Abstract
BackgroundNeuromuscular and quadriceps exercises have been shown to be effective approaches to relieve pain and to improve function for patients with knee osteoarthritis. In this study, we aim to provide an informative feasible model in which therapeutic exercise and education will be undertaken with physiotherapy supervision and instruction via video link. We also aim to explore the relationship between program-induced pain alleviation/functional improvements and reduction in irritability, which might be mediated through program-induced psychosocial benefits.MethodsIn this proposed two-parallel group (neuromuscular exercise versus quadriceps exercise), single-blinded, randomised controlled trial, participants aged ≥50 years with osteoarthritic knee pain will undergo a 12-week intervention, comprising video-linked education, supervised exercises, and a 12-week follow-up. Seven measurements will be taken to collect longitudinal data. A generalised estimating equation will be used to establish the adjusted difference in effectiveness on pain, function, irritability, and psychosocial outcomes between participants undertaking neuromuscular exercises and those undertaking quadriceps exercises. The primary outcomes are overall average pain in the knee joint during walking, as assessed through the 11-point Numerical Pain Rating Scale, and the Western Ontario and McMaster Universities osteoarthritis index physical function subscale. Furthermore, pressure pain threshold and changes in self-report pain scores pre-, during, and post-exercise were also measured as an indication of irritability. In addition, both the 6-min walk test and a timed up & go test were used to assess walking function performance. Finally, patients’ emotions (e.g., fear and catastrophising), self-trust, needs in terms of disease knowledge, mental resilience, social support and health-related quality of life were investigated. Two four-wave cross-lagged models will be used to investigate directional relationships, aiming to investigate the complex mechanisms concerning the effects of exercise programmes.DiscussionThrough summarising the study’s strengths and limitations, this study may provide promising insights in terms of exercise therapy optimisation for people with knee osteoarthritis and/or other chronic pain within a psychosocial framework.Trial registrationChiCTR2100041978 (chictr.org.cn), January 10, 2021.
Highlights
Neuromuscular and quadriceps exercises have been shown to be effective approaches to relieve pain and to improve function for patients with knee osteoarthritis
Neuromuscular exercise, based on biomechanics and neuromuscular control principles, comprises a series of motions or actions aimed at improving sensorimotor control and achieving functional stability [6], in which there is an emphasis on the quality of open and closed chain movements through performing functionally weight-bearing exercises with correct posture and alignment [7]
Recent clinical trials have suggested that both exercise regimens could markedly ease pain and improve function [9,10,11]; whether significant differences in pain-relieving and functional improvement effects exist between the two exercise types is controversial
Summary
This protocol is guided by the Standard Protocol Items: Recommendations for Interventional Trials statement [34]. The messages twice a week used to remind to exercise before exercise at home, messages weekly used to remind to video-link with a physiotherapist, and exercise diary three times a week after every exercise session will be delivered to the participants with Joint Consultation. Primary outcomes Primary outcomes are as follows: (i) overall average pain in the knee joint during walking over the previous month: an 11-point NPRS will be used to investigate participant-reported pain ranging from 0 (no pain) to 10 (the worst pain), with 1.8 units having been reported as a minimum clinically important difference (MCID) [54]; and (ii) difficulty with physical function: the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) physical function subscale [55] will be used to evaluate self-reported dysfunction using 17 questions. (3) Functional physical performance, determined using a 6-min walk test and a timed up & go (TUG) test to assess walking function performance [58]
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