Abstract
BackgroundKnee osteoarthritis (OA) is a mechanically driven disease, and it is suggested that medial tibiofemoral knee-joint load increases with pharmacologic pain relief, indicating that pharmacologic pain relief may be positively associated with disease progression. Treatment modalities that can both relieve pain and reduce knee-joint load would be preferable. The knee-joint load is influenced by functional alignment of the trunk, pelvis, and lower-limb segments with respect to the knee, as well as the ground-reaction force generated during movement. Neuromuscular exercise can influence knee load and decrease knee pain. It includes exercises to improve balance, muscle activation, functional alignment, and functional knee stability. The primary objective of this randomized controlled trial (RCT) is to investigate the efficacy of a NEuroMuscular EXercise (NEMEX) therapy program, compared with optimized analgesics and antiinflammatory drug use, on the measures of knee-joint load in people with mild to moderate medial tibiofemoral knee osteoarthritis.Method/DesignOne hundred men and women with mild to moderate medial knee osteoarthritis will be recruited from general medical practices and randomly allocated (1:1) to one of two 8-week treatments, either (a) NEMEX therapy twice a week or (b) information on the recommended use of analgesics and antiinflammatory drugs (acetaminophen and oral NSAIDs) via a pamphlet and video materials. The primary outcome is change in knee load during walking (the Knee Index, a composite score of the first external peak total reaction moment on the knee joint from all three planes based on 3D movement analysis) after 8 weeks of intervention. Secondary outcomes include changes in the external peak knee-adduction moment and impulse and functional performance measures, in addition to changes in self-reported pain, function, health status, and quality of life.DiscussionThese findings will help determine whether 8 weeks of neuromuscular exercise is superior to optimized use of analgesics and antiinflammatory drugs regarding knee-joint load, pain and physical function in people with mild to moderate knee osteoarthritis.Trial registrationClinicalTrials.gov Identifier: NCT01638962 (July 3, 2012).
Highlights
Knee osteoarthritis (OA) is a mechanically driven disease, and it is suggested that medial tibiofemoral knee-joint load increases with pharmacologic pain relief, indicating that pharmacologic pain relief may be positively associated with disease progression
These findings will help determine whether 8 weeks of neuromuscular exercise is superior to optimized use of analgesics and antiinflammatory drugs regarding knee-joint load, pain and physical function in people with mild to moderate knee osteoarthritis
Despite its use in other conditions and in more-severe stages of OA, only one study has investigated the effect of this exercise form in early stages of knee OA: an uncontrolled pilot study consisting of 13 patients with mild knee OA [27] that resulted in a −0.8 Nm/kg reduction (14%) in peak knee-adduction moment (KAM) during one-leg rise after 8 weeks of neuromuscular exercise
Summary
Knee osteoarthritis (OA) is a mechanically driven disease, and it is suggested that medial tibiofemoral knee-joint load increases with pharmacologic pain relief, indicating that pharmacologic pain relief may be positively associated with disease progression. Clinical guidelines advocate nondrug treatments as first-line treatment for knee OA [4,5,6] These include information, exercise, and weight loss, and are preferred for their anticipated negligible adverse effects while still having relevant clinical efficacy. Both overthe-counter and prescribed pain-reducing pharmacologic agents (analgesics and antiinflammatory agents) are widely and more commonly used treatments for knee OA in primary health care [7]. These are preferred for their ease of application and dose-dependent painrelieving effect [8], they have dose-dependent adverse effects [9,10,11]
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