Effects of High-Intensity Strength Training in Adults With Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Effect of strength training on knee proprioception in patients with knee osteoarthritis: A systematic review and meta-analysis

Proprioception is significantly impaired in knee osteoarthritis (KOA), contributing to reduced functionality. Strength training (ST) is essential in KOA by improving muscle strength, although it may also be effective in improving proprioception. The purpose was to determine the effect of ST on knee proprioception in KOA patients. Pubmed, CINAHL, Scopus, WOS, and PEDro were searched for randomized controlled trials (RCTs) (inception to March 2023). Comparisons for ST were physical exercise different from ST, non-exercise-based interventions, and no intervention. Methodological quality was assessed using the PEDro scale, and risk of bias (RoB) using the Cochrane tool. Meta-analyses were performed by comparison groups using the standardized mean difference (SMD) (Hedge's g) with random effects models, also considering subgroups by proprioception tests. Finally, six RCTs were included. The mean PEDro score was 6.3, and the highest proportion of biases corresponds to performance, selection, and detection. The meta-analysis indicated that only when compared with non-intervention, ST significantly improved knee proprioception for the joint position sense (JPS) (active + passive), JPS (passive), and threshold to detect passive motion (TTDPM) subgroups (g ​= ​-1.33 [-2.33, -0.32], g = ​-2.29 [-2.82, -1.75] and g ​= ​-2.40 [-4.23, -0.58], respectively). However, in the knee JPS (active) subgroup, ST was not significant (g ​= ​-0.72 [-1.84, 0.40]). In conclusion, ST improves knee proprioception compared to non-intervention. However, due to the paucity of studies and diversity of interventions, more evidence is needed to support the effectiveness of ST. Future RCTs may address the limitations of this review to advance knowledge about proprioceptive responses to ST and contribute to clinical practice.

Acute Effects of In-Hospital Resistance Training on Clinical Outcomes in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial

OBJECTIVE

The aim of the study is to evaluate the acute responses, in the in-hospital setting, of intensive elastic resistance training on physical function, pain, psychosocial variables, and inflammatory markers in patients undergoing total knee arthroplasty.

DESIGN

In a randomized controlled trial, 40 patients with total knee arthroplasty (≥55 yrs) were assigned to either (1) the intervention group (elastic resistance strengthening) or (2) a control group (conventional protocol). Patients performed three sessions in the hospital at 24, 48, and 72 hrs after total knee arthroplasty. Outcome measures included: self-administered physical function, pain intensity, kinesiophobia, catastrophizing, self-efficacy, range of motion, perceived change, test timed up and go, knee joint effusion, isometric strength, pressure pain thresholds, and inflammatory markers (levels of procalcitonin and C-reactive protein).

RESULTS

The mixed analysis of variance model showed a significant group*time interaction in favor of the intervention group with a large effect size for kinesiophobia (ηp 2 = 0.308, P < 0.001), catastrophizing (ηp 2 = 0.242, P < 0.001), and passive range of motion flexion (ηp 2 = 0.167, P < 0.001) and a moderate effect size for physical function (ηp 2 = 0.103, P = 0.004), pain intensity (ηp 2 = 0.139, P < 0.001), timed up and go (ηp 2 = 0.132, P = 0.001), self-efficacy (ηp 2 = 0.074, P = 0.016), active range of motion flexion (ηp 2 = 0.121, P = 0.002), levels of procalcitonin (ηp 2 = 0.099, P = 0.005), and C-reactive protein (ηp 2 = 0.106, P = 0.004).

CONCLUSIONS

Three sessions of intensive elastic resistance training improve physical function, perceived pain, psychosocial variables, and inflammatory markers during the hospitalization period after total knee arthroplasty.

Dropout From Exercise Interventions in Adults With Knee or Hip Osteoarthritis: A Systematic Review and Meta-analysis

OBJECTIVE

To investigate the prevalence and moderators of dropout rates among adults with knee or hip osteoarthritis participating in exercise randomized controlled trials (RCTs).

DATA SOURCES

Two authors searched Embase, CINAHL, PsycARTICLES, and PubMed up to 01/09/2023.

STUDY SELECTION

We included RCTs of exercise interventions in people with knee or hip osteoarthritis that reported dropout rates.

