The Study of Neuromuscular Exercise Therapy and Patients Self-management Program in Knee Osteoarthritis

Study Overview
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Brief Summary
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Osteoarthritis is the most common chronic disabling disease,the importance of patient's self-management in chronic disease has been paid more and more attention internationally. Currently, the self-management of OA patients in China is lack of instructions from professional clinicians, and leads to inappropriate excise, irregular drug medication. OAKP (Osteoarthritis of the Knee Self-Management Program) is a program initiated from University of Southern Denmark, follows clinical guidelines of OA, formatted for easy use by patients and clinicians, including customized neuromuscular exercise therapy, educational sessions of what is OA and how to control body weight to protect the knee. The main purpose of this study is to verify the effectiveness of neuromuscular exercise therapy and OAKP, see whether it can help patients to relief the symptom and improve life quality.

Detailed Description
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The study plans to enroll patients above 50 years old who suffered from knee OA, but patients meets any of the exclusion criteria will not be enrolled. 400 patients of knee OA will be randomly divided into A, B, C, D four parallel groups with fully informed, each group will enroll 100 patients, A for control group, B for neuromuscular exercise, C for self-management program, D for neuromuscular exercise and self-management program, respectively. Each collaborate hospital would enroll patients as a multicenter clinical trial. Patient will receive a baseline and 3m, 6m, 12m follow-up evaluation of their knee physical function. Primary outcome measure is KOOS (Knee Injury and Osteoarthritis Outcome Score), secondary evaluation include VAS, EQ-5D, Arthritis self-efficacy score, 6-minutes Walk test, TUG test, 20 meters quick walk test,Stand up test in 30 seconds, Balance test, Kellgren& Lawrence（KL）, Pain medication. Outcome will compare the mean difference between baseline survey and 12 months of follow-up in each group, using t-test or chi-square test,respectively.

Official Title
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The Study of Neuromuscular Exercise Therapy and Patients Self-management Program in Knee Osteoarthritis

Conditions
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Exercise Therapy

Intervention / Treatment
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* Behavioral: Self-management program
* Behavioral: Neuromuscular exercise therapy
* Behavioral: Health education


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - 1.Clinical diagnosis of knee osteoarthritis, Diagnostic criteria is based on the Chinese medical association's 2007 diagnosis and treatment guidelines for osteoarthritis: Repeated knee joint pain within 1 month; X-ray(weight-bearing or not)shows narrowed joint space,sclerosis and (or) cystic degeneration of subchondral bone, osteophytes of the joints; The joint fluid (at least twice) is clear and viscous, WBC<2000个/ml; Age of patients ≥40 yrs; Morning stiffness≤3 min; Bone friction in the activity; Note：Combine clinical feature, laboratory and X-ray examination,when the patients meet(1)+(2) or (1)+(3)+(5)+(6) or (1)+(4)+(5)+(6)，they can be diagnosis as knee osteoarthritis. 2.VAS≥4分; 3.No surgical treatment is planned within 6 months; Exclusion Criteria: Other types of arthritis, such us RA(rheumatoid arthritis) Severe deformity of knee joint; Over obesity patients（BMI>35）; Other comorbidities that would severely affect somatic function, such as: cerebral infarction, lumbar disease that meets surgical indications, lower extremity angiopathy; Decompensated cardiac dysfunction; Severe cardiovascular and cerebrovascular diseases, or the patient is too weak for any kinds of exercise; Lack of compliance;

Ages Eligible for Study
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Minimum Age: 50 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: Factorial Assignment
Interventional Model Description: Patients of knee OA will be divided into A, B, C, D four parallel groups with fully informed, each group will enroll 100 patients, A for control group, B for neuromuscular exercise, C for self-management program, D for neuromuscular exercise and self-management program, respectively.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Control<br>The patients in this group will only receive health education intervention. | Behavioral: Health education<br>* All four groups of patient will receive two times of health education in the first week.<br>|
| Other: Neuromuscular exercise therapy<br>The patients in this group will receive exercise therapy intervention.Besides, health education will be performed for every group. | Behavioral: Neuromuscular exercise therapy<br>* The exercise therapy is basically combined with neuromuscular training and anti resistance training. The aim is to improve the stability of the joints, enhance sensory motor control of lower extremities, reconstruct neutral position line. The exercise mode, frequency, intensity and duration will be adjusted individually through monitoring patient's pain.<br>Behavioral: Health education<br>* All four groups of patient will receive two times of health education in the first week.<br>|
| Other: Self-management program<br>The patients in this group will receive self-management intervention.Besides, health education will be performed for every group. | Behavioral: Self-management program<br>* Self-management diary will record the frequency of pain, fatigue and injury of knee joint due to knee OA, if patients maintain proper activities, it will be also recorded by an smart phone APP. Patients diet and intake calorie will also be recorded in the diary，which help clinicians to adjust their diet, control their body weight.<br>Behavioral: Health education<br>* All four groups of patient will receive two times of health education in the first week.<br>|
| Other: Exercise therapy+self-management<br>The patients in this group will receive exercise therapy and self-management intervention.Besides, health education will be performed for every group. | Behavioral: Self-management program<br>* Self-management diary will record the frequency of pain, fatigue and injury of knee joint due to knee OA, if patients maintain proper activities, it will be also recorded by an smart phone APP. Patients diet and intake calorie will also be recorded in the diary，which help clinicians to adjust their diet, control their body weight.<br>Behavioral: Neuromuscular exercise therapy<br>* The exercise therapy is basically combined with neuromuscular training and anti resistance training. The aim is to improve the stability of the joints, enhance sensory motor control of lower extremities, reconstruct neutral position line. The exercise mode, frequency, intensity and duration will be adjusted individually through monitoring patient's pain.<br>Behavioral: Health education<br>* All four groups of patient will receive two times of health education in the first week.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Western Ontario and McMaster Universities Osteoarthritis Index，WOMAC | WOMAC grade is a reliable knee osteoarthritis patients' self-reported therapeutic effect evaluation system, including three dimensions: pain, stiffness, daily activities and quality of life, and each dimension includes several questions scale from 0(worst) to 4(best) , total score of each dimension range from zero (worst) to 100 (best). Score of each question add together will be the total score. Baseline, 3 months, 6 months, 12 months, through visit or telephone follow-up will be recorded. Compare the mean difference of WOMAC grade between baseline survey and 12 months of follow-up in each group. | Baseline, 3 months, 6 months, 12months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual Analog Score（VAS） | Visual Analogue Scale of pain is a scale to extimate pain, and its score ranges from 0(worst) to 10(best). The higher the score is, the more severe pain the patient is feeling. | Baseline, 3 months, 6 months, 12months | 
| EuroQol Five Dimensions Questionnaire（EQ-5D） | EQ-5D is a scale to extimate health condition and quality of life, and its score ranges from -0.6 to 1.0. The higher the score is, the healthier the patient is. | Baseline, 3 months, 6 months, 12months | 
| Kellgren& Lawrence（KL） | The higher the KL score is ,the more severe the patient is. Baseline,through visit or telephone follow-up. | Baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Self-Management, Neuromuscular Exercise Therapy, Knee osteoarthritis