Strengthening Exercises Versus Proprioception and Balance Exercises in the Treatment of Knee Osteoarthritis

Study Overview
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Brief Summary
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The aim of the study is to investigate and compare the effect of balance and proprioception exercises with strengthening exercises on muscle strength, pain, proprioception, function and quality of life in knee osteoarthritis patients.

Detailed Description
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Damage or loss of mechanoreceptors in osteoarthritis patients affects balance and proprioception. There are studies showing that proprioceptive deficit is associated with the onset and progression of knee osteoarthritis leading to pain and disability. Because the proprioception provides a sense of power generation and allows the power output to be better regulated. When the literature is examined, studies investigating the effects of proprioception and balance exercises on muscle strength, function and pain are limited. In our study patients will be randomly divided into two groups: Group I (Proprioception and Balance) and Group II (muscle strengthening exercises). While Group I will be applied Proprioception and Balance training exercises, Group II will be applied closed and open kinetic strengthening exercises. Two group will perform exercise 3 times a week during 8 weeks.

Official Title
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Comparison of the Effect of Strengthening Exercises Versus Proprioception and Balance Exercises in the Treatment of Knee Osteoarthritis

Conditions
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Osteo Arthritis Knee, Pain

Intervention / Treatment
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* Other: Proprioception and Balance Program
* Other: Strengthening Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients who have a diagnosis of knee Osteoarthritis according to the American Society of Rheumatology (ACR) criteria, Between 45 to 75 years of age Can read and write in Turkish language Exclusion Criteria: Active synovitis Taking any physical therapy section in the last 6 months Have a neurological problems that affect walking Have an arthritis problem in the ankle and hip joint Have a history of lower extremity surgery Intraarticular steroid injection in the last 6 months Use psychoactive drug Have a severe defect of vision and hearing, speech disorders Vestibular dysfunction

Ages Eligible for Study
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Minimum Age: 45 Years
Maximum Age: 75 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: Proprioception and Balance Training<br>Proprioception and Balance Program | Other: Proprioception and Balance Program<br>* Balance Trainer device and playing ball in tandem position for using to improve balance, vibration and reposition exercises for using to improve proprioception. Progressive of training will increase after each 2 weeks.Patients will be taken to the treatment program 3 days in a week for 8 weeks.<br>|
| Experimental: Strengthening Training<br>Strengthening Program | Other: Strengthening Program<br>* Exercises which include open and closed kinetic chain exercise will be applied to strength knee and hip muscle. Progressive of training will increase after each 2 weeks. Patients will be taken to the treatment program 3 days in a week for 8 weeks.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Western Ontario and McMaster Universities Arthritis Index (WOMAC) | The WOMAC is widely used self-administered health status measure used in assessing pain, stiffness and function in patients with OA of the knee or hip. The test questions are scored on a scale of 0-4, which correspond to: None (0), Mild (1), Moderate (2), Severe (3), and Extreme (4). The scores for each subscale are summed up, with a possible score range of 0-20 for Pain, 0-8 for Stiffness, and 0-68 for Physical Function. Higher scores on the WOMAC indicate worse pain, stiffness, and functional limitations. | WOMAC will be filled first time at baseline and second time after 4 weeks and third time after 8 weeks rehabilitation program . After treatment change will be assessed | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual Analogue Scale (VAS) | The Visual Analog Scale (VAS) is a 10 cm line with anchor statements on the left (no pain) and on the right (extreme pain). The patient is asked to place a vertical mark on the scale to indicate the level of intensity of his or her pain. | Evaluation will perform first time at baseline and second time after 4 weeks and third time after 8 weeks rehabilitation program. | 
| Pressure Algometer | Pressure algometry is one of a number of outcome measures that manual therapy practitioners are able to use in both clinical and research settings. The pressure algometer is used to determine the pressure pain threshold of specific muscle and bone locations. | Evaluation will perform first time at baseline and second time after 4 weeks and third time after 8 weeks rehabilitation program. | 
| Hand-Held Dynamometer | Handheld dynamometers are one of the most objective and consistent tools to use when muscle testing. It is an ergonomic hand-held device for objectively quantifying muscle strength. | Evaluation will perform first time at baseline and second time after 4 weeks and third time after 8 weeks rehabilitation program. | 
| Isokinetic Dynamometer for measuring position sense | Isokinetic dynamometer is a well known device to measure active and passive JPS and also provides target angle result without any researcher bias/It has shown good reliability and validity for measuring position sense. | Evaluation will perform first time at baseline and second time after 4 weeks and third time after 8 weeks rehabilitation program. | 
| Short Form-36 | The Short Form (36) Health Survey is a 36-item, patient-reported survey of health related quality of life. The RAND 36-Item Health Survey taps eight health concepts: physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions. It also includes a single item that provides an indication of perceived change in health. | Evaluation will perform first time at baseline and second time after 4 weeks and third time after 8 weeks rehabilitation program. | 
| Global Rating of Change Scale | Global rating of change (GRC) scales are very commonly used in clinical research, particularly in the musculo-skeletal area These scales are designed to quantify a patient's improvement or deterioration over time, usually either to determine the effect of an intervention or to chart the clinical course of a condition. Global Rating of Change Scale will be used to evaluate patients' satisfaction from treatment. | Evaluation will perform first time at baseline and second time after 4 weeks and third time after 8 weeks rehabilitation program. | 
| Aggregated Locomotor Function (ALF) Score | The aggregated locomotor function (ALF) score, a simple measure of observed locomotor function, using timed walking, stairs and transfers, was developed and evaluated for intra-tester reliability, criterion-related validity and responsiveness in a sample of patients with knee osteoarthritis. | Evaluation will perform first time at baseline and second time after 4 weeks and third time after 8 weeks rehabilitation program. | 
| Digital Goniometer | Digital Goniometer is a tool used most commonly for evaluating joint ROM in the clinical settings. Also it is a simple alternative for global use. | Evaluation will perform first time at baseline and second time after 4 weeks and third time after 8 weeks rehabilitation program. | 
| Timed Up and Go (TUG) Test | Timed Up and Go (TUG) Test will be used clinical performance-based measure of lower extremity function, mobility and fall risk. | Evaluation will perform first time at baseline and second time after 4 weeks and third time after 8 weeks rehabilitation program. | 
| Tandem and Stand on One Leg | Tandem and Stand on One Leg will ve used to assesment of static balance of patients | Evaluation will perform first time at baseline and second time after 4 weeks and third time after 8 weeks rehabilitation program. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Rehabilitation, Pain, Functionality, Proprioception