The McKenzie System With Arthritic Knees: Do Some Knees Respond to Specific Exercise More Than General or no Exercise

Study Overview
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Brief Summary
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The purpose of the study is to explore if a subgroup of people with osteoarthritic knees can be identified using the McKenzie System of Mechanical Diagnosis and Therapy. In the spine this subgroup, termed derangement,has been shown to respond rapidly to specific directional exercises. The trial will explore whether these derangements in the knee respond to specific exercises compared to a control group with no exercises and non-derangement knees given general exercises.

Detailed Description
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The Mechanical Diagnosis and Therapy (MDT) approach has been extensively used to classify and treat patients with spinal pain. Studies have shown this approach to be valid, reliable and able to predict outcome. Although the approach has been used for extremity joints there is no research on using this approach to classify individuals presenting with knee osteoarthritis. An assessment tool that could potentially identify a subgroup of patients who would experience dramatic and rapid improvement to conservative care would be valuable. Patients with an osteoarthritic knee diagnosis will be recruited after a consultation with an orthopaedic surgeon. Patients who consent to participate will be randomized into an intervention group and a control group. Baseline self reported function and pain will be collected. The control group will continue as planned on the waiting list for either a follow up orthopaedic consultation or for knee surgery. The intervention group will be assessed by one of three McKenzie credentialed therapist over 3 assessment sessions. The therapist will classify the patients as either having a derangement or not. Those classified as a derangement will have 2-3 follow up sessions and will be given direction specific exercises consistent with the principles of the McKenzie System over 2 weeks. Those patients who were not classified as derangements will be given 2-3 sessions of evidenced based osteoarthritis treatment consisting of strengthening exercises and advice on aerobic fitness exercise. At 2 weeks both groups will have baseline measures reassessed and will be discharged. Follow-up by telephone at 3 months and 1 year will reassess functional and pain measures. Due to the high prevalence of knee osteoarthritis and the associated economic burden on our health care system it is important to investigate if physiotherapists are able to predict who will respond to conservative therapy. Classifying individuals with knee osteoarthritis into rapid responders or non responders to short-term physiotherapy treatment will allow more expensive medical evaluation and intervention to be directed to appropriate patients and avoid unnecessary treatment for patients likely to recover from less costly therapy.

Official Title
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The McKenzie System's Derangement Classification in Osteoarthritic Knees: Efficacy of McKenzie Treatment Versus Evidence Based Care: A Randomised Controlled Trial

Conditions
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Knee Osteoarthritis

Intervention / Treatment
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* Procedure: Exercise
* Procedure: Evidence based exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosed with knee osteoarthritis Pain for longer than four months Knee X-ray/CT/MRI showing osteoarthritic changes Able to attend physiotherapy 2-3 times per week for 2 weeks Able to participate in exercise based therapy Exclusion Criteria: Unable to provide informed consent Unable to understand written or spoken English Neurological conditions
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: Specific directional exercise<br>During the assessment a specific exercise will be identified for this group. The exercise will consist of a repeated specific end range movement of the knee | Procedure: Exercise<br>* Directional specific exercise<br>* Other names: Repeated end range exercise;|
| Active Comparator: Evidence based exercise<br>Quadriceps strengthening and advice on aerobic exercises will be given | Procedure: Evidence based exercise<br>* Quadriceps exercises and advice on aerobic exercises. Exercises are based on current evidence for the best exercises for osteoarthritic knee<br>* Other names: step downs, resisted quadriceps, cycling, gym exercises;|
| No Intervention: No intervention<br>Patient waits on the surgeons waiting list for next appointment or for planned knee surgery | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Four item pain intensity measure (P4) | Measure of pain at different times of day as well as with activity on an eleven point scale from zero to ten | Change from Baseline in 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Knee injury and Osteoarthritis Outcome Score (KOOS) | Functional outcome measure specific for knee osteoarthritis with subscales of pain, symptoms, sport, function and quality of life | Baseline, 2 weeks, 3 months, 1 year | 
| Intermittent and Constant Osteoarthritis Pain: Knee version (ICOAP) | Measures nature of pain i.e. constant versus intermittent on a 5 point scale | Baseline, 2 weeks, 3 months, 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Directional preference, Knee, Osteoarthritis, McKenzie system, Exercise, Mechanical Diagnosis and Therapy