Motor Learning in Knee Osteoarthritis

Study Overview
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Brief Summary
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Non-surgical treatment options, like exercise therapy, show excellent short-term effects regarding pain reduction and improvement of knee function. However, mid- and long-term effects are missing so far. This might indicate that long-lasting changes in motor-skill performance (Motor Learning) have not occurred. Motor learning is associated with permanent changes in the capability for skilled movement behavior avoiding unfavorable joint loads and inappropriate muscle activation patterns, leading to compensatory movement strategies. One-sided and high repetitive loads in the knee joint could be one reason for the progression of knee osteoarthritis. Physiotherapeutic strategies should therefore be able to stimulate motor learning processes. In physiotherapy, motor learning can be optimized by using instructions and feedback, targeting an external focus of attention, when learning specific movement patterns. This study investigates the effects of a 12 week exercise therapy program, using an external focus of attention, on functional and biomechanical parameters in patients with knee osteoarthritis. To measure possible changes, functional measurements are taking place at baseline, after 6, 12 and 24 weeks. The biomechanical measurements (3D gait analysis) are taking place at baseline, after 12 and 24 weeks.

Official Title
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Motor Learning in Knee Osteoarthritis Therapy - A New Rehabilitation Approach

Conditions
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Knee Osteoarthritis, Lower Extremity Biomechanics, Physiotherapy

Intervention / Treatment
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* Other: External Focus Of Attention
* Other: Internal Focus Of Attention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Kellgren-Lawrence-Score 1-3 BMI < 33 Free range of motion in the knee joint Exclusion Criteria: Activated knee osteoarthritis Lower extremity surgery in the past 6 weeks Intake or injection of corticosteroids in the past 3 month Long-term medication non-steroidal anti-inflammatory drugs Neurological diseases Drug or alcohol abuse

Ages Eligible for Study
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Minimum Age: 45 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: External focus of attention training program<br>The intervention group receives a strength and neuromuscular training program. The training instructions have an external focus of attention. | Other: External Focus Of Attention<br>* Instructions and feedback are used to direct the learner's focus to an external source (e.g. the effect the intended movement has) promoting long-term learning by stimulating automatic cognitive control processes.<br>|
| Active Comparator: Internal focus of attention training program<br>The control group receives a strength and neuromuscular training program. The training instructions have an internal focus of attention. | Other: Internal Focus Of Attention<br>* In contrast, adopting an internal focus of attention (e.g. focus on specific body areal) can disrupt automatic control processes and interfere automatic movement.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Knee Adduction Moment (change over a period of 6 month with 3 measurement dates) | 3D gait analysis during walking | Baseline, 12 weeks, 24 weeks | 
| Knee Osteoarthritis Outcome Score (change over a period of 6 month with 4 measurement dates) | Questionnaire; Minimum value: 0 (highest limitation), Maximum: 100 (no limitation) | Baseline, 6 weeks, 12 weeks, 24 weeks | 
| Star Excursion Balance Test (change over a period of 6 month with 4 measurement dates) | An established test to determine movement control and balance ability. The test person stands on one leg and will is asked to stretch the non supporting leg as far as possible in the directions presented. | Baseline, 6 weeks, 12 weeks, 24 weeks | 
| Isometric strength tests (change over a period of 6 month with 4 measurement dates) | Measures the isometric force of the knee extensors, knee flexors, hip abductors, hip extensors and hip external rotators with a portable dynamometer | Baseline, 6 weeks, 12 weeks, 24 weeks | 
| Six minute walking test (change over a period of 6 month with 4 measurement dates) | The six minute walking test is a reliable measuring tool to examine the distance a person can walk in a given time period. | Baseline, 6 weeks, 12 weeks, 24 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Physiotherapy, External Focus Of Attention, Knee Adduction Moment, Gait Analysis, Osteoarthritis, Motor Learning