Comparison of the Efficacy of Russian,Aussie Currents With Isokinetic Exercise Patellofemoral Pain Syndrome
Condition: Patellofemoral Pain Syndrome
MeSH terms: Patellofemoral Pain Syndrome; Syndrome; Somatoform Disorders
Study type: Interventional

Summary: 
      Summary

      Patellofemoral pain syndrome (PFPS) is defined as common anterior knee pain that occurs
      during non-traumatic activities such as squatting, running, climbing and climbing stairs.The
      effectiveness of electrotherapy in increasing muscle strength and endurance in PFPS has
      generally been investigated using low frequency electrical stimulation methods, and studies
      on the effectiveness of medium frequency burst module alternating currents are few in number.
      Since there are no studies in the literature comparing the efficacy of Russian and Aussie
      currents from mid-frequency burst modulated alternating currents with isokinetic exercise in
      patients with PFPS, the aim of this study is to examine the pain, functionality, daily living
      activities of Russian and Aussie currents with knee and hip Isokinetic Exercise (IE) in
      patients with PFPS and its effect on quality of life.

      This study, which has a randomized controlled and single-blind design, is planned to be
      conducted on at least 60 volunteers who meet the inclusion criteria of patients with PFPS who
      came to Necmettin Erbakan University Sports Medicine Clinic. Participants' physical and
      socio-demographic information will be recorded; pain intensity Patellofemoral Syndrome Pain
      Severity Scale; functionality Kujala Patellofemoral Score, Timed Up and Go Test and stair
      climb test; activity levels Tegner Activity Level score; functional impairment Lysholm Knee
      Scoring Scale; activities of daily living Knee Test for Activities of Daily Living; quality
      of life Short Form SF-36; passive and painless active range of motion goniometer; Isokinetic
      forces of quadriceps, hamstring and gluteus medius muscles CYBEX (2009) device; The Q angle
      will be evaluated using a goniometer.

      Participants will be randomized into four groups; The first group will receive knee and hip
      IE treatment for three weeks for 15 sessions, the second group will receive Aussie Current in
      addition to IE, the third group will receive Russian Current in addition to IE, and the
      fourth group will receive placebo electrical stimulation in addition to IE. Evaluations will
      be made at the beginning, immediately after the first treatment, at the end of three weeks of
      treatment and one month after the end of the treatment, in total four times. It is thought
      that the results of the study will be an important source of information about the place of
      medium frequency burst modulated alternating currents in physiotherapy programs of patients
      with PFPS.
    

Detailed description: 
      Patellofemoral pain syndrome (PFPS) is the most common pain syndrome of the knee arising
      around the patella due to knee overload during flexion and extension. It is defined as common
      anterior knee pain that occurs during non-traumatic activities such as squatting, running,
      climbing and climbing stairs. Risk factors for PFPS include dynamic valgus, female gender,
      foot abnormalities, overuse and sudden increase in physical activity, patellar instability,
      and quadriceps weakness .

      In order to reveal effective treatment in PFPS, primary reasons that may cause the syndrome
      should be emphasized. The causes of PFPS are multifactorial and it is difficult to determine
      the actual effects that may cause the disease.However, when PFPS is considered from a
      biomechanical point of view, there is a strong relationship between the knee joint and the
      ankle and hip joint.

      While rest, ice and analgesics are used in the early period in PFPS treatment, non-steroidal
      anti-inflammatory drugs (NSAIDs), patellar banding, patellofemoral knee and foot orthoses,
      biofeedback, running gait retraining, blood circulation restriction therapy are used in the
      treatment of PFPS in the early period. Dry needling, manual therapy, biophysical agents,
      patient education and combined therapies are used. In the treatment of patellofemoral pain
      syndrome, the treatment method that has been focused in recent years is conservative
      treatment. Among these, physiotherapy is the cornerstone of treatment.

      Although the common treatment is quadriceps strengthening, in recent years, therapies have
      been emphasized to strengthen the gluteus medius and increase the stability of the core. At
      the 5th International Meeting of the Patellofemoral Pain Research Center (2018, Australia),
      combined strengthening programs with strengthening of the quadriceps and hip muscles were
      recommended in the treatment of PFPS.

      Although a versatile treatment is generally performed, the rate of PFAS recurrence is 91%.
      Due to the high recurrence rate, more effective treatment options should be revealed. When
      the literature is reviewed, it has been reported that in PFPS cases, there is an increase in
      muscle strength and endurance with the isokinetic exercise (IE) program, and this provides
      dynamic knee stabilization.The IE program is mostly in the direction of knee flexion /
      extension, and it has been found that there are very few applications of IE programs in the
      direction of hip (gluteus medius) abduction / adduction, internal and external rotation.

      Physiotherapy applications are directed towards the management of developing dysfunction and
      reducing pain. Strengthening and endurance training are emphasized in routine treatment.
      Although isokinetic enhancement programs are the most effective method in treatment,
      neuromuscular electrical stimulation rehabilitation programs are also frequently used. The
      effectiveness of eletrotherapy modalities to increase muscle strength and endurance is not
      clear. Among these, medium frequency burst modality alternative (Russian and Australian)
      current can be used as a new treatment option. Low frequency pulsed currents (LFPC) and
      medium (kHz) frequency alternating currents (FAC) are frequently used in physiotherapy and
      rehabilitation.

