LOW LOAD RESISTANCE BLOOD FLOW RESTRICTION TRAINING VERSUS NEUROMUSCULAR TRAINING IN KNEE OSTEOARTHRITIS

Study Overview
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Brief Summary
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This study will be conducted to compare the effect of BFR with LLRT versus neuromuscular training on quadriceps muscle strength, knee joint function and proprioception accuracy.

Detailed Description
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PURPOSE: This study will be conducted to compare the effect of BFR with LLRT versus neuromuscular training on quadriceps muscle strength, knee joint function and proprioception accuracy. BACKGROUND: Patients with knee OA may have reduction of tolerance of the high-load programs which is recommended for eliciting strength gains (Messier et al., 2013). Thus, for reducing disease risk and enhancing physical function, there is a need for effectively strengthening the quadriceps muscle while limiting pain and adverse joint loading in people with knee OA (Segal et al., 2015). Blood flow restriction (BFR) with low-load resistance training (LLRT) is an alternative to traditional strength training that can be used in knee OA with minimal adverse joint loading that is normally found in traditional strengthening programs(Pope et al., 2013). It is attained through applying pressure externally with a pneumatic cuff or tourniquet. The applied pressure occludes venous outflow while maintaining arterial inflow with intent to promote blood pooling in the capillary beds of the limb muscles distal to the tourniquet (Slysz et al., 2016). Kubota et al., (2008), showed that BFR can be applied during periods of immobilization to decrease disuse muscle atrophy of limbs. Also it can be combined with exercise which enhances muscular development. Resistance exercise appears to provide great muscular gains when combined with BFR (Slysz et al., 2016). HYPOTHESES: There will not be a significant difference between traditional training, BFR with LLRT and neuromuscular training on improving quadriceps muscle strength using HHD in patients with unilateral knee OA. There will not be a significant difference between traditional training, BFR with LLRT and neuromuscular training on improving knee joint function on WOMAC questionnaire in patients with unilateral knee OA. There will not be a significant difference between traditional training, BFR with LLRT and neuromuscular training on improving knee joint proprioception in patients with unilateral knee OA. RESEARCH QUESTION: Does blood flow restriction with low load resistance training and neuromuscular training have a significant effect over traditional rehabilitation protocol (stretching and strengthening for hip and knee muscles) on quadriceps muscle strength, knee joint function and proprioception accuracy in patients with unilateral knee OA?

Official Title
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LOW LOAD RESISTANCE BLOOD FLOW RESTRICTION TRAINING VERSUS NEUROMUSCULAR TRAINING IN KNEE OSTEOARTHRITIS

Conditions
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Osteoarthritis of the Knee

Intervention / Treatment
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* Other: Traditional exercise therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age range from 45-60 years (Segal et al., 2015). Walk with painful knee OA without assistive devices (Bryk et al., 2016). Mild to moderate unilateral OA grade II-III (K/L) (Bryk et al., 2016). BMI < 30 kg/m² (not being classified as obese) (Bryk et al., 2016). Never participated in resistance training in the 3 months prior to their appointment (Jan et al., 2008) Exclusion Criteria: Severe knee OA (grade IV according to K/L classification). Bilateral knee OA. Congenital or acquired inflammatory, rheumatic or neurological (systemic or local) diseases involving the knee. Repeated treatment with steroids. Secondary knee OA. Received joint replacement surgery in either Knee or/and hip. Cardiovascular and neuromuscular disorders Diabetic patients Psychiatric disorders.

Ages Eligible for Study
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Minimum Age: 45 Years
Maximum Age: 60 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
Interventional Model Description: Sixty Three patients of both genders with mild to moderate unilateral tibiofemoral OA, with age range from 45-60 years will be randomly assigned to 1 of 3 groups control group (Traditional therapy group) (n=21): patients will receive traditional training exercises (high load resistance training) Experimental group I (BFR training group) (n=21): patients will receive LLRT with BFR. Experimental group II (Neuromuscular training group) (n=21): patients will receive neuromuscular training exercises
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: control group (Traditional therapy group)<br>control group (Traditional therapy group) (n=21): patients will receive traditional training exercises (high load resistance training | Other: Traditional exercise therapy<br>* Neuromuscular training<br>* Other names: Blood flow restriction training;|
| Experimental: Experimental group I (BFR training group)<br>Experimental group I (BFR training group) (n=21): patients will receive LLRT with BFR. | Other: Traditional exercise therapy<br>* Neuromuscular training<br>* Other names: Blood flow restriction training;|
| Experimental: Experimental group II (Neuromuscular training group)<br>Experimental group II (Neuromuscular training group) (n=21): patients will receive neuromuscular training exercises | Other: Traditional exercise therapy<br>* Neuromuscular training<br>* Other names: Blood flow restriction training;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Muscle strength | Hand-Held Dynamometer for measuring muscle strength | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Knee joint function | Western Ontario and McMaster Universities osteoarthritis index for an Arab population for assessing knee function | 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Blood flow restriction training