Center-based Physical Therapy and Home-based Physical Therapy After Platelet Rich Plasm Injection
Condition: Knee Osteoarthritis
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      Osteoarthritis (OA) of the knee is a chronic disease characterized by pain, reduced range of
      motion, instability and effusion in the joint. Moreover, no study has investigated the effect
      of Platelet-rich Plasma (PRP) in comparison with that of a placebo injection in the same
      patient with bilateral knee OA. The purpose of this study was to compare the effectiveness of
      supervised physiotherapy and home exercises after PRP injection in patients with knee OA. The
      investigator hypothesized that the supervised physiotherapy program would be more effective
      in decreasing pain and improving muscle strength, physical function, and quality of life than
      home exercises following PRP injection in patients with knee OA. A total of 30 patients with
      complete follow-up to 6 weeks post-intervention; 17 patients randomized to the supervised
      exercise group and 13 patients randomized to the home exercise group. Subjects were recruited
      from who had radiographic evidence (Kellgren-Lawrence Grade II-III) of knee OA and ranged
      from 45 to 70 years of age. Measurements including pain during rest and activity, muscle
      strength assessment, self-estimated functions of the affected knee and functional performance
      tests for lower extremity strength were performed.
    

Detailed description: 
      A total of 30 patients with complete follow-up to 6 weeks post-intervention; 17 patients
      randomized to the supervised exercise group and 13 patients randomized to the home exercise
      group. Subjects were recruited from who had radiographic evidence (Kellgren-Lawrence Grade
      II-III) of knee OA and ranged from 45 to 70 years of age. Measurements including pain during
      rest and activity, muscle strength assessment, self-estimated functions of the affected knee
      and functional performance tests for lower extremity strength were performed.

      Pain Measurement Visual Analog Scale was used to assess the subjects' pain during rest and
      activity. A 10 cm line was driven and subjects was wanted to mark the point (0; no pain, 10;
      worst imaginable pain) as representing the pain during rest and activity.

      Muscle Strength Measurement Quadriceps, hamstring muscles and the hip stability isometric
      test (HipSIT) strength were measured with a hand-held digital dynamometer. Each subject was
      verbally informed before the test in order to ensure correct movement and subjects were asked
      to perform submaximal contraction against the evaluator's hand before testing. ''Break test''
      technique was performed for the strength measurement. According to this technique, the
      evaluator gradually overcomes the muscle strength and stops when the joint gives way. The
      quadriceps muscle strength was measured in a sitting position (Hip 90° flexion, knee
      extended) with hands crossed across the chest. The hand-held dynamometer was positioned on
      the anterior surface of the lower leg proximal to the ankle during test. Hamstring muscle
      group measurement was carried out on prone position (Hip neutral position, knee flexion 90°).
      The hand-held dynamometer was positioned on the posterior surface of the lower leg proximal
      to the ankle during test. The HipSIT evaluates the abductor, external rotator and extensor
      muscles of the hip together. This test was performed in a side-lying position (Hips 45°
      flexion, knees 90° flexion, heels in contact with the limb tested superior to opposing limb
      as 20° abduction). The hand-held dynamometer was placed on laterally positioned 5 cm above
      the knee joint interline during test. Each measurement for each muscle was performed 3 times
      at 30 sec intervals and the higher value was recorded. There was also a minute interval
      between muscle groups measurements.

      Functional Status The Western Ontario and McMaster Universities (WOMAC) index is a disease
      specific self-administered test for OA to assess functions of the affected joints. It
      consists of 24 questions (three subscale; pain (5 questions), stiffness (2 questions) and
      daily activities (17 questions).

      Interventions Each subject was informed about knee OA and daily activities that negatively
      affect the knee OA. They were also asked to use cold press 3 times (10-15 min) a day for 6
      weeks. Supervised physiotherapy group performed exercises 3 times a week for 6 weeks under
      supervision of a physiotherapist after the first evaluation. The subjects in home exercise
      group were taught exercises and they were informed to do exercises 3 times a week for 6
      weeks. Home exercise group was telephoned to motivate them to do exercise or to find out if
      they have any problem about the exercises once a week for 6 weeks. The exercise programs for
      each group consisted of these parts: warm up, strengthening, balance and cool down period.
      The standard exercises were performed by all of the subjects in each group in order to
      standardize the exercise procedure. We used OMNI Resistance Exercise Scale for perceived
      effort to standardize elastic-band (Thera-Band; The Hygenic Corporation, Akron, OH)
      resistance among subjects. Subjects were asked to do 3 repetitions for each exercise starting
      with lowest resistance elastic band, and the resistance of the elastic band was increased
      until it reached 5 on the 11-point scale to determine the appropriate elastic band. Second
      measurements were performed at the end of 6 weeks, the day of routine doctor control for PRP
      injection. All assessments were performed by the same physiotherapist.
    

Intervention name(s): Exercise (center-based); Exercise (home-based)
Intervention type(s): Other; Other
Intervention description(s): Exercise therapy with a physical therapist in a clinic.; Patients did exercises at home every day and 3 times per day.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: supervised exercise group home exercise group
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Knee; Osteoarthritis; Exercise; Platelet rich plasma; muscle strength