Different Modalities of Aquatic Physiotherapy in Patients With Knee Osteoarthrosis

Study Overview
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Brief Summary
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The aim of this study is to evaluate the effects of different modalities of aquatic physiotherapy on the biochemical and functional behavior of patients with knee's Osteoarthritis.

Detailed Description
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The subjects will be informed about the study and its potentials risks and sign the informed consent. The sample will be submitted to three different modalities of AF interventions: (a) low impact immersion, (b) conventional aquatic physiotherapy and (c) high intensity aquatic physiotherapy. The functional variables of flexibility, pain, joint volume will be evaluated before and immediately after each intervention whereas the biochemical variables will be evaluated from the analysis of peripheral blood following times: baseline moment (immediately before the intervention), moment 1 (immediately after the intervention), and moment 2 (24 hours after the intervention).

Official Title
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Effects of Different Modalities of Aquatic Physiotherapy on Biomechanical and Functional Behavior of Subjects With Knee Osteoarthrosis

Conditions
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Osteoarthritis of the Knee

Intervention / Treatment
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* Other: Low impact immersion
* Other: Conventional aquatic physiotherapy
* Other: High intensity aquatic physiotherapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients over 50 years old and diagnosed with OA in at least one knee Presence of pain and at least one functional dysfunction for at least 6 months Absence of physical limitation that prevents the exercise protocol from being performed Kellgren and Lawrence ranking between I and IV walk independently and without auxiliary device Exclusion Criteria: Inflammatory, rheumatic or autoimmune conditions Use of psychotropic, immunosuppressive and steroid medications Antioxidant consumption Alcohol and tobacco consumption Progressive ankylosis states neurological injuries Infections or skin diseases that contraindicate swimming pool immersion Surgical procedures on the knee joint in the last 12 months (excluding meniscectomy or arthroscopy) Lower Limb Joint Prosthesis Presence of inflammatory or infectious diseases, uncontrolled systemic arterial hypertension, uncontrolled diabetes, chronic obstructive pulmonary disease and history of ischemic heart disease Self-report of aquatic phobia and chlorine allergies

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 95 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: Crossover Assignment
Interventional Model Description: Randomized clinical trial, of the crossover type
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Low impact immersion<br>This intervention will use the principles of Ai Chi, a model defined as a low-intensity aquatic exercise strategy | Other: Low impact immersion<br>* Consists of a sequence of shoulder, trunk and hip movements. In this modality, the aim will be to understand the physiological effects of immersion in heat water. Resisted movements (either by turbulence or by floats) or interventional maneuvers in the knee joints will not be performed. Considering the period of 5 minutes for acclimatization to the liquid environment, the program will last approximately 47 minutes.<br>|
| Experimental: Conventional aquatic physiotherapy<br>In this intervention, medium impact exercises will be performed, with a comfortable movement speed. | Other: Conventional aquatic physiotherapy<br>* include warm-up, strengthening and calming down activities. Aquatic steppes will be used to ensure that all participants will maintain the waterline level approximately in the xiphoid appendix. For strengthening activities, the exercises must be performed at an adequate speed, which ensures a comfortable level for the activity. For this purpose, a subjective feedback will be extracted from the participants constantly. The warm-up sequence consists of six different active hip and knee movements performed at maximum range of motion and contributes to neuromuscular activation. For strengthening, each movement should be performed for 1 minute (30 seconds for each lower limb) followed by a period of 30 seconds of rest between each movement.<br>|
| Experimental: High intensity aquatic physiotherapy<br>In this intervention, high-impact exercises will be performed, with maximum movement speed, twice time of the medium-intensity protocol | Other: High intensity aquatic physiotherapy<br>* In this modality subjects will perform the same sequence of exercises of the Conventional Aquatic Physiotherapy program will be respected. However the work load and speed will be adjusted to the maximum level. For strengthening, each movement should be performed for 2 minutes (1 minute for each lower limb) followed by a period of 30 seconds of rest between each movement. To guarantee the maximum effort of the participants, verbal stimuli will be constantly provided. The program will last approximately 68 minutes.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Biochemical variables over time | Variations in the concentration of and Glutathione perioxidase in peripheral blood resulting from three aquatic physical therapy interventions evaluated comparatively between the different interventions in U/L | Baseline moment (immediately before the intervention), moment 1 (immediately after the intervention) measured in all interventions | 
| Biochemical variables over time | Variations in the concentration of Metalloproetinase | Baseline moment (immediately before the intervention), moment 1 (immediately after the intervention) measured in all interventions in mg/mL | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Degree of pain over time | Performed using the visual analogue pain scale, from a scale graduated from zero to 10, in which zero corresponds to cases without pain and 10 corresponds to the worst imaginable pain. | Baseline moment (immediately before the intervention), moment 1 (immediately after the intervention) measured in all interventions. | 
| Edema over time | Performed based on the measurement of the circumference of the affected knee. Result expressed in centimeters | Baseline moment (immediately before the intervention), moment 1 (immediately after the intervention) | 
| Flexibility over time | Assessed by measuring the amplitude of the active and passive movement for the knee flexion and, for that, a conventional goniometer will be used. Result expressed in degrees | Baseline moment (immediately before the intervention), moment 1 (immediately after the intervention) measured in all interventions. | 
| Muscle strength over time | Measured by dynamometer to assess knee extension strength. Results expressed in kg of force. | Baseline moment (immediately before the intervention), moment 1 (immediately after the intervention) measured in all interventions. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Osteoarthritis, Hydrotherapy