Effects of Anti-gravity Treadmill Training on Knee Osteoarthritis in Geriatric Population.
Condition: Osteo Arthritis Knee
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      Knee osteoarthritis is a very common disorder affecting majority of elderly population. There
      is considerable functional disability associated with this disorder. The financial burden
      associated with this disease is quite high. Although various forms of pharmacologic and non
      pharmacologic therapies exist for its management, but most of these interventions only deal
      with symptoms without taking into account the associated factors aggravating the condition.
      Research suggests that abnormal loading of an arthritic joint will only increase the pain and
      disability. Participation in a regular exercise program involving weight bearing activities
      is a successful way to reduce or prevent decline in functional abilities. But the major
      problem with this approach lies in its abnormal loading of joint leading to altered
      biomechanics resulting in more joint damage. To counter this problem, lower body positive
      pressure or anti gravity treadmills have been designed. These treadmills provide up to 80%
      body weight support, thus considerably un-weighing the joint while retaining proper joint
      biomechanics. So with the help of this specialized training unit, elderly population will be
      better equipped to cope with arthritic changes leading to greater functional independence.
    

Detailed description: 
      Osteoarthritis is a very common chronic joint disease resulting in functional disability.
      Knee OA is considered to be most common form of arthritis in western countries. Knee OA is
      mainly characterized by presence of pain, radiographic evidence of reduced joint space, wear
      and tear of articular cartilage and formation of osteophytes i.e., new bone formation at the
      center and margins of joint. Pain and resultant joint changes causes a change in joint
      biomechanics and an eventual disuse of limb leading to muscle weakness and atrophy. According
      to an estimate from a study, knee OA nearly affects 10% of people older than 55 years of age,
      resulting in severe functional disability in a quarter of this affected population. In
      elderly population, knee OA poses almost the same risk of disability as caused by heart
      disease and a larger threat than due to any other medical condition. The prevalence of OA is
      reported to be as high as 28% in urban and 25% in rural areas of Pakistan.

      Literature on knee OA treatment suggest that weight bearing activities in the form of walking
      are useful in the management of joint symptoms. Loading across the joint must be optimal so
      that there is no abnormal stress on any compartment of the joint. Abnormal valgus and varus
      stress results in 4 fold and 5 fold increase in lateral and medial compartments OA of the
      knee respectively. But this increased loading on an already worn joint can cause considerable
      pain and damage to the joint. For this purpose, aquatic exercises and hydrotherapy are
      usually used to counteract the forces acting on the joint. Then there are different types of
      harness systems and robotic devices to physically lift the patients for unloading the joint.
      But the problem with these interventions is that they do not account for proper joint
      kinematics necessary for optimal distribution of forces across the joints. For this purpose,
      anti gravity treadmills or lower body positive pressure treadmills are designed which take
      into account the proper joint kinematic s while partially un-weighing the joint. These
      treadmills are based on NASA technology used for astronauts to counteract the joint problems
      experienced by them.

      These treadmills consist of an air tight chamber surrounding the lower body in which
      increased pressure is applied, so that the treadmill causes an upward lifting force. This
      results in successfully decreasing the body weight and gravitational forces on the lower
      extremity to an adjustable level with a high degree of consistency. Body weight can then be
      adjusted to as small increments as 1% and as large as 80% by using positive air pressure.
      This method is considered superior to other methods of un-weighing (harness systems and
      aquatic therapy) because there is uniform application of pressure over the lower limbs,
      thereby decreasing the creation of pressure points (common with harness systems) while
      retaining normal muscle activation and gait patterns (which are changed during water based
      activities).

      This study will help the patients suffering from osteoarthritis to rehabilitate in a pain
      free environment focusing on proper joint kinematics.
    

Intervention name(s): Anti gravity treadmill training; Physical Therapy
Intervention type(s): Device; Procedure
Intervention description(s): Lower Body Positive Pressure (LBPP) treadmill training for 15 minutes; Heat Therapy in combination with Electro-therapy for 10 minutes, followed by tibio-femoral and patello-femoral joint mobilization
Other intervention name(s): Lower Body Positive Pressure (LBPP) treadmill training
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment