Effectiveness of three modes of kinetic-chain exercises on quadriceps muscle strength and thigh girth among individuals with knee osteoarthritis

Characterization and critical appraisal of physiotherapy intervention research in Nigeria: a systematic review

OBJECTIVES

Clinical research is the bedrock of clinical innovation, education and practice. We characterized and critically appraised physiotherapy clinical research to avoid implementing misleading research findings into practice and to task the Nigerian physiotherapy societies on responsible conduct of clinical research.

METHODS

This is a systematic review of articles published in English between 2009 and 2023. We started with 2009 because at least few Nigerian Physiotherapy school had commenced postgraduate (research) training by then. We searched Pubmed, Medline, Cumulative Index to Nursing and Allied Health Literature, Academic Search Complete, PsycINFO and African Journal Online, and reference lists of relevant articles. We Data were selected and extracted according to predesigned eligibility criteria and using a standardized data extraction table. Where appropriate, the Pedro and Cochrane ROBINS1 were used to examine the risk of bias.

RESULTS

A total of 76 Nigerian studies were included in this study. The mean age of the study participants was 46.7 ± 8.6 years. Approximately, 45% of the participants were males. Of the clinical experiments, the randomized controlled trial (RCT) was the most common design (87.5%). Musculoskeletal conditions (39.3%) were the most studied disorder. Approximately 86% of the RCT had studies possessed fair to good quality. Interventions constituted exercise therapy (76.3%), manual therapy (8.5%) and electrotherapy (8.5%). More than half (67.8%) of the studies recorded medium to large effect sizes. A fair proportion (48.2%) of the studies had a confounding-by-indication bias. Approximately 43% of the clinical experiments were underpowered, and a few studies conducted normality tests (10.9%) and intention-to-treat analysis (37.5%).

CONCLUSIONS

RCT is the most frequent clinical experiment, with majority of them possessing fair to good quality. The most important flaws include improper computation of sample size, statistical analysis, absent intention-to-treat approach, among others. The magnitude of effects of Physiotherapy interventions varies from nil effect to large effect. Musculoskeletal condition is the most prevalent disorder and exercise is the most important intervention in Nigerian physiotherapy practice.

TRIAL REGISTRATION

We registered the protocol with PROSPERO. The registration number: CRD42021228514.

Effect of Combined Kinematic Chain Exercise on Physical Function, Balance Ability, and Gait in Patients with Total Knee Arthroplasty: A Single-Blind Randomized Controlled Trial

Total knee arthroplasty (TKA) is an effective treatment for end-stage osteoarthritis. However, evidence of combined kinematic chain exercise (CCE) in early-phase rehabilitation after TKA remains lacking. This study investigated the effects of CCE training on physical function, balance ability, and gait in 40 patients who underwent TKA. Participants were randomly assigned to the CCE (n = 20) and open kinematic chain exercise (OKCE) groups (n = 20). The CCE and OKCE groups were trained five times a week (for 4 weeks) for 30 min per session. Physical function, range of motion (ROM), balance, and gait were assessed before and after the intervention. The time × group interaction effects and time effect as measured with the Western Ontario and McMaster Universities Osteoarthritis Index, ROM, Knee Outcome Survey-Activities of Daily Living, balancing ability (e.g., confidence ellipse area, path length, and average speed), and gait parameters (e.g., timed up-and-go test, gait speed, cadence, step length, and stride length) were statistically significant (p < 0.05). In the group comparison of pre- and postintervention measurements for all variables, the CCE group showed substantial improvements compared to the OKCE group (p < 0.05). Both groups showed significant within-group improvement from baseline to postintervention. Our results suggest that CCE training positively affects physical function, balance ability, and gait as an early intervention for patients undergoing TKA.

The effects of close kinetic chain exercises on proprioception and physical activity level in pediatric patients with hemophilia

INTRODUCTION

Knee joint proprioception is affected, and lower extremity functioning declines over time in patients with hemophilia A.

AIM

To investigate the effects of a structured exercise programme consisting of the close kinetic chain (CKC) exercises on proprioception and physical activity level in pediatric patients with hemophilia.

METHODS

A total of 21 patients with hemophilia A who had at least one target knee joint were randomized into three groups: Study Group (SG, n = 7), Conventional Treatment Group (CTG, n = 7) and Control Group (CG, n = 7). The SG received a structured, lower limb-specific exercise protocol consisting of CKC exercises 2 days a week for 12 weeks, in addition to prophylactic treatment. The CTG received exercise training as described in the published literature. The CG continued to receive prophylactic treatment during the study period. Proprioception was measured using a digital goniometer before and after treatment in open and closed kinetic chain positions (CKCPs). The Five Times Sit to Stand (STS), Timed Up and Go (TUG) and Functional Independence Score in Hemophilia were used for the assessment of physical activity level.

