JME + PRE have the best effect in improving the QOL and preventing lymphedema after surgery. In improving pain, the effect of JME + AE appears earlier, and the overall effect of JME + PRE is better. In addition, long-term and planned monitoring and follow-up are also important.

Effects of the Practice of Movement Representation Techniques in People Undergoing Knee and Hip Arthroplasty: A Systematic Review

OBJECTIVE

To analyze the effects of movement representation techniques (MRT) combined with conventional physical therapy (CFT) in people undergoing knee and hip arthroplasty compared to conventional physical therapy alone in terms of results in physical and functionality variables, cognitive function, and quality of life.

METHODOLOGY

the review was carried out according to the criteria of the PRISMA statement, considering studies in the electronic databases PubMed/Medline, Pubmed Central/Medline, Web of Science, EBSCO, and ScienceDirect.

RESULTS

MRT plus CFT generated therapeutic effects in some aspects of the physical variables: 100% pain (7 of 7 studies); 100% strength (5 out of 5 studies); range of motion 87.5% (7 out of 8 studies); 100% speed (1 of 1 study), functional variables: 100% gait (7 of 7 studies); functional capacity 87.5% (7 out of 8 studies); cognitive variables: 100% motor visualization ability (2 out of 2 studies); cognitive performance 100% (2 of 2 studies); and quality of life 66.6% (2 of 3 studies). When comparing its effects with conventional physical therapy, the variables that reported the greatest statistically significant changes were motor visualization ability, speed, pain, strength and gait. The most used MRT was motor imagery (MI), and the average time extension of therapies was 3.5 weeks.

CONCLUSIONS

movement representation techniques combined with conventional physical therapy are an innocuous and low-cost therapeutic intervention with therapeutic effects in patients with knee arthroplasty (KA) and hip arthroplasty (HA), and this combination generates greater therapeutic effects in physical, functional, and cognitive variables than conventional physical therapy alone.

The Immediate Effect of Backward Walking on External Knee Adduction Moment in Healthy Individuals

Backward walking (BW) has been recommended as a rehabilitation intervention to prevent, manage, or improve diseases. However, previous studies showed that BW significantly increased the first vertical ground reaction force (GRF) during gait, which might lead to higher loading at the knee. Published reports have not examined the effects of BW on medial compartment knee loading. The objective of this study was to investigate the effects of BW on external knee adduction moment (EKAM). Twenty-seven healthy adults participated in the present study. A sixteen-camera three-dimensional VICON gait analysis system, with two force platforms, was used to collect the EKAM, KAAI, and other biomechanical data during BW and forward walking (FW). The first ( $P<0.001$ ) and second ( $P<0.001$ ) EKAM peaks and KAAI ( $P=0.02$ ) were significantly decreased during BW when compared with FW. The BW significantly decreased the lever arm length at the first EKAM peak ( $P=0.02$ ) when compared with FW. In conclusion, BW was found to be a useful strategy for reducing the medial compartment knee loading even though the first peak ground reaction force was significantly increased.

Functional Resistance Training After Anterior Cruciate Ligament Reconstruction Improves Knee Angle and Moment Symmetry During Gait: A Randomized Controlled Clinical Trial

PURPOSE

The purpose of this study was to determine 1) whether progressive functional resistance training (FRT) during walking would improve knee biomechanical symmetry after anterior cruciate ligament (ACL) reconstruction and 2) whether the mode of delivery of FRT would have a differential effect on symmetry.

METHODS

Thirty individuals who underwent primary ACL reconstruction at a single institution volunteered for this study. Participants were randomized into one of three groups: 1) BRACE, 2) BAND, or 3) CONTROL. The BRACE group received FRT with a novel robotic knee brace along with real-time kinematic feedback. The BAND group received FRT with a custom resistance band device along with real-time kinematic feedback. The CONTROL group received only real-time kinematic feedback. Participants in all groups received training (2-3/week for 8 weeks) while walking on a treadmill. Knee angle and moment symmetry were calculated immediately prior to beginning the intervention and within 1 week of completing the intervention. Statistical Parametric Mapping was used to assess differences in biomechanical symmetry between groups across time.

RESULTS

There was a significant interaction in knee moment symmetry from 21 and 24% of the stance phase (P = .046), in which the BAND group had greater improvements following training compared with both BRACE (P = .043) and CONTROL groups (P = .002). There was also a significant time effect in knee angle symmetry from 68 to 79% of the stance phase (P = .028) and from 97 to 100% of the swing phase (P = .050) in which only the BRACE group showed significant improvements after the intervention (stance: P = .020 and swing: P < .001).

CONCLUSION

The results of this randomized controlled clinical trial indicate that 8 weeks of progressive FRT during treadmill walking in individuals with ACL reconstruction improves knee angle and moment symmetry during gait. The findings suggest that FRT could serve as a potential therapeutic adjuvant to traditional rehabilitation after ACL reconstruction and can help restore knee joint biomechanical symmetry.

LEVEL OF EVIDENCE

Level II, randomized controlled trial.

Serial Backward Locomotor Treadmill Training Improves Bidirectional Walking Performance in Chronic Stroke

Background and Research Question

Walking impairment remains a major limitation to functional independence after stroke. Yet, comprehensive and effective strategies to improve walking function after stroke are presently limited. Backward Locomotor Treadmill Training (BLTT) is a promising training approach for improving walking function; however, little is known about its mechanism of effect or the relationship between backward walking training and resulting overground forward walking performance. This study aims to determine the effects of serial BLTT on spatial aspects of backward and forward walking in chronic post-stroke individuals with residual walking impairment.

Methods

Thirty-nine adults (>6 months post-stroke) underwent 6 days of BLTT (3 × /week) over 2 weeks. Outcome measures included PRE-POST changes in backward and forward walking speeds, paretic and non-paretic step lengths, and single-support center of pressure distances. To determine the association between BLTT and overground walking, correlation analyses comparing training-related changes in these variables were performed.

Results

We report an overall improvement in BLTT and overground walking speeds, bilateral step lengths, and single-support center of pressure distances over six training sessions. Further, there were weak positive associations between PRE-POST changes in BLTT speed, BLTT paretic step length, and overground forward walking speed.

Conclusion and Significance

Our findings suggest that individuals with chronic post-stroke walking impairment experience improvements in spatial walking measures during BLTT and overground. Therefore, BLTT may be a potential adjunctive training approach for post-stroke walking rehabilitation.

Conservative treatment of knee osteoarthritis: A review of the literature

Knee osteoarthritis (KOA) is a common chronic debilitating disease with an estimated prevalence of 23.9% in the general adult population. The condition is characterised by joint pain, functional impairment and significant reduction in quality of life. Management for KOA can generally be divided into conservative (non-operative) and surgical (operative) measures. Conservative management broadly compromises pharmacological and non-pharmacological options and is conventionally the first line treatment to avoid or delay the need for surgical management. The aim of this study is to provide an overview of the current recommendations, efficacy and safety profile of different conservative treatments through a review of the literature.

Machine learning to predict incident radiographic knee osteoarthritis over 8 Years using combined MR imaging features, demographics, and clinical factors: data from the Osteoarthritis Initiative

OBJECTIVE

To develop a machine learning-based prediction model for incident radiographic osteoarthritis (OA) of the knee over 8 years using MRI-based cartilage biochemical composition and knee joint structure, demographics, and clinical predictors including muscle strength and symptoms.

DESIGN

Individuals (n = 1,044) with baseline Kellgren Lawrence (KL) grade 0-1 in the right knee from the Osteoarthritis Initiative database were analyzed. 3T MRI at baseline was used to quantify knee cartilage T₂, and Whole-Organ Magnetic Resonance Imaging Scores (WORMS) were obtained for cartilage, meniscus, and bone marrow. The outcome was set as true if a subject developed KL grade 2-4 OA in the right knee over 8 years (n = 183) and false if the subject remained at KL 0-1 over 8 years (n = 861). We developed and compared three models: Model 1: 112 predictors based on OA risk factors; Model 2: top ten predictors based on feature importance score from Model 1 and clinical relevance; Model 3: Model 2 without the imaging predictors. We compared the models using the area under the ROC curve derived from hold-out data.

RESULTS

The 10-predictor model (Model 2, that includes cartilage and meniscus WORMS scores and cartilage T₂) had a slightly lower AUC (0.772) compared to the model with 112 predictors (Model 1: AUC = 0.792, p = 0.739); and had a significantly higher AUC compared to the model without MR imaging predictors (Model 3, AUC = 0.669, p = 0.011).

