Effects of Deep Stripping Versus Kneading on Pain, Range of Motion and Function in Knee Osteoarthritis

Study Overview
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Brief Summary
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This is a randomized controlled trial, 44 participants selected based on inclusion criteria from physical therapy department of Surriya Azeem Surgical Hospital, Pattoki. Participants randomly recruited into two groups, 22 in deep stripping group receiving deep stripping with conventional physical therapy and 22 in kneading group receiving kneading with conventional physical therapy. Pain, range of motion and functional mobility are the primary outcomes measured by numeric pain rating scale, universal goniometer and lower extremity functional scale. Data collected at the baseline, at the 6th session, and the 12th session.

Detailed Description
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In this randomized controlled trial, 44 individuals with knee osteoarthritis (II-III grade of Kellgren-Lawrence scale) pre-diagnosed by an orthopedic, were assessed for eligibility from the physical therapy department of Surriya Azeem Surgical Hospital, Pattoki. Participants with any other musculoskeletal disorder, cognitive problem and receiving any treatment within the past three months were excluded from the study. The participants were randomly recruited into two groups with 22 participants in each group. Group A received deep stripping along with conventional physiotherapy and group B received kneading along with conventional physiotherapy. Both the deep stripping and kneading technique applied on the quadriceps muscle group, hamstring muscle group and around the knee joint. Data collected by a blinded assessor at the baseline, at the 6th session, and the 12th session. Outcome measures were pain (measured by Numeric Pain Rating Scale), range of motion (measured by Universal Goniometer), and functional mobility (assessed by Lower Extremity Functional Scale). After collecting the data, normality of the data will be entered and analyzed in Statistical Package for the Social Sciences and than the statistical test will be applied to compare the within group analysis and between group analysis.

Official Title
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Effects of Deep Stripping Technique Versus Kneading Technique on Pain, Range of Motion and Function in Patients With Knee Osteoarthritis: A Randomized Controlled Trial

Conditions
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Knee Osteoarthritis

Intervention / Treatment
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* Other: Deep Stripping
* Other: Kneading


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Chronic osteoarthritis (more than 3 months) with pain in one knee joint (unilateral) A prior medical diagnosis having radiographic evidence of grade 2 and 3 of Kellgren and Lawrence criteria for knee osteoarthritis by an orthopedic. Pain intensity level more than 3 points of the numeric pain rating scale. Exclusion Criteria: Any acute inflammation, contracture, or surgery affecting the knee joint. Any cognitive problem. Participants taking non-steroid anti-inflammatory drugs, intra-articular injection, or physical therapy within the last three months for the knee joint. Participants having a lumbar spine and/or any other lower limb impairment and/or surgery affecting knee joint.

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 65 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
Interventional Model Description: In this study there are two groups, one receiving deep longitudinal stripping technique with conventional physical therapy and the second group receiving kneading technique with conventional physical therapy
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Deep Stripping<br>This group will receive deep stripping technique with conventional physical therapy. | Other: Deep Stripping<br>* The deep longitudinal stripping can be applied on adhesions and knots in muscles. The lengthening stokes are parallel to muscle fiber and applied in an oblique direction with the help of the thumbs of hands/ elbow/ knuckles<br>|
| Experimental: Kneading<br>This group will receive deep kneading with conventional physical therapy. | Other: Kneading<br>* kneading lifts the muscle in circular movements with the help of the hands. It lifted, rolled, and squeezed muscle<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from the baseline in Numeric pain rating scale at 2nd and 4th week | It is the simplest and most commonly used numeric scale in which the individual rates the pain from 0 (no pain) to 10 (worst pain) 0 = no pain, 1-3 = mild pain, 4-6 = moderate pain, 7-10 = severe pain | Baseline, 2nd week, 4th week | 
| Change from baseline in Universal Goniometer at 2nd and 4th week | the range of motion (flexion and extension) measured by using Universal Goniometer. For the range of motion, Universal Goniometer was used. It is an instrument made up of plastic material; it has a moveable arm, stationary arm and a fulcrum. The range of motion of the knee joint in extension and flexion was measured. The normal knee flexion range is 0⁰-130⁰ and the extension range is 130⁰-0⁰. | Baseline, 2nd week, 4th week | 
| Change from baseline in Lower Extremity Functional Scale at 2nd and 4th week | For functional mobility Lower Extremity Functional Scale is used. This questionnaire contains 20 questions about the ability of a person to carry out his/her daily routine tasks. Every question has 5 options 0 = Extreme difficulty or unable to perform an activity = Quite a bit of difficulty = Moderate difficulty = a little bit of difficulty = no difficulty. The participant's score was interpreted at the end by adding all the scores of 20 questions, categorizing them into very high function, moderate function, mild function and very low function | Baseline, 2nd week, 4th week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Non-inflammatory disease, Degenerative joint disease, Osteoarthritis, knee joint, soft tissue mobilization, deep longitudinal stripping, kneading