RESULTS

A significant pre/post-treatment difference was found among the groups in proprioception (p = .001) and physical activity level (TUG p = .008, STS p = .001, FISH p = .006). Improvements in proprioception and physical activity level were greater in the SG compared to the other two groups (p < .05).

CONCLUSION

Compared to conventional exercise, the structured exercise protocol consisting of CKC exercise training produced improvements in proprioception and physical activity in patients with hemophilia A.

Comparison of the open kinetic chain and closed kinetic chain strengthening exercises on pain perception and lower limb biomechanics of patients with mild knee osteoarthritis: a randomized controlled trial protocol

Background

Clinical recommendations suggest exercises as the main treatment modality for patients with knee osteoarthritis (OA). This study aimed to compare the effects of two different exercise interventions, i.e., open kinetic chain (OKC) and closed kinetic chain (CKC) exercises, on the pain and lower limb biomechanics of patients with mild knee OA.

Method

A total of 66 individuals with painful early knee OA, aged 50 years and above, with body mass index (BMI) between 18.9kg/m2 and 29.9 kg/m2 in Kelantan, Malaysia, will be recruited in this study. Participants will be randomly allocated into three different groups, either the OKC, CKC, or control groups. All three groups will attend an individual session with a physiotherapist. The participants in the OKC and CKC groups will perform the exercises three times weekly for 8 weeks at their home. The control group will receive education about clinical manifestations, risk factors, diagnosis, treatment, and nursing care for knee via printed materials. The primary outcomes include self-reported pain scores (visual analog scale), disability scores (Western Ontario and McMaster Universities Arthritis Index), and quality of life scores (Osteoarthritis Knee and Hip Quality of Life). Secondary outcomes include lower limb biomechanics during gait and sit-to-stand as well as isokinetic knee strength. The outcomes will be measured before and after the intervention.

Discussion

The present study will compare the effects of two different home-based exercise intervention programs among patients with mild knee OA. The study findings will provide vital information that can be used to design an effective exercise program that aims at delaying the OA progression.

Trial registration

The protocol was registered on 22 December 2020 at ClinicalTrials.gov (registration number: NCT04678609).

Wireless Motion Sensors-Useful in Assessing the Effectiveness of Physiotherapeutic Methods Used in Patients with Knee Osteoarthritis-Preliminary Report

Osteoarthritis of the knee (OAK) is characterized by pain, limitation of joint mobility, and significant deterioration of proprioception resulting in functional decline. This study assessed proprioception in OAK patients following two ten-day rehabilitation programs using the Orthyo® system. Fifty-four study participants with clinical symptoms and radiological signs of OAK were randomly divided into an exercise group (n = 27) or a manual therapy group (n = 27). The control group consisted of 27 volunteers with radiological signs of OAK, but with no clinical symptoms or prior history of rehabilitation. The following parameters were assessed: knee proprioception using inertial sensors and a mobile application, patients' function using Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and pain intensity using the visual analog scale (VAS). Following rehabilitation, knee proprioception tests did not improve in either study group. Both study groups showed significant improvement of the WOMAC-assessed function (exercise group: p < 0.01, manual therapy group: p = 0.01) and a significant decrease (p < 0.01) of VAS-assessed pain following rehabilitation, but the post-therapy results did not differ significantly between the aforementioned groups. The Orthyo® system provided a quick and accurate assessment of the knee joint position sense. There was no direct relationship between functionality, pain, and proprioception threshold in the knee joint.

A Novel Approach to Evaluate Brain Activation for Lower Extremity Motor Control

BACKGROUND AND PURPOSE

The purpose of this study was to assess the consistency of a novel MR safe lower extremity motor control neuroimaging paradigm to elicit reliable sensorimotor region brain activity.

METHODS

Participants completed multiple sets of unilateral leg presses combining ankle, knee, and hip extension and flexion movements against resistance at a pace of 1.2 Hz while lying supine in a 3T MRI scanner. Regions of Interest (ROI) consisted of regions primarily involved in lower extremity motor control (right and left primary motor cortex, primary somatosensory cortex, premotor cortex, secondary somatosensory cortex, basal ganglia, and the cerebellum).

RESULTS

The group analysis based on mixed effects paired samples t-test revealed no differences for brain activity between sessions (P > .05). Intraclass correlation coefficients in the sensorimotor regions were good to excellent for average percent signal change (.621 to .918) and Z-score (.697 to .883), with the exception of the left secondary somatosensory cortex percent signal change (.165).

CONCLUSIONS

These results indicate that a loaded lower extremity force production and attenuation task that simulates the range of motion of squatting, stepping, and landing from a jump is reliable for longitudinal neuroimaging applications and support the use of this paradigm in further studies examining therapeutic interventions and changes in dynamic lower extremity motor function.