Neuromuscular versus quadriceps strengthening exercise in patients with medial knee osteoarthritis and varus malalignment

a randomized controlled trial

Kim L Bennell, Mary Kyriakides, Ben Metcalf, Thorlene Egerton, Tim V Wrigley, Paul W Hodges, Michael A Hunt, Ewa M. Roos, Andrew Forbes, Eva Ageberg, Rana S Hinman

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

OBJECTIVE: To compare the effects of neuromuscular exercise (NEXA) and quadriceps strengthening (QS) on the knee adduction moment (an indicator of mediolateral distribution of knee load), pain, and physical function in patients with medial knee joint osteoarthritis (OA) and varus malalignment.

METHODS: One hundred patients with medial knee pain, mostly moderate-to-severe radiographic medial knee OA, and varus malalignment were randomly allocated to one of two 12-week exercise programs. Each program involved 14 individually supervised exercise sessions with a physiotherapist plus a home exercise component. Primary outcomes were peak external knee adduction moment (3-dimensional gait analysis), pain (visual analog scale), and self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index).

RESULTS: Eighty-two patients (38 [76%] of 50 in the NEXA group and 44 [88%] of 50 in the QS group) completed the trial. There was no significant between-group difference in the change in the peak knee adduction moment (mean difference 0.13 Nm/[body weight × height]% [95% confidence interval (95% CI) -0.08, 0.33]), pain (mean difference 2.4 mm [95% CI -6.0, 10.8]), or physical function (mean difference -0.8 units [95% CI -4.0, 2.4]). Neither group showed a change in knee moments following exercise, whereas both groups showed similar significant reductions in pain and improvement in physical function.

CONCLUSION: Although comparable improvements in clinical outcomes were observed with both neuromuscular and quadriceps strengthening exercise in patients with moderate varus malalignment and mostly moderate-to-severe medial knee OA, these forms of exercise did not affect the knee adduction moment, a key predictor of structural disease progression.

OriginalsprogEngelsk
TidsskriftArthritis & Rheumatology
Vol/bind66
Udgave nummer4
Sider (fra-til)950-9
Antal sider10
ISSN1537-2960
DOI
StatusUdgivet - apr. 2014

Fingeraftryk

Knee Osteoarthritis
Knee
Randomized Controlled Trials
Exercise
Confidence Intervals
Physical Therapists
Ontario
Pain Measurement
Knee Joint

Citer dette

Bennell, Kim L ; Kyriakides, Mary ; Metcalf, Ben ; Egerton, Thorlene ; Wrigley, Tim V ; Hodges, Paul W ; Hunt, Michael A ; Roos, Ewa M. ; Forbes, Andrew ; Ageberg, Eva ; Hinman, Rana S. / Neuromuscular versus quadriceps strengthening exercise in patients with medial knee osteoarthritis and varus malalignment : a randomized controlled trial. I: Arthritis & Rheumatology. 2014 ; Bind 66, Nr. 4. s. 950-9.
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title = "Neuromuscular versus quadriceps strengthening exercise in patients with medial knee osteoarthritis and varus malalignment: a randomized controlled trial",
abstract = "OBJECTIVE: To compare the effects of neuromuscular exercise (NEXA) and quadriceps strengthening (QS) on the knee adduction moment (an indicator of mediolateral distribution of knee load), pain, and physical function in patients with medial knee joint osteoarthritis (OA) and varus malalignment.METHODS: One hundred patients with medial knee pain, mostly moderate-to-severe radiographic medial knee OA, and varus malalignment were randomly allocated to one of two 12-week exercise programs. Each program involved 14 individually supervised exercise sessions with a physiotherapist plus a home exercise component. Primary outcomes were peak external knee adduction moment (3-dimensional gait analysis), pain (visual analog scale), and self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index).RESULTS: Eighty-two patients (38 [76{\%}] of 50 in the NEXA group and 44 [88{\%}] of 50 in the QS group) completed the trial. There was no significant between-group difference in the change in the peak knee adduction moment (mean difference 0.13 Nm/[body weight × height]{\%} [95{\%} confidence interval (95{\%} CI) -0.08, 0.33]), pain (mean difference 2.4 mm [95{\%} CI -6.0, 10.8]), or physical function (mean difference -0.8 units [95{\%} CI -4.0, 2.4]). Neither group showed a change in knee moments following exercise, whereas both groups showed similar significant reductions in pain and improvement in physical function.CONCLUSION: Although comparable improvements in clinical outcomes were observed with both neuromuscular and quadriceps strengthening exercise in patients with moderate varus malalignment and mostly moderate-to-severe medial knee OA, these forms of exercise did not affect the knee adduction moment, a key predictor of structural disease progression.",
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author = "Bennell, {Kim L} and Mary Kyriakides and Ben Metcalf and Thorlene Egerton and Wrigley, {Tim V} and Hodges, {Paul W} and Hunt, {Michael A} and Roos, {Ewa M.} and Andrew Forbes and Eva Ageberg and Hinman, {Rana S}",
note = "Article first published online: 28 MAR 2014",
year = "2014",
month = "4",
doi = "10.1002/art.38317",
language = "English",
volume = "66",
pages = "950--9",
journal = "Arthritis & Rheumatology",
issn = "2326-5205",
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Bennell, KL, Kyriakides, M, Metcalf, B, Egerton, T, Wrigley, TV, Hodges, PW, Hunt, MA, Roos, EM, Forbes, A, Ageberg, E & Hinman, RS 2014, 'Neuromuscular versus quadriceps strengthening exercise in patients with medial knee osteoarthritis and varus malalignment: a randomized controlled trial', Arthritis & Rheumatology, bind 66, nr. 4, s. 950-9. https://doi.org/10.1002/art.38317

