Retro-walking in Knee Osteoarthritis
Condition: Knee Osteoarthritis
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      In osteoarthritis the most affected joint is knee due to degenerative changes. Degenerative
      changes cause age-related wear-and-tear and may be accelerated by injury, health and
      lifestyle factors, and possibly by genetic predisposition to joint pain or musculoskeletal
      disorders. Knee osteoarthritis causes pain, swelling & stiffness in joint. Patients unable to
      perform ADL's and IADL's due to pain.

      Various treatment methods are used for management of knee osteoarthritis. But physiotherapy
      approach is best option for making patients independent after medical management. This study
      will be a randomized control trial, used to compare the effectiveness of retro-walking and
      conventional therapy to improve pain, functional disability and performance in knee
      osteoarthritic patient. Subjects with knee osteoarthritis meeting the predetermined inclusion
      & exclusion criteria will divide into two groups using lottery method. Time up & Go (TUG),
      Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) & Numeric Pain Rating
      Scale (NPRS) tools for screening will be used for data collection. Subjects in one group will
      be treated with retro-walking & conventional therapy and other will be treated with
      conventional therapy. Each subject will receive a total 6 weeks treatment session, with 3
      treatment sessions per week. Recorded values will be analyzed for any change using SPSS 21
      version.
    

Detailed description: 
      Knee osteoarthritis causes chronic disability in the older population worldwide. Its
      prevalence increases dramatically with age. Prevalence of radiographic osteoarthritis is
      estimated at 80 % of all adults at or over the age of 65 years. The common impairments such
      as knee pain, decreased functional mobility, quadriceps strength, and stiffness leading to
      physical disability have been associated with knee osteoarthritis .

      The prevalence of osteoarthritis is gradually in- creasing in both low- and high-income
      countries.The Global Burden of Disease studies recently indicated that knee osteoarthritis is
      the fastest increasing major health dis- order and the second global cause of disability. In
      the lower extremity, the knee is often affected, and knee osteoarthritis results in
      significant mobility restrictions and a substantial financial burden. The risk of
      osteoarthritis associated disability is equal to that of cardiac disorders and more common
      than any other medical problem in older populations. The common clinical manifestations of
      knee osteoarthritis include pain, stiffness, joint enlargement, crepitus, muscle weakness,
      deformity, impaired proprioception, reduced joint motion, and disability. Therapeutic
      exercises are often used to improve physiological impairments such as reduced joint motion,
      muscle weakness, impaired balance, disability, and proprioception.

      Forward walking provides an increased opportunity to train the entire gait cycle,
      facilitating an enhanced gait pattern in children with cerebral palsy. Backward walking is
      recommended to improve the components of forward walking in those children. Hoog kamer et al.
      reported that backward walking uses the same rhythm circuitry of forward walking, but
      additionally requires specialized control circuits. Gait rehabilitation with backward walking
      puts emphasis on positioning the foot behind the body and, thus, facilitates hip extension
      while performing a knee flexion that can be useful for patients who have synergistic
      influences in the lower extremity. A longer period of muscles activity of the legs during
      backward walking training can result in greater muscle strength gain as compared with for-
      ward walking training. Furthermore, training in backward walking could require higher
      physiological and perceptual responses than forward walking at matched speed, as backward
      walking is the performance of a novel task for most children with cerebral palsy.

      Among the current possible gait training methods, backward walking has emerged as an
      important therapy. Backward walking is regulated by the same central pattern generator as
      forward walking. Unlike forward walking, backward walking has no heel contact in the early
      stance phase and thus leads to lower compression force at the patella femoral joint and
      decreased force absorption at the knee joint. In addition, lower limb muscle activity during
      backward walking is intensified on account of the higher recruitment of motor units. During
      the loading response phase of backward walking, the ground reaction force rapidly increases
      to support the weight of the entire body. The absence of visual cues during backward walking
      results in increased spatial and smaller temporal gait parameters. Therefore, backward
      walking can be considered as a treatment strategy to improve gait.

      Many pharmacological treatment strategies may improve disease-related impairments; however,
      have limited impact on gait. In recent years, backward walking has become an attractive
      alternative for training and rehabilitation purposes to improve mobility. For individuals
      with stroke, both over ground and treadmill backward walking training has been affective to
      improve walking speed, stride length , gait asymmetry, gait cycle phases, functional capacity
      and balance. Similarly, in children with cerebral palsy, Backward Walking treadmill training
      improved gait speed, step length, Stride Length and functional capacity and the addition of
      over ground Backward Walking to a traditional physical therapy program improved overall
      postural instability.

      To our knowledge, there is a lack of studies has evaluated the Effects of Retro-walking on
      pain, functional disability and performance in knee osteoarthritis. Investigator developed a
      program to apply retro-walking to Osteoarthritic patients. Repetition of movements will be
      added to program. This program is design to improve knee performance, functional ability &
      reduce pain. The purpose of the present study is to examine the efficiency of retro-walking
      to improve functional disability and performance and reduce pain in patients with
      osteoarthritis.

      Investigator predict that retro-walking will improve performance, functional disability &
      pain in patients with knee osteoarthritis; they will enhance their performance, movement as
      well as functional abilities. Also so there is awareness in community for the efficacy of
      neurodevelopmental therapy for the management in Down syndrome infants.
    

Intervention name(s): Retrowalking; Conventional Therapy
Intervention type(s): Other; Other
Intervention description(s): Treatment of retro-walking including supervised 10 min retro-walking training with 5 min of warm-up and cool down on a flat surface at their comfortable speed; Treatment of conventional therapy involve Isometric Quadriceps exercise, SLR, Isometric hip adduction exercises, Terminal knee extension exercise 1 set of 10 Reps twice a day.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Knee osteoarthritis; knee joint; pain