CONCLUSIONS

A 10-predictor model including MRI parameters coupled with demographics, symptoms, muscle, and physical activity scores provides good prediction of incident radiographic OA over 8 years.

Backward Locomotor Treadmill Training Differentially Improves Walking Performance across Stroke Walking Impairment Levels

Background: Post-stroke walking impairment is a significant cause of chronic disability worldwide and often leads to loss of life roles for survivors and their caregivers. Walking impairment is traditionally classified into mild (>0.8 m/s), moderate (0.41–0.8 m/s), and severe (≤0.4 m/s), and those categorized as “severe” are more likely to be homebound and at greater risk of falls, fractures, and rehospitalization. In addition, there are minimal effective walking rehabilitation strategies currently available for this subgroup. Backward locomotor treadmill training (BLTT) is a novel and promising training approach that has been demonstrated to be safe and feasible across all levels of impairment; however, its benefits across baseline walking impairment levels (severe (≤0.4 m/s) vs. mild–moderate (>0.4 m/s)) have not been examined. Methods: Thirty-nine adults (>6 months post-stroke) underwent 6 days of BLTT (3×/week) over 2 weeks. Baseline and PRE to POST changes were measured during treadmill training and overground walking. Results: Individuals with baseline severe walking impairment were at a more significant functional disadvantage across all spatiotemporal walking measures at baseline and demonstrated fewer overall gains post-training. However, contrary to our working hypothesis, both groups experienced comparable increases in cadence, bilateral percent single support times, and step lengths. Conclusion: BLTT is well tolerated and beneficial across all walking impairment levels, and baseline walking speed (≤0.4 m/s) should serve as a covariate in the design of future walking rehabilitation trials.

Benefits and Mechanisms of Exercise Training for Knee Osteoarthritis

Knee osteoarthritis is a chronic degenerative disease. Cartilage and subchondral bone degeneration, as well as synovitis, are the main pathological changes associated with knee osteoarthritis. Mechanical overload, inflammation, metabolic factors, hormonal changes, and aging play a vital role in aggravating the progression of knee osteoarthritis. The main treatments for knee osteoarthritis include pharmacotherapy, physiotherapy, and surgery. However, pharmacotherapy has many side effects, and surgery is only suitable for patients with end-stage knee osteoarthritis. Exercise training, as a complementary and adjunctive physiotherapy, can prevent cartilage degeneration, inhibit inflammation, and prevent loss of the subchondral bone and metaphyseal bone trabeculae. Increasing evidence indicates that exercise training can improve pain, stiffness, joint dysfunction, and muscle weakness in patients with knee osteoarthritis. There are several exercise trainings options for the treatment of knee osteoarthritis, including aerobic exercise, strength training, neuromuscular exercise, balance training, proprioception training, aquatic exercise, and traditional exercise. For Knee osteoarthritis (KOA) experimental animals, those exercise trainings can reduce inflammation, delay cartilage and bone degeneration, change tendon, and muscle structure. In this review, we summarize the main symptoms of knee osteoarthritis, the mechanisms of exercise training, and the therapeutic effects of different exercise training methods on patients with knee osteoarthritis. We hope this review will allow patients in different situations to receive appropriate exercise therapy for knee osteoarthritis, and provide a reference for further research and clinical application of exercise training for knee osteoarthritis.

Comparison of Health Care Expenditures Among U.S. Older Adults With Pain Who Reported Frequent Exercise Versus Nonfrequent Exercise

This cross-sectional study included a nationally representative sample of U.S. adults aged ≥50 years with self-reported pain in the past 4 weeks from the 2018 Medical Expenditure Panel Survey. Adjusted linear regression analyses accounted for the complex survey design and assessed differences in several types of annual health care expenditures between individuals who reported frequent exercise (≥30 min of moderate-vigorous intensity physical activity ≥5 times per week) and those who did not. Approximately 23,940,144 of 56,979,267 older U.S. adults with pain reported frequent exercise. In adjusted analyses, individuals who reported frequent exercise had 15% lower annual prescription medication expenditures compared with those who did not report frequent exercise (p = .007). There were no statistical differences between frequent exercise status for other health care expenditure types (p > .05). In conclusion, adjusted annual prescription medication expenditures were 15% lower among older U.S. adults with pain who reported frequent exercise versus those who did not.

The Efficacy of Backward Walking on Static Stability, Proprioception, Pain, and Physical Function of Patients with Knee Osteoarthritis: A Randomized Controlled Trial

Objective

Impaired static stability and proprioception have been observed in individuals with knee osteoarthritis (KOA), which serves as a major factor increasing risk of fall. This study aimed to investigate the effects of backward walking (BW) on static stability, proprioception, pain, and physical function in KOA patients.

Methods

Thirty-two subjects with knee osteoarthritis were randomly assigned to either an BW group (BG, n = 16) or a control group (CG, n = 16). The participants in the BG received combination treatment of a 4-week BW training and conventional treatments, while those in the CG was treated with conventional treatments alone. All the participants were tested for the assessment of static stability [center of pressure (COP) sway, including sway length (SL, mm) and sway area (SA, mm²)] and proprioception [average trajectory error (ATE, %) and completion time (CT, second)]. Additionally, pain and knee function scores were measured by the numerical rating scale (NRS) and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, respectively. The assessments were conducted before and after intervention.

Results

The COP sway (SA and SL), ATE, NRS, and WOMAC showed a significant decline at week 4 in the two groups in contrast to their baseline (P < 0.05). Moreover, after 4-week intervention, the SA [(610.50 ± 464.26) mm² vs. (538.69 ± 420.52) mm²], NRS [(1.56 ± 0.63) vs. (2.25 ± 0.86)], and WOMAC [(11.69 ± 2.50) vs. (16.19 ± 3.94)] showed a significantly greater decrease in the BG compared to the CG (P < 0.05, respectively). However, the proprioception (ATE and CT) was closely similar between both groups at week 4 (P > 0.05).

Conclusion

BW is an effective adjunct to conventional treatment in reducing pain, improving physical function and static stability for KOA patients. It should be taken into consideration when developing rehabilitation programs for people with KOA.

Effects of TheraBand and Theratube Eccentric Exercises on Quadriceps Muscle Strength and Muscle Mass in Young Adults

Purpose

This study was aimed at comparing the effects of TheraBand and theratube eccentric exercises on quadriceps muscle strength in young adults.

Methods

Thirty young adults (19 females, 11 males) participated in this pretest-posttest experimental study. Participants were randomly assigned to one of the two groups: TheraBand and theratube groups. They received the training intervention 3 times a week for 4 weeks (12 sessions) with progression after 2 weeks. Maximum eccentric quadriceps strength was assessed using the Biodex isokinetic dynamometer system. Additionally, quadriceps muscle mass was measured using a tape.

Results

Both groups showed a significant improvement in the peak torque of the eccentric isokinetic quadriceps' strength after weeks 2 and 4. Strength change in the quadriceps was nonsignificant in the theratube group compared to the TheraBand group after 4 weeks of training (p < 0.05). There was no increase in muscle mass during the 4 weeks of training in any group (p > 0.05).

Conclusion

Both the TheraBand and theratube are equally effective in the strengthening of the quadriceps muscle in young adults. Therefore, either the TheraBand or theratube may be used according to the availability and feasibility of the subjects for training intervention.

Effectiveness of Isometric Exercise and Counseling on Level of Pain Among Patients With Knee Osteoarthritis

Introduction

Osteoarthritis (OA) is one of the emerging health issues in Asian countries in elderly population. Knee osteoarthritis (KOA) is a major age related public health issue characterized by progressive loss of articular cartilage resulting in pain, functional impairment, disability and diminished quality of life. The aim of this study was to assess the effectiveness of Isometric exercise and counseling on level of pain among patients with KOA.

Methods

Quantitative research approach and a quasi-experimental pretest-posttest control group research design was utilized. The study was conducted at MIOT hospital and Devadoss Hospital, Madurai, Tamil Nadu, India. Data was collected from a total of 200 patients with KOA, 100 in the study and 100 in the control group. These patients were clinically diagnosed to have Grade I, II and III KOA. The demographic variables and clinical profile were recorded for both groups. The self-administered WOMAC questionnaire was used to assess the level of pain of KOA patients. Post-test assessment was carried out on Day 15, Day 30, Day 60 and Day 90. The data was analyzed using SPSS windows 16.

Results

The comparison of level of pain between the study and control group has showed a remarkable reduction in level of pain among patients with KOA in the study group. The post-test level of pain in the study group was 14.9% (13.3% -16.5% with 95% CI) and was 2.1% (1.2% -3.0% with 95% CI) in the control group. It showed that the reduction in the level of pain was higher in the study group than the control group.