      Austrian current (AC) is a more effective and comfortable current between 1-10 kHz medium
      frequency currents. This current can be used for various purposes including muscle
      strengthening, pain control, increasing circulation, edema control and aesthetic treatments.

      AC started to be used in the Latin America region with the devices it launched with Ibramed
      company in 2010. It creates much less discomfort in the patient compared to AC Russ Current
      (RC) and low frequency currents. It is used in sinusoidal wave form.

      In recent meta-analysis studies on PFAS, she stated that new methods should be aimed at
      identifying the most cost-effective and most effective treatment modalities. Although there
      are studies in the literature showing the effect of neuromuscular electrical stimulation, it
      has been found that there are no studies comparing medium frequency burst modulated
      alternating currents (AC and RC) with IE in patients with PFPS.

      In the national literature, there are no scientific studies on the Australian current method.
      The application of RC and AC together with the isokinetic method, whose effectiveness has
      been determined in the literature, is very important in terms of determining the most
      effective treatment method.

      Objectives of the study In individuals with PFPS, isokinetic IE together with medium
      frequency burst modality alternating currents;

        -  To reduce the pain during rest and activity,

        -  Increasing functional mobility,

        -  Facilitating Activities of Daily Living (FADL),

        -  To increase the quality of life.

      Sample of the Research Power analysis G*Power 3.1.9.2 program was used to calculate the
      sample size. The power of the research is defined as the possibility of revealing the
      difference between the two applications. The effect size was 0.25, the alpha level was 0.05,
      and the power of the study was 0.95, and it was determined that a total of 52 subjects should
      be included in the study in the calculation made in the form of four groups and four repeated
      measurements made in the G-power program. In similar studies in the literature, it was
      determined that there was a 15% loss. In this study, it was planned that a total of 60 cases
      should be included in the study, assuming 15% loss.

      Application Closed opaque envelopes showing the patient's group will be prepared. Opaque
      envelopes will be listed from 1 to 60 according to the randomly generated numbers. An
      envelope will be given to the patient according to the order of the incoming patient. The
      assignment code of each patient will only be disclosed to the physiotherapist performing the
      treatment at the beginning of the treatment protocol.The physiotherapist will include the
      patient in the group in accordance with the code and perform the application.It will be
      ensured that subjects in the RC, AC and placebo electrical stimulation groups do not know
      what type of stimulation they were given.

      Pilot Study A pilot study will be conducted on a group of four people (one person from each
      group) in order to evaluate the applicability of data collection forms and treatments to be
      used in the study.

      Blinding İsokinetic exercise (IE), Aussie current (AC), Rus current (RC), Placebo Electrical
      Stimulation (PES) Group,

      Patients in theIE, IE + AC, IE + RC, IE +PEC groups will not be informed about the
      application other than exercise. The evaluations will be carried out by a physiotherapist who
      does not know which group the patients are in.

      The physical (age, height, gender, body mass index) and socio-demographic (occupation,
      marital status, educational status, income-expense balance) information of the participants
      who will read the informed consent form and volunteer to participate in the study will be
      recorded. The duration of the PFPS complaint (weeks), the time elapsed since the diagnosis of
      PFPS (weeks), history characteristics (hypertension, diabetes mellitus and other chronic
      systemic diseases) will be noted. Pain intensity at rest and during performance-based
      functional mobility tests will be determined using the Patellofemoral Syndrome Pain Severity
      Scale (PSPSS). All evaluations will be done before treatment (BT), immediately after
      treatment, after three weeks of treatment (TA), and one month after treatment (Control).

      Treatment Program The Isokinetic Exercise program will be applied to the patients as
      described above. Appropriate modalities will be set on the electrical stimulation device, but
      the device will not be operated. It will be applied for 20 minutes.

      4 treatment groups will be treated five days a week, 15 sessions for three weeks. If
      participants miss any treatment, there will be additional treatment sessions.

      Dependent Variables of the Research

        -  Patellofemoral Syndrome Pain Severity Scale

        -  Timed Get Up and Go Test result

        -  Stair up and down test

        -  Kujala Patellofemoral score

        -  Tegner Activity Level score

        -  Lysholm Knee Scoring Scale score

        -  Knee Test Score for Daily Living Activities

        -  Short Form SF-36 score

        -  Passive and Painless Active Knee Joint Range of Motion

        -  Isokinetic Muscle Strength score

        -  Q Angle Measurement Degree

      Study Independent Variable

        -  Isokinetic Exercise Therapy Program

        -  Isokinetic Exercise Australia Current Therapy Program

        -  Isokinetic Exercise Russian Current Therapy Program

        -  Isokinetic Exercise Placebo Electrical Stimulation Therapy Program
    

Intervention name(s): Isokinetick Exercise, Aussie Current, Russion Current, Plasebo Electirical Stimulasyon
Intervention type(s): Device
Intervention description(s): Evaluation and treatment will be done with the Cybex humac device.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Posttest and control grouped randomized controlled clinical trial.
Masking: Single (Care Provider)
Primary purpose: Supportive Care
Keywords: Patellofemoral Pain Syndrome; Aussie Current