End-range Mobilization on Knee Osteoarthritis

Study Overview
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Brief Summary
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Different manual therapy techniques and conservative therapy have been used separately for alleviation of pain and improvement of physical function in patients with knee osteoarthritis (KOA). However, no study has reported the effect of combination of these treatment modalities in the management of KOA. The aim of this study was to investigate the effect of end-range mobilization added to conservative therapy versus conservative therapy alone on decrease of pain and improvement of functional status in KOA.

Detailed Description
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Knee osteoarthritis (KOA) is a musculoskeletal condition affecting older people. It is characterized by pain and loss of physical function, which has a negative impact on patients' quality of life. The different international guidelines recommend several non-invasive treatment modalities for the management of KOA. Conservative therapy including land-based exercises, aquatic exercises, Transcutaneous Electro Neuro Stimulation (TENS) therapy and balneotherapy has been reported positively in the management of patients with KOA (1, 2). Manual therapy is also a preferred treatment modality with the aim of alleviation of pain, improvement of joint mobility and therefore the physical condition (1, 2). Out of manual therapy techniques, end-range mobilization is a well applied treatment technique in the management of different musculoskeletal conditions (3). Till date, the effect of end-range mobilization has not been investigated so far in knee OA. Therefore, the aim of this study was to investigate the effect of end-range mobilization added to conservative therapy versus conservative therapy alone on decrease of pain and improvement of functional status in KOA.

Official Title
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End-range Mobilization Effecting Pain and Physical Function in the Management of Knee Osteoarthritis

Conditions
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Osteo Arthritis Knee

Intervention / Treatment
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* Procedure: Conservative therapy
* Procedure: Manual therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: KOA according to the American College of Rheumatology categorization as End Of Range Problem based on Maitland's classification. at least half year existing and at least 3 pain scores measured with Visual Analogue Scale (VAS) during weight-bearing activities bilateral, moderate-to-severe symptomatic tibiofemoral knee OA with radiographic evidence at least 90 degree passive knee flexion range sufficient mental status Exclusion Criteria: acute inflammation of the knee intraarticular injections within the last 3 months total knee replacement in the opposite side class II. obesity (body mass index, BMI>35kg/m2) severe degenerative lumbar spine disease (e.g. spondylolisthesis) systemic inflammatory arthritic or neurological condition physiotherapy and other balneotherapy attendance within 6 months contraindication for conservative and manual therapy unstable heart condition complex regional pain syndrome

Ages Eligible for Study
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Minimum Age: 60 Years
Maximum Age: 90 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: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: End-range mobilization<br>End-range mobilization applied 6 times for 2*2 min in end-range of flexion and extension end-range of the tibiofemoral and patellofemoral joint beside the same conservative therapy, as used for the Control | Procedure: Conservative therapy<br>* Conservative therapy including aquatic exercises, land-based exercises, balneotherapy, TENS therapy<br>Procedure: Manual therapy<br>* End-range mobilization<br>|
| Active Comparator: Control<br>Conservative therapy including aquatic exercises (5-times), land-based exercises (3-times), balneotherapy (5-times) and TENS therapy (3-times) | Procedure: Conservative therapy<br>* Conservative therapy including aquatic exercises, land-based exercises, balneotherapy, TENS therapy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| general pain intensity | measuring of general pain intensity with Visual Analogue Scale | at the end of the 3-week rehabilitation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pain intensity during getting up from a chair | measuring of pain intensity during getting up from a chair with Visual Analogue Scale | at the end of the 3-week rehabilitation | 
| pain intensity during getting in car | measuring of pain intensity during getting in car with Visual Analogue Scale | at the end of the 3-week rehabilitation | 
| pain intensity during turning while walking | measuring of pain intensity during turning while walking with Visual Analogue Scale | at the end of the 3-week rehabilitation | 
| pain intensity during stair descending | measuring of pain intensity during stair descending with Visual Analogue Scale | at the end of the 3-week rehabilitation | 
| Flexion and extension passive range of motion | Flexion and extension passive range of motion of the tibiofemoral joint | at the end of the 3-week rehabilitation | 
| Quadriceps and hamstring muscles peak muscle force | Quadriceps and hamstring muscles peak muscle force of both knees | at the end of the 3-week rehabilitation | 
| 6-minute walk test | 6-minute walk test measuring functional capacity | at the end of the 3-week rehabilitation | 
| Timed Up and Go test | Timed Up and Go test measuring functional capacity | at the end of the 3-week rehabilitation | 

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