Exercise Therapy For Knee Osteoarthritis Research Articles

Lifetime Cost-Effectiveness of Structured Education and Exercise Therapy for Knee Osteoarthritis in Australia.

Structured education and exercise therapy programs have been proposed to reduce reliance on total knee replacement (TKR) surgery and improve health care sustainability. The long-term cost-effectiveness of these programs is unclear. To estimate the lifetime cost-effectiveness of implementing a national structured education and exercise therapy program for individuals with knee osteoarthritis with the option for future TKR compared with usual care (TKR for all). This economic evaluation used a life table model in combination with a Markov model to compare costs and health outcomes of a national education and exercise therapy program vs usual care in the Australian health care system. Subgroup, deterministic, and probabilistic sensitivity analyses were completed. A hypothetical cohort of adults aged 45 to 84 years who would undergo TKR was created. Structured education and exercise therapy intervention provided by physiotherapists. The comparator was usual care where all people undergo TKR without accessing the program in the first year. Incremental net monetary benefit (INMB), with an incremental cost-effectiveness ratio threshold of 28 033 Australian dollars (A$) per quality-adjusted life-year (QALY) gained, was calculated from a health care perspective. Transition probabilities, costs, and utilities were estimated from national registries and a randomized clinical trial. The hypothetical cohort included 61 394 individuals (53.9% female; 93.6% aged ≥55 years). Implementation of an education and exercise therapy program resulted in a lifetime cost savings of A$498 307 942 (US $339 922 227), or A$7970 (US $5537) per individual, and resulted in fewer QALYs (0.43 per individual) compared with usual care. At a population level, education and exercise therapy was not cost-effective at the lifetime horizon (INMB, -A$4090 [-US $2841]). Subgroup analysis revealed that the intervention was cost-effective only for the first 9 years and over a lifetime only in individuals with no or mild pain at baseline (INMB, A$11 [US $8]). Results were robust to uncertainty around model inputs. In this economic evaluation of structured education and exercise therapy compared with usual care, the intervention was not cost-effective over the lifetime for all patients but was for the first 9 years and for those with minimal pain. These findings point to opportunities to invest early cost savings in additional care or prevention, including targeted implementation to specific subgroups.

Variability in effect sizes of exercise therapy for knee osteoarthritis depending on comparator interventions.

Systematic reviews of exercise therapy for knee osteoarthritis (OA) have largely ignored the variability in comparator interventions. To assess how effect estimates of exercise therapy for knee OA as reported in randomized controlled trials vary depending on the comparator interventions. We followed the Cochrane Handbook and PRISMA guidance to conduct and report this meta-epidemiological study. Randomised controlled trials (RCTs) were identified from systematic reviews published in 2015 or later and reference lists of included studies. Exercise therapy RCTs testing interventions that adhered to the American College of Sports Medicine (ACSM) guidelines compared to any comparator intervention in people with knee OA and reporting outcomes of knee pain, physical function and/or quadriceps strength at the end of intervention were included. Thirty-five RCTs with 2412 participants were included. Comparator interventions included no intervention, non-ACSM compliant exercise therapy, education/self-management, and passive modalities. For pain, standardized mean difference (SMD) for ACSM compliant exercise therapy compared to passive modalities was 1.76 (95% CI 0.49, 3.04), no intervention 0.93 (95% CI 0.50; 1.36), education/self-management 0.27 (95% CI 0.07, 0.47), and non-ACSM compliant exercise therapy 0.09 (95% CI -0.06, 0.23). For physical function, SMD for ACSM compliant exercise therapy compared to passive modalities was 1.29 (95% CI 0.41, 2.17), no intervention 0.76 (95% CI 0.15, 1.36), non-ACSM compliant exercise therapy 0.25 (95% CI -0.00, 0.51) and education/self-management 0.21 (95% CI -0.14, 0.55). For quadriceps strength, SMD for ACSM compliant exercise therapy compared to no intervention was 0.69 (95% CI 0.42, 0.96), non-ACSM compliant exercise therapy 0.23 (95% CI -0.01, 0.46), education/self-management -0.02 (95% CI -0.45, 0.42) and passive modalities 0.80 (95% CI -0.10, 1.71). The effect of exercise therapy for knee OA varies significantly depending on the comparator intervention. This variability should be assessed routinely in systematic reviews.