Conclusion

The study found that a 12-week Isometric exercise and counseling program has significantly reduced pain, stiffness and improved physical function. Therefore, the Isometric exercise and counselling should be adopted as a routine care in the hospitals treating patients with KOA.

Efficacy of Electromyographic-Biofeedback Supplementation Training with Patellar Taping on Quadriceps Strengthening in Patellofemoral Pain Syndrome among Young Adult Male Athletes

This study compares the effects of electromyographic-biofeedback (EMG-BF)-guided isometric quadriceps strengthening with patellar taping and isometric exercise alone in patellofemoral pain syndrome (PFPS) among young adult male athletes. Sixty young adult male athletes with PFPS participated in the study. Participants were randomly divided into two groups: (1) EMG-BF-guided isometric exercise training with patellar taping (experimental group, n = 30), and (2) sham EMG-BF training with an isometric exercise program (control group, n = 30). Participants conducted their respective exercise programs for five days per week across four weeks. Study outcomes were pain (measured by the visual analog scale), functional disability (measured by the Kujala Anterior Knee Pain scale), and quadriceps strength (measured by an ISOMOVE dynamometer). Measurements were taken at baseline, Week 2, Week 4, and during a follow-up at Week 6. The experimental group demonstrated significantly lower VAS score at Weeks 2 and 4 compared to that of the control group (p = 0.008 and 0.0005, respectively). The score remained significantly lower at the Week 6 follow-up compared to the control group (p = 0.0005). There were no differences in knee function at Weeks 2 and 4 between the two groups (p = 0.086 and 0.171, respectively); however, the experimental group showed significantly better knee function at Week 6 compared to the control group (p = 0.002). There were no differences in quadriceps strength at Week 2 between the two groups (p = 0.259); however, the experimental group demonstrated significantly higher quadriceps strength at Weeks 4 and 6 compared to the control group (p = 0.0008). Four weeks of EMG-BF supplementation training with patellar taping demonstrated significant improvements in pain intensity, functional disability, and quadriceps muscle strength in young adult male athletes with PFPS.

Evaluation of the effect of a three-color ladder management model for knee osteoarthritis in the community

OBJECTIVE

To explore the application effect of a three-color ladder management system for knee osteoarthritis in the community.

METHODS

Eighty-six patients with knee osteoarthritis in our community were obtained for study and randomly grouped. The control group received routine management, while the research group received three-color ladder management for 12 months. The knee joint function (WOMAC score), pain degree (VAS score), joint flexibility, health-related behavior score, self-care ability scale (exercise of self-care agency scale (ESCA) score), quality of life (knee osteoarthritis quality of life scale (AIMS2-SF) score) and knee replacement rate were compared between the two groups before and after management, and the changes of patients' visits and treatment costs before and after management were observed.

RESULTS

After 12 months, the scores of WOMAC and VAS in the research group were significantly lower than those of the control group (P<0.05), while the scores of joint flexibility and extension, cognition, behavior and condition of Omaha System health-related behaviors, ESCA and AIMS2-SF were significantly higher than those of the control group (P<0.05). After 12 months, the monthly visits and expenses of green cards, yellow cards and red cards in the research group were significantly lower than those before entering the group (P<0.05). After 12 months, the knee replacement rate was 20.93% (9/43) in the research group, while it was 27.91% (12/43) in the control group, with no significant difference between the two groups (P>0.05).

CONCLUSION

The three-color ladder management system for knee osteoarthritis patients in the community can reduce the number of doctor visits and overall expenses, improve knee joint function, reduce pain, improve self-management ability and quality of life, and it has high community popularization.

Association of Self-Reported Frequent Exercise Among a Nationally Representative Sample of Older People in the United States With Self-Reported Pain

This retrospective, cross-sectional database study aimed to identify characteristics associated with self-reported frequent exercise (defined as moderate- to vigorous-intensity exercise for ≥30 min five times a week) in older U.S. (≥50 years) adults with pain in the past 4 weeks, using 2017 Medical Expenditure Panel Survey data and hierarchical logistic regression models. The variables significantly associated with frequent exercise included being male (adjusted odds ratio [AOR] = 1.507, 95% confidence interval [CI] [1.318, 1.724]); non-Hispanic (AOR = 1.282, 95% CI [1.021, 1.608]); employed (AOR = 1.274, 95% CI [1.040, 1.560]); having no chronic conditions versus ≥5 conditions (AOR = 1.576, 95% CI [1.094, 2.268]); having two chronic conditions versus ≥5 conditions (AOR = 1.547, 95% CI [1.226, 1.952]); having no limitation versus having a limitation (AOR = 1.209, 95% CI [1.015, 1.441]); having little/moderate versus quite/extreme pain (AOR = 1.358, 95% CI [1.137, 1.621]); having excellent/very good versus fair/poor physical health (AOR = 2.408, 95% CI [1.875, 3.093]); and having good versus fair/poor physical health (AOR = 1.337, 95% CI [1.087, 1.646]). These characteristics may be useful to create personalized pain management protocols that include exercise for older adults with pain.

Osteoarthritis year in review 2020: rehabilitation and outcomes

OBJECTIVE

Systematically review and synthesize guidelines, systematic reviews, or randomized controlled trials (RCTs) published between April 1, 2019 and April 30, 2020 which evaluated or made recommendations for rehabilitation of persons with osteoarthritis.

DESIGN

Five electronic databases (Medline, EMBASE, Cochrane CENTRAL, CINHAL, Web of Science) were searched with a comprehensive search strategy. Guidelines for rehabilitation of persons with osteoarthritis, and systematic reviews and RCTs evaluating osteoarthritis rehabilitation that included at least one patient-reported outcome measure and/or clinical test of function were included. Two authors independently screened records and assessed methodological quality using the AGREE-II (guidelines), AMSTAR-2 (systematic reviews) or PEDro scale (RCTs). Data were extracted to summarize included records and a narrative synthesis of findings related to core recommended osteoarthritis rehabilitation treatments performed.

RESULTS

Of 2,479 potential records, 253 records were reviewed. Two guidelines, 18 systematic reviews and 38 RCTs were included. 84% (n = 49) of included records related to knee osteoarthritis, 13% (n = 8) to hip, 10% (n = 6) to hand, 3% (n = 2) to mixed, and 1% (n = 1) to foot osteoarthritis. Exercise-therapy, methods to deliver exercise-therapy remotely, and approaches to facilitate exercise-therapy behaviour change were the most commonly evaluated interventions (n = 27). 94% of systematic reviews and 63% of RCTs rated high-quality.

CONCLUSIONS

Osteoarthritis rehabilitation research continues to focus on knee osteoarthritis and exercise-based interventions. Emerging topics include rehabilitation of comorbid populations, exercise behaviour change and technology supports. A better understanding of rehabilitation of osteoarthritis in joints other than the knee, and methods to determine and promote ideal exercise-therapy prescription are needed.

A randomized control trial on retro-walking improves symptoms, pain, and function in primary knee osteoarthritis

BACKGROUND

Primary knee osteoarthritis is the leading cause of chronic disability and pain among adults worldwide. Retro-walking has been shown to reduce patellofemoral pain, increases functional capability while strengthening the lower limbs and improving proprioception and balance. We aim to examine the effects of retro-walking on symptoms, pain, and perceived ability to perform daily activities in comparison to forward-walking in subjects with primary knee osteoarthritis.

METHODS

This was a single-blinded, randomized control trial involving 34 subjects between the age of 45-70 years (58.41±5.93) comparing retro-walking (RW) to forward-walking (FW). Subjects were randomly allocated to receive either RW with structured resistance training (SRT) or FW with SRT; 3 times a week for 12 weeks. The symptoms, pain, and function of daily living sub scores of the Knee Injury and Osteoarthritis Outcome Score (KOOS) along with Timed up and go (TUG) and Chair stand test (CST) were assessed at baseline and after 12 weeks. The outcomes were analyzed with two-way repeated measure analysis of variance.

RESULTS

Significant improvements for all outcomes were observed intra-group (P value <0.05) after 12 weeks. The KOOS sub scores, TUG and CST times was not statistically significant between study groups (P value >0.05). However, the partial eta squared scores for all outcomes were better in the RW group compared to FW except for CST.

CONCLUSIONS

It can be concluded that RW is a feasible and non-inferior option to FW in the rehabilitation of subjects with bilateral knee OA.

