Effect of Mechanical Traction and Therapeutic Exercises in Treatment of Primary Knee Osteoarthritis
Condition: Knee Osteoarthritis
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      The purpose of this study is to compare between therapeutic exercises and therapeutic
      exercises preceded by mechanical traction in treatment of patients with primary knee
      osteoarthritis attributed to the outcomes of pain, muscle strength, functional disability and
      functional performance.

      Hypotheses

        1. There will be no significant difference between therapeutic exercises and therapeutic
           exercises preceded by mechanical traction on reduction of knee pain severity in patients
           with primary knee osteoarthritis.

        2. There will be no significant difference between therapeutic exercises and therapeutic
           exercises preceded by mechanical traction on reduction of functional disability in
           patients with primary knee osteoarthritis.

        3. There will be no significant difference between therapeutic exercises and therapeutic
           exercises preceded by mechanical traction on increasing isometric quadriceps muscle
           strength in patients with primary knee osteoarthritis.

        4. There will be no significant difference between therapeutic exercises and therapeutic
           exercises preceded by mechanical traction on increasing isometric hamstring muscle
           strength in patients with primary knee osteoarthritis.

        5. There will be no significant difference between therapeutic exercises and therapeutic
           exercises preceded by mechanical traction on decreasing walking time in patients with
           primary knee osteoarthritis.

        6. There will be no significant difference between therapeutic exercises and therapeutic
           exercises preceded by mechanical traction on decreasing ascending and descending stairs
           time in patients with primary knee osteoarthritis.
    

Detailed description: 
      Knee osteoarthritis is the most common cause of musculoskeletal pain and disability,
      resulting in major disability and pain in affected individuals. It is a chronic degenerative
      disorder of multifactorial aetiology, including acute and/or chronic insults from normal wear
      and tear, age, obesity and joint injury. It nearly affects about one in each eight adults
      worldwide, its prevalence rates vary from 7.8 to 9.3% in Egyptian population.

      Current clinical guidelines recommend non pharmacological conservative strategies including
      physical therapy given their ease of application and relatively low cost with minimal adverse
      effects (e.g.: strengthening exercises, aerobic exercises, stretching exercises,
      hydrotherapy, manual therapy, massage therapy, thermotherapy, electrotherapy, ultrasound
      therapy, external support braces and taping).

      It was reported that therapeutic exercise is beneficial for patients with knee osteoarthritis
      in terms of outcomes of pain, function, performance and quality of life. In addition, it was
      reported that strengthening, flexibility and neuromotor skill exercises have a large efficacy
      over aerobic and mind body exercise.

      Unloading strategies should be proposed as a first line of therapy for the patient with knee
      osteoarthritis before any attempts are made at tissue regeneration, repair or replacement.

      Manual or mechanical knee joint distraction is a conservative technique that provides
      transient joint separation and unloading that aids in improving clinical symptoms of
      patients.

      Addition of mechanical knee distraction to therapeutic exercises helps in gaining the
      positive effects of both exercise and unloading techniques. Although this approach has not
      been used extensively or applied pragmatically, several studies were found showing promising
      results in terms of reducing pain at both rest and movement, improving knee flexion and
      extension range of motion, reducing disability, increasing functional abilities and improving
      the quality of life of patients.

      Forty male and female patients with the diagnosis of primary knee osteoarthritis will be
      recruited in this study. All patients will be assessed and treated in the outpatient clinic
      of the faculty of physical therapy, Cairo University. Patients will be randomly distributed
      into 2 equal experimental groups: the first experimental group will receive therapeutic
      exercises (stretching and strengthening exercise) while the second experimental group will
      receive mechanical traction of the knee followed by therapeutic exercises. All patients will
      be treated for 12 sessions, 3 times per week each other day for 4 weeks. Clinical assessments
      will include assessment of pain severity, functional disability, isometric muscle strength,
      and functional performance.
    

Intervention name(s): Mechanical knee traction; Therapeutic exercises
Intervention type(s): Other; Other
Intervention description(s): Continuous knee joint mechanical traction will be applied to the patients positioned in supine lying position with the affected knee flexed at 25-30 degrees by a wedge placed under the affected knee. The thigh will be secured with a strap for stabilization and the leg will be held by the specially designed greave with the weight of traction hanging throughout a pulley system. The amount of traction will be set to about 10% of body weight. The treatment will be applied for 20 minutes continuously, once a day, 3 times per week for 4 weeks. The traction force will be progressed gradually during the program ( e.g.: weekly increase force by 1% of body weight if the patient can tolerate the duration of 20 min with the preset force).; Therapeutic exercises will be divided into stretching and strengthening exercises:
Stretching will be done passively for the hamstring, rectus femoris and calf muscles. Each exercise will be done for 3 reps each with a hold period of 30-60 secs with a 30-60 rest period between reps.
Strengthening exercises will be done for the quadriceps and hamstring muscles ( inner range knee extension- knee extension in sitting- straight leg raise in flexion- prone hamstring curl- standing hamstring curl- straight leg raise in extension). Exercise will be done for 3 sets each will consist of 10 reps with a rest period of 2-3 minutes between sets. The starting weight should be 50% of the patient's 1 RM. The end position will be held for 5 seconds. Progression will be achieved by increasing the exercise rep and intensity gradually throughout the program. E.g.: weekly increase force by 5% if patient can tolerate an increased repetition of 20 rep with the preset force.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: 2 groups
The first group will include 20 patients and will receive therapeutic exercises in the form of stretching and strengthening exercises of the knee.
The second group will include 20 patients and will receive the same exercise program of the first group preceded by continuous mechanical traction of the knee.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Traction; Distraction; Therapeutic exercises