End-range Mobilization on Time Curve of Pressure Pain Threshold

Study Overview
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Brief Summary
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Pain in knee osteoarthritis (OA) represents increased pain intensity due to peripheral and central sensitivity. Pressure pain threshold (PPT) is a widely applied technique for measuring the magnitude of peripheral and central sensitivity in knee OA. Despite several manual therapy techniques has been proven to increase PPT in knee OA, the effect of end-range mobilization on the time curve of PPT has not been evaluated so far in knee OA. The aim of this study was to investigate the effect of end-range mobilization on the time curve of PPT and some function-related measures in knee OA.

Detailed Description
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Knee osteoarthritis (OA) is the most common form of arthritis leading to a major disability worldwide. Although many mechanisms may contribute to knee pain severity, the patient-reported hyperalgesia can be attributed to peripheral and central sensitivity in knee OA. Amongst quantitative sensory testing methods, pressure pain threshold (PPT) measurement is a simple and commonly applied method for measuring somatosensory function in musculoskeletal disorders, just as in knee OA. Many trials have presented lower PPT in knee OA compared to healthy controls underlining the presence of peripheral and central sensitivity. The different joint-based mobilization techniques may not only alleviate pain, but also increase pain tolerance to the locally applied mechanical pressure. Positive results of these techniques on increase of PPT has been reported in knee OA; however, the time curve of PPT has not evaluated so far in knee OA. Therefore, the aim of this study was to investigate the effect of end-range mobilization on the time curve of PPT and some function-related measures in knee OA.

Official Title
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The Effect of End-range Mobilization on Time Curve of Pressure Pain Threshold in Knee Osteoarthritis

Conditions
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Knee Osteoarthritis

Intervention / Treatment
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* Biological: End-range mobilization
* Biological: Non end-range mobilization
* Biological: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: the clinical classification criteria of knee OA according to the American College of Rheumatology Categorization of patients as End Of Range Problem based on manual therapy unilateral/bilateral symptomatic tibiofemoral knee osteoarthritis with radiographic evidence of Kellgren-Lawrence scale between 1 and 3 pain during weight-bearing activities at least within 6 months sufficient mental status Exclusion Criteria: acute inflammation of the knee class II. obesity (body mass index, BMI>35kg/m2) severe degenerative lumbar spine disease (e.g. spondylolisthesis) systemic inflammatory arthritic or neurological condition physiotherapy/balneotherapy attendance or manual therapy within 3 months intraarticular injections in the prior 12 months use of walking aids contraindication for manual therapy complex regional pain syndrome cognitive impairment

Ages Eligible for Study
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Minimum Age: 60 Years
Maximum Age: 80 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: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: End-range mobilization<br>End-range mobilization performed in end-position of the tibiofemoral joints' flexion and extension for 2*3 min | Biological: End-range mobilization<br>* End-range mobilization performed in end-range of the tibiofemoral joints' flexion and extension<br>|
| Active Comparator: Non end-range mobilization<br>Non end-range mobilization performed in tibiofemoral joints' loose position | Biological: Non end-range mobilization<br>* Non end-range mobilization performed in tibiofemoral joints' loose position<br>|
| Placebo Comparator: Placebo<br>Hands-on treatment technique performed in end-range of the tibiofemoral joints' flexion and extension for 2*3 min | Biological: Placebo<br>* Hands-on technique performed in end-range of the tibiofemoral joints' flexion and extension<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PPT of the knee | pressure pain threshold of the knee | 30 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PPT of the m. Extensor Carpi Radialis Longus (ECRL) | pressure pain threshold at the ECRL | 30 minutes | 
| PPT of the m. Extensor Carpi Radialis Longus (ECRL) | pressure pain threshold at the ECRL | every 2nd day for the following 6-day | 
| Timed Up and Go test | Timed Up and Go test measuring functional capacity | 30 minutes | 
| Timed Up and Go test | Timed Up and Go test measuring functional capacity | every 2nd day for the following 6-day | 
| Strength of passive tension of the knee | Strength of passive tension of the knee measured in Newton at the beginning of pain | 30 minutes | 
| Strength of passive tension of the knee | Strength of passive tension of the knee measured in Newton at the beginning of pain | every 2nd day for the following 6-day | 
| Pressure Pain Threshold measurement of the knee | pressure pain threshold measurement of the knee via hand-held algometer | every 2nd day for the following 6-day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Musculoskeletal Manipulations, Osteoarthritis, Knee, Pain Threshold