Annals for Educators - February 2023.

Annals for Educators - February 2023.

Knee osteoarthritis: A systematic Review on different Exercise therapy Interventions on K.A.M

Exercise therapy can be part of a conservative treatment plan for knee osteoarthritis. Knee adduction moments (KAMs) are thought to be reduced with exercise therapy. A large study looked at exercise therapy's effect on KAM and other physical factors in persons with knee osteoarthritis. Methods: Searches were performed on the following electronic databases: MEDLINE, Google Scholar, Cochrane Central, EMBASE, and OpenGrey. Study participants with knee osteoarthritis undergoing structured exercise therapy were randomized controlled trials. For every study, we conducted independent analyses to extract data and analyze the bias risks. We calculated the mean differences and 95% confidence intervals for each outcome. Results: In the three studies that involved 233 participants, there were no significant differences in KAMs between intervention and control groups. Two of the studies observed improvements in physical function after exercise therapy and one of them demonstrated significant reductions in pain. All three trials favor the intervention group in terms of muscle strength and torque. Conclusions: A change in knee adduction time was not associated with the therapeutic benefits of exercise therapy. Exercise therapy for knee osteoarthritis may not be effective if there is no momentary adduction. Dynamic joint loading may result from a shift in neuromuscular control after exercise therapy

COMPARATOR GROUPS MATTER! - THE IMPACT OF COMPARATOR INTERVENTIONS ON EFFECT ESTIMATES: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS OF EXERCISE FOR KNEE OSTEOARTHRITIS

Purpose: In randomized controlled trials (RCTs), the effectiveness of exercise therapy for knee osteoarthritis (OA) has been determined by comparing it to no intervention controls and a variety of comparator interventions. While efforts have been made to investigate whether effect estimates differ between subgroups of patients and types of exercise programs, systematic reviews of exercise therapy for knee OA have largely ignored the variability in interventions provided in the comparator groups and its impact on effect sizes.

Benefits and Mechanisms of Exercise Training for Knee Osteoarthritis

Knee osteoarthritis is a chronic degenerative disease. Cartilage and subchondral bone degeneration, as well as synovitis, are the main pathological changes associated with knee osteoarthritis. Mechanical overload, inflammation, metabolic factors, hormonal changes, and aging play a vital role in aggravating the progression of knee osteoarthritis. The main treatments for knee osteoarthritis include pharmacotherapy, physiotherapy, and surgery. However, pharmacotherapy has many side effects, and surgery is only suitable for patients with end-stage knee osteoarthritis. Exercise training, as a complementary and adjunctive physiotherapy, can prevent cartilage degeneration, inhibit inflammation, and prevent loss of the subchondral bone and metaphyseal bone trabeculae. Increasing evidence indicates that exercise training can improve pain, stiffness, joint dysfunction, and muscle weakness in patients with knee osteoarthritis. There are several exercise trainings options for the treatment of knee osteoarthritis, including aerobic exercise, strength training, neuromuscular exercise, balance training, proprioception training, aquatic exercise, and traditional exercise. For Knee osteoarthritis (KOA) experimental animals, those exercise trainings can reduce inflammation, delay cartilage and bone degeneration, change tendon, and muscle structure. In this review, we summarize the main symptoms of knee osteoarthritis, the mechanisms of exercise training, and the therapeutic effects of different exercise training methods on patients with knee osteoarthritis. We hope this review will allow patients in different situations to receive appropriate exercise therapy for knee osteoarthritis, and provide a reference for further research and clinical application of exercise training for knee osteoarthritis.

Are manual therapy or booster sessions worthwhile in addition to exercise therapy for knee osteoarthritis: Economic evaluation and 2-year follow-up of a randomized controlled trial

BackgroundExercise therapy is known to be an effective intervention for patients with osteoarthritis, however the evidence is limited as to whether adding manual therapy or booster sessions are cost-effective strategies to extend the duration of benefits. ObjectiveTo investigate the cost-effectiveness, at 2-year follow-up, of adding manual therapy and/or booster sessions to exercise therapy. Design2-by-2 factorial randomized controlled trial. MethodsParticipants with knee osteoarthritis were randomly allocated (1:1:1:1) to: exercise therapy delivered in consecutive sessions within 9 weeks (control group), exercise therapy distributed over 1 year using booster sessions, exercise therapy plus manual therapy delivered within 9 weeks, and exercise therapy plus manual therapy with booster sessions. The primary outcome was incremental cost-effectiveness from health system and societal perspectives interpreted as incremental net monetary benefit (INMB). ResultsOf 75 participants, 66 (88 %) were retained at 1-year and 40 (53 %) at 2-year follow-up. All three interventions were cost-effective from both the health system and societal perspectives (INMBs, at 0.5 × GDP/capita willingness to pay (WTP) threshold: $3278 (95%CI -3244 to 9800) and $3904 (95%CI -2823 to 10,632) respectively for booster sessions; $2941 (95%CI -3686 to 9568) and $2618 (95%CI -4005 to 9241) for manual therapy; $270 (95%CI -6139 to 6679) and $404 (95%CI -6097 to 6905) for manual therapy with booster sessions). ConclusionManual therapy or booster sessions in addition to exercise therapy are cost-effective at 2-year follow-up. The evidence did not support combining both booster sessions and manual therapy in addition to exercise therapy.

Standardize the conduction of exercise therapy for knee osteoarthritis

膝骨关节炎（OA）患病率在我国持续升高。近两年，膝OA的运动治疗在我国方兴未艾。为规范运动治疗膝OA的应用，相关从业者应了解运动治疗有效性和安全性，应将其作为一线治疗推荐给膝OA患者。对于患者的运动处方应做到确切、具体、可执行、及时个体化调整。同时患者教育可提高其依从性，对长期疗效的维持至关重要。.

Study on the application of nanotube combined exercise rehabilitation therapy in the treatment of knee arthritis patients

Knee osteoarthritis (KOA) is a common chronic joint disease in clinical practice, and there is currently no effective cure. Among the many non-surgical therapies for KOA, exercise therapy as a safe and effective treatment has been accepted by more and more people. At present, more clinically applied and researched exercise therapies include strength training, aerobic training, neuromuscular training, proprioceptive neuromuscular promotion method, whole body vibration training, and its therapeutic effects include alleviating knee pain, enhancing lower limb muscle strength and stability to improve knee function. The current research has explored the action mechanism of exercise therapy for KOA from the perspective of molecular biology and physiology, but the specific action mechanisms of various kinds of exercise therapy and the intensity, time and frequency in clinical application need to be further studied. In this paper, titanium dioxide nanotube coatings were prepared by electrochemical anodisation, and the structure characterisation and electron microscope observation were performed. Materials with different nanotube pore sizes were prepared under different preparation conditions and their structural characteristics were compared. Then, bone marrow mesenchymal stem cells were cultured on the surface of titanium nanotubes, and their activities of adhesion, growth and differentiation were observed. The effects of nanotube structure on osteoblasts were compared on different nanostructure surfaces. Finally, it was found that the surface of the titanium nanotube material is suitable for bone marrow mesenchymal stem cells to adhere, grow, and promote their differentiation into osteoblasts. The surface of titanium nanotube materials with different pore sizes has different effects on bone marrow mesenchymal stem cells. When d = 30 nm, stem cells tend to adhere and have less morphology. As the pore diameter increases to 100 nm, the ability to adhere to cells decreases, and the morphology of the cells becomes longer and the osteogenesis ability is enhanced.

"I Was Really Pleasantly Surprised": Firsthand Experience and Shifts in Physical Therapist Perceptions of Telephone-Delivered Exercise Therapy for Knee Osteoarthritis-A Qualitative Study.

To explore physiotherapists' perceptions before and after delivering exercise advice via telephone to patients with knee osteoarthritis (OA). We performed a descriptive qualitative study (based on interpretivist methodology) embedded within a randomized controlled trial. Before and after providing exercise therapy to patients with knee OA, all 8 physiotherapists who were involved in the trial participated in semi-structured interviews via telephone. Interviews were audio recorded, transcribed verbatim, and thematically analyzed. Prior to delivering the intervention, physiotherapists thought that the telephone should be used only for follow-up rather than as the primary mode of providing care. They believed that telephone-delivered care would be convenient and cost-saving for patients, would provide increased opportunity for patient education, and also increase access to services, but that the lack of visual and physical contact with patients would be problematic. After delivering the intervention, physiotherapists reflected that telephone-delivered care exceeded their expectations, noting positive patient outcomes including improved pain, function, and confidence. The focus on communication allowed more personal conversations with patients and shifted patient expectations of care away from manual therapies and toward self-management. Numerous implementation considerations were identified, including the need for clinician training in communication skills, written resources for patients to supplement telephone calls, and careful deliberation of how to schedule telephone consultations during the usual in-person consultations in the clinic. Although physiotherapists were initially skeptical about the effectiveness of telephone-delivered service models to patients with knee OA, perceptions shifted once they experienced delivery of care via this nontraditional method. Our findings suggest that firsthand experience may be necessary for physiotherapists to embrace new models of service delivery.

Systematic review of clinical practice guidelines on exercise therapy for knee osteoarthritis and critical appraisal using AGREEII instrument

Systematic review of clinical practice guidelines on exercise therapy for knee osteoarthritis and critical appraisal using AGREEII instrument

Patients’ views toward knee osteoarthritis exercise therapy and factors influencing adherence – a survey in China

ABSTRACTObjectives: To understand the views toward exercise therapy for knee osteoarthritis (KOA) in China and to analyze factors affecting treatment adherence.Methods: A survey-based study, which included multiple choice and open-ended questions on knee OA exercise therapy was conducted in a Chinese population. The content included the respondents’ attitudes and beliefs, willingness to receive treatment, and reasons why they could or could not adhere to the treatment. We used Chi-squared tests to compare cognitive differences between the patients and non-patient groups.Results: A total of 1,069 people responded to the questionnaire, and the response rate was 81.8%. A total of 93.6% of the patients thought that they could adhere to the exercise treatment if they received professional advice and prescriptions. The following questionnaire items achieved consensus: ‘Increasing the strength of the muscles around the knee stops the knee pain from getting worse,’ ‘It is the person’s own responsibility to continue doing their exercise program,’ ‘How helpful the exercise program will be determines how well a person sticks to it,’ ‘Health professionals should educate patients with knee pain about how to change their lifestyle for the better,’ and ‘Exercise for knee pain is most helpful when it is designed for each person, to suit their own particular needs.’ Patient adherence was affected by multiple factors, and some negative factors included ‘forgetfulness,’ ‘getting joint symptoms improved after therapy,’ ‘professional guidance, subsequent monitoring and supervision,’ ‘willing to enhance overall health and quality of life,’ ‘having no time,’ ‘occupational factors,’ ‘considering that the pain would worsen while/after exercise,’ and ‘family factors.’Conclusions: A general Chinese population accepted exercise therapy for treating KOA in our survey. Education is necessary because patients were uncertain and had misunderstandings regarding the potential benefits of exercise therapy. Some factors related to treatment adherence were also analyzed.

Exercise Therapy for Knee Osteoarthritis in Patients with Major Comorbidities

Exercise therapy is recommended for patients with knee osteoarthritis (OA). However, data are lacking on exercise therapy for patients with knee OA who

The role of muscle strengthening in exercise therapy for knee osteoarthritis: A systematic review and meta-regression analysis of randomized trials.

To analyze if exercise interventions for patients with knee osteoarthritis (OA) following the American College of Sports Medicine (ACSM) definition of muscle strength training differs from other types of exercise, and to analyze associations between changes in muscle strength, pain, and disability. A systematic search in 5 electronic databases was performed to identify randomized controlled trials comparing exercise interventions with no intervention in knee OA, and reporting changes in muscle strength and in pain or disability assessed as standardized mean differences (SMD) with 95% confidence intervals (95% CI). Interventions were categorized as ACSM interventions or not-ACSM interventions and compared using stratified random effects meta-analysis models. Associations between knee extensor strength gain and changes in pain/disability were assessed using meta-regression analyses. The 45 eligible trials with 4699 participants and 56 comparisons (22 ACSM interventions) were included in this analysis. A statistically significant difference favoring the ACSM interventions with respect to knee extensor strength was found [SMD difference: 0.448 (95% CI: 0.091-0.805)]. No differences were observed regarding effects on pain and disability. The meta-regressions indicated that increases in knee extensor strength of 30-40% would be necessary for a likely concomitant beneficial effect on pain and disability, respectively. Exercise interventions following the ACSM criteria for strength training provide superior outcomes in knee extensor strength but not in pain or disability. An increase of less than 30% in knee extensor strength is not likely to be clinically beneficial in terms of changes in pain and disability (PROSPERO: CRD42014015344).

