Neuro-muscular Exercise Training Verses Quadriceps Training in Mild to Moderate Knee Osteoarthritis
Condition: Knee Osteoarthritis
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      A randomized controlled trial in which Neuro-muscular exercise training and Isolated
      quadriceps training program would be applied on patients with symptomatic knee Osteoarthritis
      by using different tools and changes would be examined pre and post intervention .The
      participants fulfilling inclusion criteria would be randomly allocated to two groups. Both
      groups received different protocols and will be assessed on data collection tool on their
      first and last visit by using Numeric Pain Rating Scale (NPRS), The Western Ontario and
      McMaster Osteoarthritis Index (WOMAC), Timed Up and Go test (TUG test), 30sec chair stand
      test,6min walk test (6MWT).Participants of both groups will be pre-tested before the
      application of interventional programs and post-tested after the application of respective
      intervention.
    

Detailed description: 
      The knee joint is a complex modified hinge joint with the greatest range of movement. Three
      bones come together to form the joint, which are the femur, tibia, and patella.
      Osteoarthritis, commonly known as wear-and-tear arthritis, is a condition in which the
      natural cushioning between joints, cartilage wears away. The bones of the joints rub more
      closely against one another with less of the shock-absorbing benefits of cartilage. The
      rubbing results in pain, swelling, stiffness, decreased ability to move and, sometimes, the
      formation of bone spurs.

      Osteoarthritis is widespread among physically active individuals . The quadriceps weakness
      commonly associated with osteoarthritis of the knee is widely believed to result from disuse
      atrophy secondary to pain in the involved joint. However, quadriceps weakness may be an
      etiologic factor in the development of osteoarthritis. Several studies have indicated that
      Physical modalities for the treatment of knee pain in patients with osteoarthritis include
      physical therapy, exercise, weight loss, and the use of braces or heel wedges. High- and
      low-intensity aerobic exercises are equally effective in improving functional status, gait,
      pain, and aerobic capacity in persons with knee osteoarthritis water-based and land-based
      exercises reduce knee pain and physical disability and aerobic walking, quadriceps
      strengthening, resistance exercise reduce pain and disability.Several proptocols are
      available for management of knee joint osteoarthritis. These protocols include Neuro motor
      training exercise and isolated quadriceps training program. Neuromotor training is basically
      combination of three parts warming up, a circuit program, and cooling down. Main principle of
      Neuro-motor training is to improve sensorimotor control and compensatory functional
      stability.[3]Patients with symptomatic osteoarthritis pain, stiffness, flexibility and
      decreases range of motion is a common clinical finding. Flexibility is an important component
      of fitness needed for most desirable musculoskeletal functioning and maximizing the
      performance of physical activities. Flexibility is a biomechanical property of the body
      tissues and it determines the range of motion possible without injury at a joint or group of
      joints. Decrease range of motion has been shown to predispose a person to several
      musculoskeletal overuse injuries and considerably affect a person level of function.Changes
      in joint appearance/ joint deformities be one of the more commonly established causes of
      osteoarthritis. The target in treating patients with OA should be the safest possible
      intervention, with the best pain relief and prevention of further functional disability.
      Neuromotor training is also one of the treatment option related to physical therapy in
      reducing knee pain with home plane exercises to gain required ROM and resume function. Time
      up and go test (TUG test).the tug is internationally accepted functional dynamic test of
      balance with known reliability and validity as well as being low cost and easy to apply. The
      tug test measures the time in seconds that takes a subject to stand up from chair and sit
      down. Subject will score less than 10 seconds are consider normal, less than 15 sec are at
      risk of fall ,less than 20 sec are independent in ambulation and able to climb the stairs,
      and greater than 30 seconds need help with chair. The 30 Second Chair Stand Test, in
      conjunction with other measures such as the 4-Stage Balance Test, Timed Up and Go (TUG) Test
      and an assessment of postural hypotension can help to indicate if a patient is at risk of
      falling. Purpose is to test leg strength and endurance Equipment: A chair with a straight
      back, without arm rests, placed against a wall to prevent it moving. Sit in the middle of the
      chair. Place each hand on the opposite shoulder crossed at the wrists. Place your feet flat
      on the floor. Keep your back straight and keep your arms against your chest. On "Go", rise to
      a full standing position and then sit back down again. Repeat this for 30 seconds. On "Go"
      begin timing. Do not continue if you feel the patient may fall during the test. Count the
      number of times the patient comes to a full standing position in 30 seconds and record it in
      the box below. If the patient is over halfway to a standing position when 30 seconds have
      elapsed, count it as a stand. If the patient must use his or her arms to stand then stop the
      test and record "0" for the number below.The western Ontario and McMaster universities
      osteoarthritis (womac) is a widely used by health professionals to evaluate the condition of
      patient with osteoarthritis of knee . womac measures 5 items for pain score 0-20. 2 for
      stiffness score 0-8 and 17 for functional limitation score 0-68. Physical functioning
      question of daily activities such as siting standing walking lying on bed taking of socks
      getting in or out of bath. Numeric pain rating scale (NPRs) is used for measure of pain
      intensity. In NPRS 0-10 integers that best reflects the intensity of pain. 0 represent no
      pain.

      Previous studies were more focused on hydrotherapeutic exercises, muscle stretching
      strengthening, aerobics. There is still a challenge to explore best type of exercise therapy
      for improving sensorimotor function, alleviating symptoms and showing the disease process in
      different sub groups of patients with degenerative knee disease
    

Intervention name(s): Neuro-muscular exercise training Group; quadriceps training program
Intervention type(s): Other; Other
Intervention description(s): Training takes place 3 days a week for 8 weeks follow up, under the supervision of physical therapist A training session lasts for 40 minutes, and consists of three parts.
PART 1:Warming up:
warm-up period consists of ergometer cycling for 10 minutes
PART 2: Circuit program:
comprises four exercises, core stability/postural function; postural orientation; lower extremity muscle strength; and functional exercises. Each exercise is performed 2-3 sets 10-15 repetitions.
PART 3:Cooling down:
The cooling down part consists of walking exercises forward and backwards, about 10 meters in each direction, in front of mirror (mobility exercises for the lower extremity muscles for a total of about 10 minutes. Changes in patient's symptom assessed by structural questionnaire; Apply Tens (10min+ hot pack 7-10min) Before excercise ROM,Quadriceps and hamstring stretching exercise's and strengthening exercises.
4th-6th week (in addition): Straight leg raise, Quads over a roll, Hamstring curls. 7th and 8th week (in addition): Elastic band exercise, Hamstring curls, Quads chair, isometric strengthening All exercises are performed in set of 10 repetitions. 1 set of all exercises was twice a day for first 3 week, and 2 sets twice a day until 6th week and then 3 sets twice a day until 8th week
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Other
Keywords: isolated quadriceps training; Neuro-muscular exercise training; knee Osteoarthritis