Towards improved efficacy of exercise programmes in knee osteoarthritis

AI-Khlaifat, LS 2012, Towards improved efficacy of exercise programmes in knee osteoarthritis , PhD thesis, University of Salford.

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Abstract

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

Item Type: Thesis (PhD)
Contributors: Jones, R (Supervisor), Hammond, A (Supervisor) and Herrington, LC (Supervisor)
Schools: Schools > School of Health Sciences
Depositing User: Institutional Repository
Date Deposited: 30 Jul 2021 13:27
Last Modified: 27 Aug 2021 21:56
URI: http://usir.salford.ac.uk/id/eprint/61371

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