Do manual therapy or booster sessions in addition to exercise therapy for knee osteoarthritis provide additional benefits? A randomized clinical trial

Do manual therapy or booster sessions in addition to exercise therapy for knee osteoarthritis provide additional benefits? A randomized clinical trial

The effects of shoes on knee pain and medial joint loading in persons with knee osteoarthritis: A systematic review with meta-analysis

The effects of shoes on knee pain and medial joint loading in persons with knee osteoarthritis: A systematic review with meta-analysis

Effectiveness of Thermotherapy Using a Heat and Steam Generating Sheet for Cartilage in Knee Osteoarthritis

[Purpose] Superficial heat treatment is one of the most widely used physical therapies for osteoarthritis (OA). We clinically evaluated the effects of local heat treatment and exercise therapy for knee OA, and evaluated the articular cartilage using magnetic resonance imaging (MRI) T2 mapping. [Subjects and Methods] Eighteen females aged 50–69 (59.5 ± 8.5 years, mean ± SD) years diagnosed with early-stage knee OA were randomly assigned using computer-generated random numbers to either a local heat treatment group (LH group, 9 subjects) or an exercise therapy group (EX group, 9 subjects). These groups were subjected to a 12-week intervention experiment. MRI T2 mapping was performed for cartilage imaging and quantitative evaluation. For clinical evaluation, the Japanese Knee Osteoarthritis Measure (JKOM) and the Timed Up and Go (TUG) test were performed. Both clinical and MRI evaluations were performed at the beginning and end of the intervention (0 week (Time 0) and 12 weeks). [Results] The total JKOM score had a significantly decreased in the LH group at 12 weeks. However, in the EX group the total JKOM scores at Time 0 and 12 weeks were not significantly different. The TUG time in the EX group was significant shorter at 12 weeks, whereas it showed no significant change in the LH group at 12 weeks, though the TUG times of 7 of the 9 patients decreased, exhibiting some improvement. The T2 value of the LH group was significantly shorter at 12 weeks. However, the T2 value in the EX group showed no significant change at 12 weeks. [Conclusion] After local heat treatment using heat- and steam moisture-generating sheets for 12 weeks, we observed improvements in clinical symptoms and walking abilities. Moreover, positive effects on cartilage metabolism were suggested.

Severity of patellofemoral joint disease is associated with increased functional limitations and lower limb impairments in patients with coexisting tibiofemoral osteoarthritis