DATA EXTRACTION

Dropout rates from exercise and control conditions and exerciser/participant, provider, and design/implementation related moderators.

DATA SYNTHESIS

In total, 209 RCTs involving 277 exercise arms in 13,102 participants were included (mean age at study level=64 years; median prevalence of men participants=26.8%). The trim-and-fill-adjusted prevalence of dropout across all RCTs was 17.5% (95% CI=16.7%-18.2%), which is comparable with dropout observed in control conditions (trim-and-fill-adjusted odds ratio=0.89; 95% CI=0.71-1.12, P=.37). Higher prevalence of antidepressant use at study-level predicted higher dropout (R2=0.75, P=.002, N RCTs=6, n exercisers=412). Supervision by an exercise professional was associated with lower dropout rates, with a trim-and-fill-adjusted rate of 13.2% (95% CI=11.7%-14.9%) compared with 20.8% without supervision (95% CI=18.3%-23.5%) (P<.001).

CONCLUSIONS

Dropout rates for exercise in RCTs are comparable with control conditions, suggesting that exercise is a generally well-accepted intervention. However, interventions should be supervised by an exercise professional, such as a physiotherapist or exercise physiologist, to further minimize the risk of dropout. Health professionals should consider participants' use of antidepressants as a risk factor for dropout from exercise.

Effect of Telerehabilitation-Based Exercise and Education on Pain, Function, Strength, Proprioception, and Psychosocial Parameters in Patients With Knee Osteoarthritis: A Randomized Controlled Clinical Trial

OBJECTIVE

In middle-aged individuals with early-stage knee osteoarthritis, follow-up with remote rehabilitation methods may provide effective clinical outcomes. The present study aimed to investigate the effect of telerehabilitation on pain, function, performance, strength, proprioception, and psychosocial parameters in patients with knee osteoarthritis.

DESIGN

A randomized controlled study was conducted with 54 participants with knee osteoarthritis. All patients were randomized into two groups: the home-based telerehabilitation group ( n = 29) and the home-based paper group ( n = 28). The home exercise program and training were provided with an instruction manual to paper group. The same home exercise and education prescriptions were given to individuals in telerehabilitation group via an online platform. Pain, function, quality of life, physical performance, muscle strength, and proprioception were evaluated at baseline and after 8 wks of intervention. In addition, satisfaction and usability were evaluated at week 8.

RESULTS

Telerehabilitation group demonstrated better improvement in terms of pain, function, quality of life index score, and left extremity proprioception ( P < 0.05). Telerehabilitation group was not superior to paper group in terms of muscle strength and performance tests (except the Five Times Sit to Stand Test) ( P > 0.05).

CONCLUSIONS

The home-based telerehabilitation program was superior to the home-based paper group program for pain, function, quality of life, and proprioception in patients with knee osteoarthritis.

Ebbing Strength, Fading Power: Unveiling the Impact of Persistent Fatigue on Muscle Performance in COVID-19 Survivors

The total number of confirmed cases of COVID-19 caused by SARS-CoV-2 virus infection is over 621 million. Post-COVID-19 syndrome, also known as long COVID or long-haul COVID, refers to a persistent condition where individuals experience symptoms and health issues after the acute phase of COVID-19. The aim of this study was to assess the strength and fatigue of skeletal muscles in people recovered from COVID-19. A total of 94 individuals took part in this cross-sectional study, with 45 participants (referred to as the Post-COVID Cohort, PCC) and 49 healthy age-matched volunteers (Healthy Control Cohort, HCC). This research article uses the direct dynamometry method to provide a detailed analysis of post-COVID survivors' strength and power characteristics. The Biodex System 4 Pro was utilized to evaluate muscle strength characteristics during the fatigue test. The fatigue work in extensors and flexors was significantly higher in the PCC. The PCC also showed significantly less power in both extensors and flexors compared to the HCC. In conclusion, this study provides compelling evidence of the impact of post-COVID-19 fatigue on muscle performance, highlighting the importance of considering these effects in the rehabilitation and care of individuals recovering from the virus. PCC achieved lower muscle strength values than HCC.