Effect of backward walking training on knee osteoarthritis: protocol of a systematic review and meta-analysis

INTRODUCTION

Backward walking (BW) is otherwise known as retrowalking. As opposed to forward walking, BW is a countersequential exercise and is a common method of rehabilitation training and disease-assisted treatment. Studies have shown that BW has a helpful effect on improving lower limb proprioception, gait synergy and improving limb balance. Many studies have concluded that BW can improve the symptoms of patients with knee osteoarthritis (KOA) and can be used for rehabilitation and adjunctive treatment of KOA, but there is a lack of evidence-based medical evidence.This research aims to provide an update to the most recent available evidence on the effect of BW on patients with KOA .

METHODS AND ANALYSES

Electronic databases, such as Ovid/MEDLINE, EMBASE, CINAHL, Scopus, Web of Science and PubMed, will be searched by us. We will include studies identified from citation until 12 May 2020 and will not be restricted by geographical setting. The search will not be limited to the language of the publication, but the study of human subjects. Randomised controlled trials (RCTs) on the BW training of KOA will be included, with outcome measures including pain, knee function or balance function. The quality of included RCTs will be evaluated according to the Cochrane Collaboration's risk of bias tool. A meta-analysis or systematic review will be performed to summarise the effects of BW training. We will perform sensitivity analysis on the sample size of RCTs, meta-regression analysis of the follow-up periods, dosages and baselines of outcome measures, and publication bias analysis.

ETHICS AND DISSEMINATION

Ethical approval is not required as this study will not involve confidential personal data. The results of this study will be disseminated through a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42020185694.

Effectiveness of Health-Led Cognitive Behavioral-Based Group Therapy on Pain, Functional Disability and Psychological Outcomes among Knee Osteoarthritis Patients in Malaysia

Background: Psychosocial interventions for patients with osteoarthritis (OA) of the knee to reduce pain and improve physical and psychological functioning are still lacking in Malaysia. Methods: A parallel-group unblinded randomized controlled trial involving 300 patients was conducted in two hospital orthopedics clinics in Malaysia. Patients were randomly assigned to receive cognitive behavioral-based group therapy (n = 150) or no further intervention (n = 150). The primary outcome was the change from baseline in knee pain as determined by the Knee injury and Osteoarthritis Outcome Score (KOOS) at 6 months. The data collected were analyzed by covariate-adjusted mixed design repeated measures analysis of variance. All analyses were performed under the terms of intention-to-treat. Results: At 6 months, mean change from baseline in the KOOS knee pain score was 0.6 points (95% CI −1.73 to 2.94) in the control group and 8.9 points (95% CI 6.62 to 11.23) (denoting less knee pain intensity) in the intervention group (significant treatment effect p < 0.0001). Patients treated with such an approach also experienced significant improvement in functional ability when performing activities of daily living and had improved ability to cope with depression, anxiety and pain catastrophizing. Conclusion: The intervention module delivered by healthcare professionals had a sustained effect on knee OA pain and functionality over 6 months, thereby leading to an overall improvement in psychological well-being, thus benefitting most of the Malaysian knee OA patients.

Effectiveness of backward walking for people affected by stroke: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Backward walking (BW) training is increasingly used in rehabilitation for stroke, but relevant evidence remains unclear.

OBJECTIVE

To determine the effect of BW training on patients with stroke.

METHODS

A keyword search was conducted in PubMed, EMBASE, CINAHL, and China National Knowledge Infrastructure database for articles published until November, 2019. Two investigators screened the articles and extract data from each included study. Meta-analysis was performed to estimate the effect of BW on stroke. In addition, the quality of evidence was evaluated by GRADE (grading of recommendations, assessment, development, and evaluation; version:3.6) approach.

RESULTS

A total of ten studies were included according to the inclusion and exclusion criteria in the review. All included studies described some positive influences of BW on stroke relative to the control group (forward walking or conventional treatment). Compared to control group, there is a statistically significant improvement for BW group in gait velocity (mean difference [MD] = 6.87, 95%CI: [1.40, 12.33], P = .01, I = 3%), Berg balance score (MD =3.82, 95%CI: [2.12, 5.52], P < .0001, I = 0%), and walk test (MD =0.11, 95%CI: [0.02, 0.20], P = .02, I = 36%).

CONCLUSIONS

For patients with stroke, BW training, as an adjunct an adjunct to conventional treatment, can improve Berg balance score (moderate evidence), walk test performance (very low evidence), gait velocity (very low evidence). More large-scale and high-quality studies are warranted.