Effect of Core Stability Exercise on Isolated Patellofemoral Osteoarthritis.
Condition: Chondromalacia Patellae
MeSH terms: Osteoarthritis; Cartilage Diseases; Chondromalacia Patellae
Study type: Interventional

Summary: 
      Purpose: to investigate the effect of core stability on PF OA. Methods: Thirty-one females
      with PF OA will be recruited. Patients will be randomly assigned into two groups, group A and
      group B . Patients in both groups will receive a traditional physical therapy treatment, but
      group (B) will receive additional core stability exercise. All patients will be evaluated for
      pain, functional performance, and muscular recruitment strategies (onset and duration) of
      multifidus, transversus abdominus (TrA), gluteus medius (GM), and vasti measured by
      quantitative Electromyography during stair ascent. pre and post-treatment.
    

Detailed description: 
      A) Procedures for evaluation:

      The practical section of the studywill be undertaken in 6 weeks (2 sessions a week).
      Measurement will be taken before the start of treatment program then after the end of 6 weeks
      treatment program f in the following manner:

        1. Patients will be asked to respond to the questions of the Kujala scale.

        2. The eleven-point numerical rating scale will be used to measure pain severity

        3. Investigators will collect the EMG activity of VMO, VL, GM, multifidus, and TrA using
           bipolar Ag-AgCl disposable surface electrodes (Better signal solution medical supply
           Co., limited, Zhongshan, China) and eight channels highresolution wireless bio amplifier
           (WBA) system (Biomation, Almonte, Canada).

           Electromyographic data will be sampled at 1000 Hz and bandpass filtered at 50-200 Hz.
           For each muscle, three electrodes will be used; two electrodes will be placed ~ 30 mm
           apart in the direction of the muscle fibers and a ground electrode will be placed over
           the closest bony prominence. Before placement of the electrodes, the subject's skin will
           be cleaned with alcohol to reduce impedance and excess hair will be removed to eliminate
           shifting of the electrodes if needed. The stair-stepping task will consist of ascending
           2 steps (each step will be 40 cm in width, 20 cm in height, without handrails. The depth
           of the first and second steps will be 30 cm and 40 cm, respectively) . Participants will
           be asked to stand on the floor confronting the stairs and 20 cm away from the edge of
           the initial step.

           The stair ascent task will be performed barefooted while arms hanged at the side of the
           body. Patients will start ascending the steps immediately in response to a command, at
           their normal speed with their affected limb. Investigators aren't going to control the
           speed of stair ascent, because controlling the timing of stair-stepping can alter the
           electromyographic signal as shown earlier for gait in asymptomatic subjects. Before data
           acquisition, participants will be asked to perform one practice trial of stair ascent to
           get familiarized with the task. Then the participants will perform three test trials
           with thirty seconds of rest after each trial to prevent fatigue. The raw data will be
           stored on a personal computer for analysis with a custom program in Matlab (Math Works,
           Natick, Massachusetts, USA). Investigators will use a mean of data in three trials for
           analysis. b) Procedures for treatment: All patients will receive a traditional physical
           therapy program in the form of TENS , stretching hamstring, quadriceps and calf muscles

           - Group (A) Patients in this group will receive a traditional therapeutic knee
           rehabilitation program based on a recent systematic review in the form of mini-squatting
           exercise (up to 45O knee flexion measured by a universal goniometer) , strengthening of
           hip abductors and external rotators using clamshell exercise . No emphasis will be
           placed on stabilizing the core musculature before initiating any of those exercises.

           To increase the intensity of exercise, elastic resistance bands will be used.

           - Group (B) Patients in this group will receive the same program as group (A) plus core
           stability exercise and the principles of core stability will be explained to patients
           before initiation of treatment and patients will be asked to comply with these
           principles during exercise. These principles include learning how to activate
           transversus abdominus by abdominal bracing without allowing pelvis tilting and ensure
           neutral spine and diaphragmatic breathing during exercise.

           c) Statistical Analysis: Data management and analysis will be conducted using the
           statistical package for social studies (SPSS) version 22 for windows (IBM SPSS, Chicago,
           IL, USA). Investigators will conduct the 2X2 Mixed Design MANOVA test to compare the
           onset and duration of each muscle, pain intensity, and performance of functional
           activities between group A (traditional therapeutic knee rehabilitation) and group B
           (core stability) pre-treatment and post-treatment.
    

Intervention name(s): a traditional therapeutic knee rehabilitation program; core stability exercise
Intervention type(s): Other; Other
Intervention description(s): mini-squatting exercise and clamshell exercise; the principles of core stability will be explained to patients before initiation of treatment and patients will be asked to comply with these principles during exercise. These principles include learning how to activate transversus abdominus by abdominal bracing without allowing pelvis tilting and ensure neutral spine and diaphragmatic breathing during exercise.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Patients will be randomly assigned into two groups, group A and group B . Patients in both groups will receive a traditional physical therapy treatment, but group (B) will receive additional core stability exercise.
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment