Abstract
Objectives:This study determined biomechanical force parameters and reliability among clinicians performing knee joint mobilizations.Methods:Sixteen subjects with knee osteoarthritis and six therapists participated in the study. Forces were recorded using a capacitive-based pressure mat for three techniques at two grades of mobilization, each with two trials of 15 seconds. Dosage (force–time integral), amplitude, and frequency were also calculated. Analysis of variance was used to analyze grade differences, intraclass correlation coefficients determined reliability, and correlations assessed force associations with subject and rater variables.Results:Grade IV mobilizations produced higher mean forces (P<0·001) and higher dosage (P<0·001), while grade III produced higher maximum forces (P = 0·001). Grade III forces (Newtons) by technique (mean, maximum) were: extension 48, 81; flexion 41, 68; and medial glide 21, 34. Grade IV forces (Newtons) by technique (mean, maximum) were: extension 58, 78; flexion 44, 60; and medial glide 22, 30. Frequency (Hertz) ranged between 0·9–1·1 (grade III) and 1·4–1·6 (grade IV). Intra-clinician reliability was excellent (>0·90). Inter-clinician reliability was moderate for force and dosage, and poor for amplitude and frequency.Discussion:Force measurements were consistent with previously reported ranges and clinical constructs. Grade III and grade IV mobilizations can be distinguished from each other with differences for force and frequency being small, and dosage and amplitude being large. Intra-clinician reliability was excellent for all biomechanical parameters and inter-clinician reliability for dosage, the main variable of clinical interest, was moderate. This study quantified the applied forces among multiple clinicians, which may help determine optimal dosage and standardize care.
Highlights
Osteoarthritis (OA) is a disease which commonly affects the knee, often resulting in pain and disability
Lifetime risk of developing symptomatic knee OA is as high as 45%, and risk factors such as aging, obesity, and female gender are linked to an increased likelihood of developing knee OA, the etiology is not entirely clear.[1,2]
Descriptives The six clinicians in the study consisted of three faculty members and three fellows-in-training working in the Army-Baylor University Doctoral Fellowship in Orthopaedic Manual Physical Therapy, San Antonio, Texas
Summary
Osteoarthritis (OA) is a disease which commonly affects the knee, often resulting in pain and disability. Lifetime risk of developing symptomatic knee OA is as high as 45%, and risk factors such as aging, obesity, and female gender are linked to an increased likelihood of developing knee OA, the etiology is not entirely clear.[1,2] Prevalence and costs associated with knee OA have increased substantially over the past decade.[3,4] Identifying and integrating effective interventions into clinical practice are necessary in order to improve functional outcomes and decrease management costs. Recommended conservative intervention strategies include exercise, medications (acetaminophen or NSAIDs), The importance of general exercise in improving knee joint function and symptoms has been shown in previous studies.[6,8] Zhang et al.[6] reported that using strength training and aerobic exercise as a targeted treatment for knee OA demonstrated a moderate effect size for relief of knee pain.
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