Effects of Action Observation Therapy on Pain and Brain Hemodynamics in Patients With Knee Osteoarthritis
Condition: Knee Osteoarthritis; Action Observation Therapy; Functional Near Infared Spectroscopy; Exercise
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      The investigators aim to explore the effects of action observation therapy on pain and brain
      hemodynamics in patients with knee osteoarthritis. This study will create a new perspective
      to understand the physiology of pain, by applying painful stimulation during the neuroimaging
      system which has attracted much interest in the literature in recent years, and will shed
      light on the studies that can be done in this regard. Participants' pain level will be
      assessed using Visual Analog Scale and pressure algometer. Also joint range of motion in the
      initial assessments will be measured by electro-goniometer, muscle strength assessment by
      JTech hand dynamometer at appropriate evaluation positions. Fear of movement of individuals
      will be assessed via Tampa Kinesiophobia Scale and functional levels will be assessed via
      Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Timed Up and
      Go Test. Functional near infrared spectroscopy (fNIRS) will be used for evaluation of brain
      hemodynamics. The first group, will receive exercises with action observation therapy; and
      the second group will receive only exercises. The exercise programme will be administered
      under physiotherapist supervision for three days a week for six weeks. The evaluations will
      be repeated at the beginning of the study and at the end of the sixth week. Data obtained
      from the study will be analyzed using appropriate statistical methods.
    

Detailed description: 
      Osteoarthritic joint has pathological changes such as damage of joint cartilage tissue,
      thickening of the subchondral bone, osteophyte formation, inflammation of synovium at
      different levels, degeneration of ligaments and meniscal structures and hypertrophy of joint
      capsule. Pain is the most common symptom in osteoarthritic patients and the ongoing pain
      effects quality of life and physical functions of them negatively. At the same time, decrease
      in joint range of motion, muscle strength loss and decline in functional level may go along
      with pain. In recent years, studies that relate chronic pain to neuroplasticity have
      demonstrated changes in the structure, function and somatotopic organization of the primary
      motor and sensory cortex of osteoarthritis patients with chronic pain. In addition to this,
      osteoarthritis studies showed that the pain does not originate solely from joint problems;
      the central nervous system is also responsible for the formation of pain sensation. Changes
      in the cortical sensorimotor areas include sensory disturbances, perceptual problems
      (differentiation of body image), and motor influences, and these changes are associated with
      severity and duration of pain. It is reported that approaches targeting cortical
      reorganization resulted in decreased pain and increased function. Action observation therapy
      is a method which activates mirror neurons and is applied to learn a specific motor skill,
      facilitate motor learning and decrease the pain level of the extremities. It is anticipated
      that action observation therapy may differentiate perception of pain by altering cortical
      activity and thus altered motor cortical activity may play an active role in reducing pain by
      modulating pain-related neural networks.

      The investigators aim to explore the effects of action observation therapy on pain and brain
      hemodynamics in patients with knee osteoarthritis. This study will create a new perspective
      to understand the physiology of pain, by applying painful stimulation during the neuroimaging
      system which has attracted much interest in the literature in recent years, and will shed
      light on the studies that can be done in this regard. Participants' pain level will be
      assessed using Visual Analog Scale and pressure algometer. Also joint range of motion in the
      initial assessments will be measured by electro-goniometer, muscle strength assessment by
      JTech hand dynamometer at appropriate evaluation positions.Fear of movement of individuals
      will be assessed via Tampa Kinesiophobia Scale and functional levels will be assessed via
      Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Timed Up and
      Go Test. Functional near infrared spectroscopy (fNIRS) will be used for evaluation of brain
      hemodynamics. The first group, will receive exercises with action observation therapy; and
      the second group will receive only exercises. The exercise programme will be administered
      under physiotherapist supervision for three days a week for six weeks. The evaluations will
      be repeated at the beginning of the study and at the end of the sixth week. Data obtained
      from the study will be analyzed using appropriate statistical methods.
    

Intervention name(s): Action observation therapy; Exercise
Intervention type(s): Other; Other
Intervention description(s): The normal human movement will be recorded and than the patients will be watched them.; Strengthening and stretching exercise programme focuses on hip and knee muscles
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment