The effect on knee-joint load of instruction in analgesic use compared with neuromuscular exercise in patients with knee osteoarthritis: study protocol for a randomized, single-blind, controlled trial (the EXERPHARMA trial)

被引:19
作者
Clausen, Brian [1 ]
Holsgaard-Larsen, Anders [2 ]
Sondergaard, Jens [3 ]
Christensen, Robin [1 ,4 ]
Andriacchi, Thomas P. [5 ,6 ,7 ]
Roos, Ewa M. [1 ]
机构
[1] Univ Southern Denmark, Inst Sports Sci & Clin Biomech, Res Unit Musculoskeletal Funct & Physiotherapy, Odense, Denmark
[2] Univ Southern Denmark, Odense Univ Hosp, Inst Clin Res, Dept Orthopaed & Traumatol,Orthopaed Res Unit, Odense, Denmark
[3] Univ Southern Denmark, Inst Publ Hlth, Res Unit Gen Practice, Odense, Denmark
[4] Copenhagen Univ Hosp, Parker Inst, Dept Rheumatol, MSU, Copenhagen, Denmark
[5] Stanford Univ, Dept Mech Engn, Stanford, CA 94305 USA
[6] Stanford Univ, Dept Orthopaed Surg, Stanford, CA 94305 USA
[7] VA Joint Preservat Ctr, Palo Alto, CA USA
关键词
Osteoarthritis; Exercise; Gait; Joint load; Knee joint; Middle-aged; Knee; Pain management; ADDUCTION MOMENT; FUNCTIONAL PERFORMANCE; REPORTED OUTCOMES; PHYSICAL FUNCTION; GENERAL-PRACTICE; GAIT ANALYSIS; NEMEX-TJR; BASE-LINE; PAIN; HIP;
D O I
10.1186/1745-6215-15-444
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Background: 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. 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/Design: One 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. Discussion: 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.
引用
收藏
页数:14
相关论文
共 82 条
[1]   Effects of neuromuscular training (NEMEX-TJR) on patient-reported outcomes and physical function in severe primary hip or knee osteoarthritis: a controlled before-and-after study [J].
Ageberg, Eva ;
Nilsdotter, Anna ;
Kosek, Eva ;
Roos, Ewa M. .
BMC MUSCULOSKELETAL DISORDERS, 2013, 14
[2]   Feasibility of neuromuscular training in patients with severe hip or knee OA: The individualized goal-based NEMEX-TJR training program [J].
Ageberg, Eva ;
Link, Anne ;
Roos, Ewa M. .
BMC MUSCULOSKELETAL DISORDERS, 2010, 11
[3]   Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 2: A review of prevention programs aimed to modify risk factors and to reduce injury rates [J].
Alentorn-Geli, Eduard ;
Myer, Gregory D. ;
Silvers, Holly J. ;
Samitier, Gonzalo ;
Romero, Daniel ;
Lazaro-Haro, Cristina ;
Cugat, Ramon .
KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, 2009, 17 (08) :859-879
[4]   DEVELOPMENT OF CRITERIA FOR THE CLASSIFICATION AND REPORTING OF OSTEOARTHRITIS - CLASSIFICATION OF OSTEOARTHRITIS OF THE KNEE [J].
ALTMAN, R ;
ASCH, E ;
BLOCH, D ;
BOLE, G ;
BORENSTEIN, D ;
BRANDT, K ;
CHRISTY, W ;
COOKE, TD ;
GREENWALD, R ;
HOCHBERG, M ;
HOWELL, D ;
KAPLAN, D ;
KOOPMAN, W ;
LONGLEY, S ;
MANKIN, H ;
MCSHANE, DJ ;
MEDSGER, T ;
MEENAN, R ;
MIKKELSEN, W ;
MOSKOWITZ, R ;
MURPHY, W ;
ROTHSCHILD, B ;
SEGAL, M ;
SOKOLOFF, L ;
WOLFE, F .
ARTHRITIS AND RHEUMATISM, 1986, 29 (08) :1039-1049
[5]   Atlas of individual radiographic features in osteoarthritis, revised [J].
Altman, R. D. ;
Gold, G. E. .
OSTEOARTHRITIS AND CARTILAGE, 2007, 15 :A1-A56
[6]   A framework for the in vivo pathomechanics of osteoarthritis at the knee [J].
Andriacchi, TP ;
Mündermann, A ;
Smith, RL ;
Alexander, EJ ;
Dyrby, CO ;
Koo, S .
ANNALS OF BIOMEDICAL ENGINEERING, 2004, 32 (03) :447-457
[7]  
[Anonymous], REF KNAEARTR
[8]  
[Anonymous], EUROPEAN INSTRUCTION
[9]  
[Anonymous], 56 ANN M ORTH RES SO
[10]   COMPARISON OF NEUROMUSCULAR AND QUADRICEPS STRENGTHENING EXERCISE IN PEOPLE WITH MEDIAL KNEE OSTEOARTHRITIS AND VARUS MALALIGNMENT: RANDOMISED CONTROLLED TRIAL [J].
Bennell, K. ;
Wrigley, T. ;
Kyriakides, M. ;
Metcalf, B. ;
Roos, E. ;
Egerton, T. ;
Hunt, M. ;
Hodges, P. ;
Forbes, A. ;
Ageberg, E. ;
Hinman, R. .
OSTEOARTHRITIS AND CARTILAGE, 2013, 21 :S273-S274