Does Multimodal Therapy Influence Functional Outcome After Total Knee Arthroplasty?

Psychosocial health may influence the outcomes after total knee arthroplasty (TKA). We investigated the hypothesis that multimodal therapy influences the quality of life and function in patients diagnosed with osteoarthritis of the knee joint. Secondly, in patients who then proceed to have TKA post-multimodal therapy, does the response to the multimodal therapy influence the overall functional outcome of surgery? Patients diagnosed with osteoarthritis of the knee were enrolled in the study and prospectively followed-up. A total of 526 patients were enrolled and available for the study. All participants were enrolled for 12 classes of 60-minute duration over 6-weeks. Apart from an exercise program, the class also included physiotherapist-led education and a 'weight management' lecture by a dietitian. In summary, the multimodal therapy program improved the SF-12, OKS, pain scores (visual analogue scale) and WOMAC scores significantly. The multimodal therapy protocol can optimize patients' psychological scores prior to TKA and may enhance ultimate functional outcome.

[Knee school as a secondary preventive approach : The sustainable treatment of occupational gonarthrosis]

BACKGROUND

2-6 months after successful medical rehabilitation in gonarthrosis, the positive effects remit without the implementation of adequate aftercare strategies.

OBJECTIVES

A prospective comparative study aimed to investigate whether and to what extent the sustainability model of knee school for the secondary preventive treatment of occupational gonarthrosis is able to maintain positive treatment effects in the medium term.

MATERIAL AND METHODS

A total of 292 male employees from the building trade went through the three-week phase 1 of the biopsychosocial knee college with a focus on ergonomics and muscle strength training. In the following 12 months (Phase 2), the participants were contacted several times by telephone in order to motivate them to continue the training. While 178 employees voluntarily and locally continued their training in selected fitness centers with financial support (VG 1), and 38 employees opted for an individual home program (VG 2), 76 participants stopped all training (KG).

RESULTS

After Phase 1, all groups showed significant improvements in the parameters mobility, as well as stretch ability and strength endurance of the thigh muscles, complaints of the knee and quality of life. While the parameters in VG 1 continued to develop positively after 12 months, the measured values in VG 2, with the exception of muscle strength, moderately remitted. By contrast, a significant decline in the measurement values partly below the status quo ante was observed for the KG.

CONCLUSIONS

As part of the aftercare, financially supported training in a fitness center with accompanying regular telephone contacts for male construction workers with knee discomforts shows positive effects if the participation is voluntary. Organized training in the fitness center is superior to individual home programs.

Evaluation of maslinic acid with whole-body vibration training in elderly women with knee osteoarthritis

Purpose

Maslinic acid (MA) is a component derived from a natural olive-based extract known to have pharmacological functions that include suppressing inflammation. This study examined how MA, in conjunction with whole-body vibration training (WBVT), can improve knee and muscle function in elderly women with knee osteoarthritis (OA).

Methods

The study was a double-blinded, placebo-controlled, randomized intervention study that enrolled individuals with knee pain. Participants were 26 females aged 65–85 years with knee OA. They performed WBVT and ingested either 16.7 mg of MA or a placebo daily for 20 weeks. We compared the effect of WBVT with placebo (WBVT/P) and WBVT with MA (WBVT/MA) in participants with various degrees of knee OA (Kellgren and Lawrence (K-L) grade) using the Japanese Orthopaedic Association (JOA) score and isokinetic dynamometer measurements to evaluate knee and muscle function with two-way ANOVA.

Results

Based on the results of two-way ANOVA analysis of muscle function measurements, there was significant interaction (time × group) (P = 0.03) in the “isokinetic extension peak torque” domain for severe OA (K-L grade ≥ 3). The simple main effect of time in the WBVT/MA group (P = 0.04) contributed to this interaction. The JOA score for WBVT/MA supported the main effect of group as having a significant correlation in the “pain on walking” (P = 0.04) and “range of motion” (P < 0.01) domains. Participants with severe knee OA in the WBVT/MA group improved in these domains, whereas the WBVT/P group had few positive results.

Conclusions

Participants with severe OA who ingested MA in conjunction with WBVT improved their knee and muscle function. This study suggests that ingesting the anti-inflammatory supplement MA while participating in WBVT, elderly women can reduce knee OA and improve their knee muscle strength.

Significant improvements in pain after a six-week physiotherapist-led exercise and education intervention, in patients with osteoarthritis awaiting arthroplasty, in South Africa: a randomised controlled trial

Background

A major challenge facing those with late stage osteoarthritis is delayed surgery due to waiting lists. In South Africa patients wait years for a hip/knee arthroplasty. Affected patients require effective management to address their pain, especially while awaiting surgery. Existing literature is mostly available from high income countries exploring effects of interventions during short waiting periods. Research is warranted in low income countries where long waiting periods are common. This study explored the effects of a six-week physiotherapist-led exercise and education intervention on pain in this population.