Effects of adding glucosamine or glucosamine combined with chondroitin to exercise on pain and physical function in adults with knee osteoarthritis: a systematic review and meta-analysis

It is well known that different types of exercise significantly improve physical function and relieve pain in knee osteoarthritis (KOA) patients. The aim of this study was to investigate the added effects of glucosamine or glucosamine and chondroitin supplementation in combination with an exercise program in the management of KOA. The randomized controlled trials on adding glucosamine (G) or G combined with chondroitin (C) to an exercise program in the treatment of KOA were searched in the PubMed, Cochrane Central Register of Controlled Trials, PEDro, and Web of Science online databases. The Pedro scale tool was used to assess quality of literature. A meta-analysis was performed using the Review Manager 5.4 software. In total, 6 studies (including 297 participants) were included for the final meta-analysis. According to the PEDro scale, the average quality of the studies was rated as good (mean = 8.2 (2)). The results showed that the effect of G, or G and C, in combination with exercise is not significant, as indicated by the assessed knee pain (WOMAC pain: SMD -0.18, 95% CI -0.47 to 0.11, p = 0.23; and VAS pain: SMD -0.34, 95% CI -0.85 to 0.17, p = 0.20) and physical function (SMD -0.13, 95% CI -0.95 to 0.69, p = 0.76). Adding glucosamine alone or a combination of glucosamine and chondroitin to exercise, has no effect on knee pain and physical function compared with exercise alone in KOA patients. Keywords: treatment, dietary supplement, physical activity, older adults.

Chinese guidelines for the rehabilitation treatment of knee osteoarthritis: An CSPMR evidence-based practice guideline

BACKGROUND

Knee osteoarthritis (KOA) is the most common degenerative joint disease in China, causing a huge economic burden on patients, families, and society. Standardized KOA rehabilitation treatment is an important means to prevent and treat the disease and promote the development of high-quality medical services. This guideline is updated on the basis of the 2016 and 2019 editions.

METHODS

Clinical questions regarding rehabilitation assessment and treatment were selected through clinical questions screening and deconstruction, and multiple rounds of Delphi questionnaire consultation. The International Classification of Functioning, Disability and Health (ICF) was used as the theoretical framework, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was used to grade the quality of evidence and recommendations.

RESULTS

The reporting of this guideline followed the standard of Reporting Items for Practice Guidelines in Healthcare (RIGHT). Taking into account patients' preferences and values and the needs of Chinese clinical practice, a total of 11 clinical questions and 28 recommendations were established. The clinical questions were grouped into two categories: KOA assessment (body function, body structure, activity and participation, quality of life, and environmental factors and clinical outcomes assessment, resulting in 9 recommendations) and KOA treatment (health education, therapeutic exercise, therapeutic modalities, occupational therapy, assistive devices, and regenerative rehabilitation approaches, resulting in 19 recommendations).

CONCLUSION

This is the first evidence-based guideline for KOA rehabilitation in China utilizing the ICF framework. This guideline provides key guidance for developing systematic, standardized, and precise rehabilitation protocols for KOA across various healthcare settings.

Exercise Therapy for Knee and Hip Osteoarthritis: Is There An Ideal Prescription?

Purpose of review

Exercise therapy is the first line treatment for patients with knee and hip osteoarthritis (OA) but is consistently underutilized. In this review, we aim to provide health care professionals with an overview of the latest evidence in the areas of exercise therapy for OA, which can serve as a guide for incorporating the ideal exercise therapy prescription in the overall management plan for their patients with OA.

Recent findings

Evidence continues to be produced supporting the use of exercise therapy for all patients with knee or hip OA. Ample evidence exists suggesting exercise therapy is a safe form of treatment, for both joint structures and the patient overall. Several systematic reviews show that exercise therapy is likely to improve patient outcomes, regardless of disease severity or comorbidities. However, no single type of exercise therapy is superior to others.

Summary

Health care practitioners and patients should be encouraged to incorporate exercise therapy into treatment plans and can be assured of the safety profile and likelihood of improvement in important patient outcomes. Since no single exercise therapy program shows vastly superior benefit, patient preference and contextual factors should be central to the shared decision-making process when selecting and individualising appropriate exercise therapy prescriptions.