Neuromuscular Versus Quadriceps Strengthening Exercise in Patients With Medial Knee Osteoarthritis and Varus Malalignment

被引：143

作者：

Bennell, Kim L. ^{[1
]}

Kyriakides, Mary ^{[1
]}

Metcalf, Ben ^{[1
]}

Egerton, Thorlene ^{[1
]}

Wrigley, Tim V. ^{[1
]}

Hodges, Paul W. ^{[2
]}

Hunt, Michael A. ^{[3
]}

Roos, Ewa M. ^{[4
]}

Forbes, Andrew ^{[5
]}

Ageberg, Eva ^{[6
]}

Hinman, Rana S. ^{[1
]}

机构：

[1] Univ Melbourne, Melbourne, Vic, Australia

[2] Univ Queensland, Brisbane, Qld, Australia

[3] Univ British Columbia, Vancouver, BC V5Z 1M9, Canada

[4] Univ Southern Denmark, Odense, Denmark

[5] Monash Univ, Melbourne, Vic 3004, Australia

[6] Lund Univ, Lund, Sweden

来源：

ARTHRITIS & RHEUMATOLOGY | 2014年 / 66卷 / 04期

基金：

澳大利亚研究理事会; 英国医学研究理事会;

关键词：

RANDOMIZED CONTROLLED-TRIAL; ADDUCTION MOMENT; DISEASE PROGRESSION; CONTACT FORCE; HIP; LOAD; GAIT; VALIDATION; ALIGNMENT; INDIVIDUALS;

D O I：

10.1002/art.38317

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective. To compare the effects of neuromuscular exercise (NEXA) and quadriceps strengthening (QS) on the knee adduction moment (an indicator of medio-lateral 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 x 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.

引用

页码：950 / 959

页数：10

共 55 条

[1] Feasibility of neuromuscular training in patients with severe hip or knee OA: The individualized goal-based NEMEX-TJR training program [J].