Neuromuscular versus quadriceps strengthening exercise in patients with medial knee osteoarthritis and varus malalignment : a randomized controlled trial. / Bennell, Kim L; Kyriakides, Mary; Metcalf, Ben; Egerton, Thorlene; Wrigley, Tim V; Hodges, Paul W; Hunt, Michael A; Roos, Ewa M.; Forbes, Andrew; Ageberg, Eva; Hinman, Rana S.

I: Arthritis & Rheumatology, Bind 66, Nr. 4, 04.2014, s. 950-9.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Neuromuscular versus quadriceps strengthening exercise in patients with medial knee osteoarthritis and varus malalignment

T2 - a randomized controlled trial

AU - Bennell, Kim L

AU - Kyriakides, Mary

AU - Metcalf, Ben

AU - Egerton, Thorlene

AU - Wrigley, Tim V

AU - Hodges, Paul W

AU - Hunt, Michael A

AU - Roos, Ewa M.

AU - Forbes, Andrew

AU - Ageberg, Eva

AU - Hinman, Rana S

N1 - Article first published online: 28 MAR 2014

PY - 2014/4

Y1 - 2014/4

N2 - OBJECTIVE: To compare the effects of neuromuscular exercise (NEXA) and quadriceps strengthening (QS) on the knee adduction moment (an indicator of mediolateral distribution of knee load), pain, and physical function in patients with medial knee joint osteoarthritis (OA) and varus malalignment.METHODS: One hundred patients with medial knee pain, mostly moderate-to-severe radiographic medial knee OA, and varus malalignment were randomly allocated to one of two 12-week exercise programs. Each program involved 14 individually supervised exercise sessions with a physiotherapist plus a home exercise component. Primary outcomes were peak external knee adduction moment (3-dimensional gait analysis), pain (visual analog scale), and self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index).RESULTS: Eighty-two patients (38 [76%] of 50 in the NEXA group and 44 [88%] of 50 in the QS group) completed the trial. There was no significant between-group difference in the change in the peak knee adduction moment (mean difference 0.13 Nm/[body weight × height]% [95% confidence interval (95% CI) -0.08, 0.33]), pain (mean difference 2.4 mm [95% CI -6.0, 10.8]), or physical function (mean difference -0.8 units [95% CI -4.0, 2.4]). Neither group showed a change in knee moments following exercise, whereas both groups showed similar significant reductions in pain and improvement in physical function.CONCLUSION: Although comparable improvements in clinical outcomes were observed with both neuromuscular and quadriceps strengthening exercise in patients with moderate varus malalignment and mostly moderate-to-severe medial knee OA, these forms of exercise did not affect the knee adduction moment, a key predictor of structural disease progression.

AB - OBJECTIVE: To compare the effects of neuromuscular exercise (NEXA) and quadriceps strengthening (QS) on the knee adduction moment (an indicator of mediolateral distribution of knee load), pain, and physical function in patients with medial knee joint osteoarthritis (OA) and varus malalignment.METHODS: One hundred patients with medial knee pain, mostly moderate-to-severe radiographic medial knee OA, and varus malalignment were randomly allocated to one of two 12-week exercise programs. Each program involved 14 individually supervised exercise sessions with a physiotherapist plus a home exercise component. Primary outcomes were peak external knee adduction moment (3-dimensional gait analysis), pain (visual analog scale), and self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index).RESULTS: Eighty-two patients (38 [76%] of 50 in the NEXA group and 44 [88%] of 50 in the QS group) completed the trial. There was no significant between-group difference in the change in the peak knee adduction moment (mean difference 0.13 Nm/[body weight × height]% [95% confidence interval (95% CI) -0.08, 0.33]), pain (mean difference 2.4 mm [95% CI -6.0, 10.8]), or physical function (mean difference -0.8 units [95% CI -4.0, 2.4]). Neither group showed a change in knee moments following exercise, whereas both groups showed similar significant reductions in pain and improvement in physical function.CONCLUSION: Although comparable improvements in clinical outcomes were observed with both neuromuscular and quadriceps strengthening exercise in patients with moderate varus malalignment and mostly moderate-to-severe medial knee OA, these forms of exercise did not affect the knee adduction moment, a key predictor of structural disease progression.

KW - Aged

KW - Bone Malalignment

KW - Exercise Therapy

KW - Female

KW - Humans

KW - Knee Joint

KW - Male

KW - Middle Aged

KW - Muscle Strength

KW - Osteoarthritis, Knee

KW - Physical Therapy Modalities

KW - Quadriceps Muscle

KW - Treatment Outcome

U2 - 10.1002/art.38317

DO - 10.1002/art.38317

M3 - Journal article

VL - 66

SP - 950

EP - 959

JO - Arthritis & Rheumatology

JF - Arthritis & Rheumatology

SN - 2326-5205

IS - 4

ER -