Comparison of The Effects of Concentric And Eccentric Isokinetic Exercises in Patients With Knee Osteoarthritis

Study Overview
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Brief Summary
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This study aims to compare the effects of concentric and eccentric isokinetic exercises on proprioception and muscle architecture in 42 patients with knee osteoarthritis enrolled the study.

Detailed Description
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This study aims to compare the effects of concentric and eccentric isokinetic exercises on proprioception and muscle architecture in patients with knee osteoarthritis. 42 patients will be included in this study. Patients will be divided into three groups; concentric exercise group (n:14), eccentric exercise group (n:14) and control group (n:14). A conventional physiotherapy program and a standard therapeutic exercise program will be applied to all subjects. In addition to these exercise and physiotherapy programme, concentric and eccentric exercise groups will perform the exercises related to their groups. All three groups will participate in this program for a total of 18 sessions 3 times a week for 6 weeks. All groups will be subject to re-evaluation after 6 weeks.

Official Title
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Comparison of The Effects of Concentric and Eccentric Isokinetic Exercises on Proprioception and Muscle Architecture in Patients With Knee Osteoarthritis

Conditions
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Knee Osteoarthritis

Intervention / Treatment
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* Other: the concentric isokinetic exercise group
* Other: the eccentric isokinetic exercise group
* Other: the control group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of primary knee osteoarthritis according to American College of Radiology Being radiographically K-L grade 2-3 Presence of symptoms for at least 3 months Patients who have been planned a conventional physiotherapy programme because of knee osteoarthritis Presence of functional capacity for outpatient physical therapy Exclusion Criteria: Patients with seconder knee osteoarthritis History of lower extremity or spine surgery History of intraarticular injection in last 1 month Patients with neurological disease that will affect muscle strength, balance and coordination

Ages Eligible for Study
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Minimum Age: 45 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
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: the concentric isokinetic exercise group<br>the concentric isokinetic exercise group will perform quadriceps and hamstring concentric isokinetic exercises in addition to the conventional physiotherapy and exercise program 3 times a week during 6 weeks. | Other: the concentric isokinetic exercise group<br>* concentric isokinetic exercises<br>Other: the control group<br>* conventional physiotherapy and standard therapeutic exercises predetermined by us<br>|
| Other: the eccentric isokinetic exercise group<br>the eccentric isokinetic exercise group will perform quadriceps and hamstring eccentric isokinetic exercises in addition to the conventional physiotherapy and exercise program 3 times a week during 6 weeks. | Other: the eccentric isokinetic exercise group<br>* eccentric isokinetic exercises<br>Other: the control group<br>* conventional physiotherapy and standard therapeutic exercises predetermined by us<br>|
| Other: the control group<br>the control group will perform the standard exercise program predetermined by us consisting of stretching exercises and isometric strengthening (these exercises will be done at home, too) and the conventional physiotherapy program will be applied 3 times a week during 6 weeks. | Other: the control group<br>* conventional physiotherapy and standard therapeutic exercises predetermined by us<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Joint position sense | Joint position sense will be evaluated with isokinetic dynamometer at predetermined angles. | 6 weeks | 
| Ultrasonographic assessment of quadriceps and hamstring muscles | Ultrasonographic evaluation is an outcome measure to evaluate muscle structure. In our study ultrasonographic evaluation will be performed to determine the muscle structure (muscle thickness(mm), fascicle length(mm), pennation angle(degree)) of quadriceps and hamstring muscles. Muscle thickness will be defined as the distance between the deeper and upper aponeurosis. The pennation angle will be calculated as the angle of insertion of muscle fascicles into the deep aponeurosis. Fascicle length will be defined as the length of the fascicular path between the superficial and deep aponeurosis. | 6 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| WOMAC (Western Ontario & McMaster Universities Osteoarthritis Index) | WOMAC Osteoarthritis Index (score range 0-100) include 3 subscales and will be used to evaluate knee pain(score range 0-20), stiffness (score range 0-8), and functional limitation (score range -68). Womac is comprised of 24 items ( pain-5 items, stiffness-2 items, physical function-17 items). All items are scored on a scale of 0-4. Lower scores indicate lower disability. | 6 weeks | 
| Range of motion | Universal goniometer will be used for assessment of range of motion of the knee | 6 weeks | 
| Muscle strength assessment | isokinetic dynamometer test will be used. | 6 weeks | 
| Shortness of muscles assessment | universal goniometer will be used for assessment | 6 weeks | 
| Pain assessment: VAS (Visual analog scale) | VAS is used to measure the psycometric pain severity in some conditions and activities. A VAS is usually a 100 mm long horizontal line. The scale is most commonly anchored by no pain (line's left, score-0), pain as bad as it could be (line's right, score-100). the score is determined by measuring the distance between the no pain anchor and the patient's mark. | 6 weeks | 
| Balance assessment | Single leg standing test with eyes open and closed will be used. Timing is recorded. | 6 weeks | 
| The timed up and go test | TUG test is used to measure functional mobility. It gives an idea about patients walking ability, fall risk and balance. The patient is asked to get up, walk 3 meters and sit down again.Timing begins when the patient rise from the chair and stops when the patient sit down. | 6 weeks | 
| Sit to stand test | Patients stand up from and sit down on a chair as quickly as possible 5 times. Patients folded their arms across their chests. Timing is recorded. | 6 weeks | 
| Timed 10 meter walk test | This test is used to assess walking speed. Timing is recorded. | 6 weeks | 
| Short Form 12 (SF-12) health survey | SF-12 is an 12- item questionnare for assessing self-reported health related quality of life. It covers eight domains of health outcomes, including physical functioning, role physical, bodily pain, general health, vitality, social functioning,role-emotional, mental health. Sf-12 physical and mental component summary scales are scored. Lower SF-12 score indicated poorer physical and mental health. | 6 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Concentric, Eccentric, Muscle Architecture, Proprioception