Methods

A randomised controlled trial was performed at two public hospitals in South Africa. Ethical approval and informed consent was obtained. 74 participants from arthroplasty waiting lists were randomly allocated to an intervention (n = 35) or control group (n = 39). The intervention included six physiotherapist-led group-based sessions (two hours/week of education, exercise and relaxation). The control group received usual care. Data collection was conducted by blinded physiotherapists at baseline, week six, 12 and month six. The primary outcome was pain, measured by the Brief Pain Inventory. Additionally, participants completed an open-ended questionnaire at month six, to gain insight regarding the intervention. Analysis was by intention to treat using two-way analysis of variance and post-hoc Tukey comparisons. Answers to subjective questions were analysed according to common themes that emerged.

Results

The intervention group had significant improvements compared with the control group with moderate to large effect sizes (ES) on pain severity [week 6: p < 0.01, ES = 0.94, 95 % CI (0.45,1.41), month 6: p = 0.02. ES = 0.74, 95 % CI (0.26,1.2)] and moderate to large effects on pain interference [week 6: p < 0.01, ES = 1.2, 95 % CI (0.70,1.69), week 12: p = 0.04, ES = 0.68, 95 % CI (0.20,1.14), month 6: p < 0.01, ES = 0.98, 95 % CI (0.49,1.45)]. 53 % of participants reported that the intervention improved their pain.

Conclusions

The intervention resulted in sustained significant improvements in pain severity and interference in patients with hip/knee osteoarthritis, awaiting arthroplasty compared with a control group. Additionally, participants’ individual feedback supported observed significant improvements in pain. Such an intervention appears to be effective in managing pain in this population and should be incorporated into practice for appropriate patients. Further research is being conducted to explore long term and postoperative outcomes.

Clinical trial registration

Pan African Clinical Trial Registry, PACTR201409000885765, PACTR201507001186115.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-016-1088-6) contains supplementary material, which is available to authorized users.

Effects of whole-body vibration exercise on muscular strength and power, functional mobility and self-reported knee function in middle-aged and older Japanese women with knee pain

BACKGROUND

Whole-body vibration training using vertical-vibration machines is called "acceleration training" (AT). The purpose of this study was to elucidate the effect of AT on lower-limb muscular strength and power, functional mobility and self-reported knee function in middle-aged and older Japanese women with knee pain.

METHODS

Thirty-eight middle-aged and older Japanese women (aged 50-73 years) with knee pain were divided into two groups: (1) the AT group (n=29) engaged in AT three times per week for eight weeks, and (2) the control group (C group, n=9). The AT program consisted of flexibility training, strength training of mainly the quadriceps and surrounding muscles and cool-down exercises. The C group was encouraged to perform the same or similar exercises at home without vibratory stimulus. We evaluated knee strength and power, functional mobility (timed up and go: TUG) and self-reported knee function (Japanese Knee Osteoarthritis Measure: JKOM).

RESULTS

No one in the AT group dropped out during the program. All JKOM categories except degree of pain improved significantly post intervention indicating improved knee function, and TUG was significantly shorter in these participants. All knee strength and power parameters except isometric knee extension peak torque improved significantly. The degree of change in JKOM total score and TUG was significantly different between the two groups.

CONCLUSION

Vibratory stimulus during an eight week AT programme can promote participation and safely improve functional mobility and self-reported knee function better than exercise without vibratory stimulus in middle-aged and older Japanese women with knee pain.

LEVEL OF EVIDENCE

level 2.

ARTICULAR SOUND AND CLINICAL STAGES IN KNEE ARTHROPATHY

Objective: To clarify the pathophysiology of knee arthropathy, articular sound in the knee joint was recorded using an accelerometer, vibroarthrography (VAG), during standing-up and sitting-down movements in patients with osteoarthropathy (OA) of the knees. Methods: VAG signals and angular changes of the knee joint during standing-up and sitting-down movements were recorded in patients with OA, including 17 knees with OA at Kellgren–Lawrence stage I and II, 16 knees with OA at III and IV stages, and 20 knees of age-matched control subjects. Results: The level of VAG signals was greater in knees with a higher stage of OA at 50–99 and 100–149 Hz among the groups (ANOVA with Tukey–Kramer multiple comparisons test, p < 0.01). The VAG signals did not correlate with WOMAC-pain or physical scores. Conclusions: We considered that the increase in VAG signals in these ranges of frequency corresponded with pathological changes of OA, but not self-reported clinical symptoms. This method of VAG can be used by clinicians during interventions to obtain pathological information regarding structural changes of the knee joint.