Purpose: Although the knee joint is comprised of both the tibiofemoral and the patellofemoral joints, knee osteoarthritis (OA) has primarily been viewed as a disorder of the tibiofemoral joint alone. Therefore, the potential impact of coexisting patellofemoral joint disease has gone largely unconsidered. As such, it is currently unclear to what extent the severity of patellofemoral joint disease is associated with the symptoms, functional limitations, and lower limb physical impairments attributed to knee OA. The purpose of the present study was to compare the knee related functional limitations and lower limb physical impairments between individuals with tibiofemoral OA who have minimal patellofemoral joint disease and those presenting with tibiofemoral OA who have more advanced patellofemoral joint disease. Methods:Asecondaryanalysis of baseline data for 167 subjects (55men; 112 women) participating in a randomized clinical trial of exercise therapy for knee OA was performed. Subjects were included in the analysis if they met the American College of Rheumatology clinical criteria for knee OA as well as having a Kellgren & Lawrence (KL) radiographic grade of 2 or greater for tibiofemoral OA. Subjects with tibiofemoral OA were subsequently divided into two groups of minimal patellofemoral joint disease (KL grade 0-2 for patellofemoral joint; N1⁄496), mean age 63.8 9.1 yr, height 168.0 9.6 cm, body mass 84.2 19.0 kg, body mass index 29.8 6.4; or moderate to severe patellofemoral joint disease (KL grade 3-4 for patellofemoral joint; N1⁄471) age 63.8 8.7 yr, height 167.8 9.3 cm, body mass 89.6 17.4 kg, body mass index 31.9 6.1. The 24-itemWesternOntario andMcMaster Universities (WOMAC)OA Index and the 14-itemActivities of Daily Living Scale of the Knee Outcome Survey (ADLS) were used to gather information on pain and limitations during performance of specific functional tasks. Pain and functional limitations reported on the individual WOMAC and ADLS items were then dichotomized as normal/mild or moderate/extreme. The association of eachWOMAC and ADLS individual itemwith severity of patellofemoral disease was examined by multiple logistic regression adjusted for age and BMI. Additionally, independent sample t-testswere used to evaluate between-group differences in quantitative knee extension strength and knee range of motion. Results: More severe patellofemoral joint disease was associated with moderate/extreme limitations with going down stairs (OR 1⁄4 2.8; 95% CI: 1.4 to 5.6) and kneeling on the front of the knee (OR1⁄4 2.6; 95%: CI 1.2 to 5.8). In addition, moderate/extreme pain with going up and down stairs (OR 1⁄4 2.2; 95% CI: 1.1 to 4.0) was associated with more advanced patellofemoral joint involvement. Patients with severe patellofemoral joint disease also demonstrated decreased knee extension strength (4.0 1.8 Nm/BMI vs. 5.0 1.8 Nm/BMI; p<0.001) along with more pronounced range of motion limitations in Knee flexion (126.8 10.9 vs. 132.9 10.3 ; p<0.001) and knee extension (-6.0 6.1 vs. -4.4 5.7 ; p1⁄40.04). Conclusions: Coexistence of moderate to severe patellofemoral joint disease along with tibiofemoral OA appears to be associated with increased pain and difficulty with negotiating stairs and kneeling, as well as decreased knee extension strength and range of motion. Thus, specific treatment strategies targeting the patellofemoral joint may be needed if these specific functional problems and lower limb impairments are to be mitigated. Further efforts on clinical recognition of coexisting patellofemoral and tibiofemoral OA may be warranted.

Measuring patient satisfaction with exercise therapy for knee osteoarthritis: evaluating the utility of the physiotherapy outpatient survey

To assess patient satisfaction with exercise for knee osteoarthritis (OA). A convenience sample of 27 patients recruited to a randomized controlled trial (RCT) comparing open kinetic chain and closed kinetic chain exercises for knee OA were reassessed at nine months post-randomization. Clinical outcomes included self-report and physical performance measures of function and pain severity. Patients also completed the Physiotherapy Outpatient Survey (POPS), which is a multi-dimensional measure of patient satisfaction with physiotherapy. There was no significant difference in satisfaction between the two intervention groups. Overall mean satisfaction for the entire cohort was 4.07 of a maximum score of 5 (standard deviation (SD) = 0.52). Lower levels of satisfaction with outcome (mean = 3.56, SD = 0.8) were reported compared with other domains of expectations, communication, organization and the therapist (mean = 3.79-4.49; SDs = 0.42-0.92). Both intervention groups improved from baseline on clinical outcomes of pain, self-report function and walking distance, with no significant differences between the two groups. High levels of satisfaction were reported in this subsample of knee OA patients participating in an RCT evaluating the effects of different exercise approaches for knee OA. Satisfaction varied depending on the satisfaction domain, with lower satisfaction with outcome compared with other aspects of care. The POPS questionnaire can be used to measure the multi-dimensional aspects of satisfaction with physiotherapy.

The frequency of visits by the physiotherapist of patients receiving home-based exercise therapy for knee osteoarthritis

Although home-based physiotherapy (PT) has an important role in the management of knee osteoarthritis (OA), the optimal frequency of monitoring by the physiotherapist is not known. Ninety-six patients with bilateral Kellgren Lawrence grade 3 OA were divided into two groups. All patients received the same PT program but group 1 was monitored at 1, 2, 3, 6, 12 and 24 weeks, while group 2 was seen at 3 and 24 weeks. At the end of the study, both groups had improved their Hospital for Special Surgery score ( P<0.05), and there was no statistically significant difference between the groups. We conclude that the frequency of visits for a home-based exercise program can be decreased without affecting the success of the therapy.