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Effect of whole body vibration exercise on muscle strength and proprioception in females with knee osteoarthritis

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  • The Parker Institute

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The purpose of this study was to assess the effect of whole body vibration (WBV) exercise on muscle strength and proprioception in female patients with osteoarthritis in the knee (knee-OA). A single blinded, randomised, controlled trial was performed in an outpatient clinic on 52 female patients diagnosed with knee-OA (mean age 60.4 years+/-9.6). They were randomly assigned to one of 3 groups: 1. WBV-exercise on a stable platform (VibM; n=17 (mean age, 61.5+/-9.2)), WBV-exercise on a balance board (VibF; n=18 (mean age, 58.7+/-11.0)), or control group (Con; n=18 (mean age, 61.1+/-8.5)). The WBV groups trained twice a week for 8 weeks, with a progressively increasing intensity. The WBV groups performed unloaded static WBV exercise. The following were measured: knee muscle strength (extension/flexion) and proprioception (threshold for detection of passive movement (TDPM)). Self-reported disease status was measured using WOMAC. It was found that muscle strength increased significantly (p<0.001) in VibM compared to Con. Isometric knee-extension significantly increased (p=0.021) in VibM compared to Con. TDPM was significantly improved (p=0.033) in VibF compared to Con, while there was a tendency (p=0.051) for VibM to perform better compared to Con. There were no effects in the self-reported disease status measures. This study showed that the WBV-exercise regime on a stable platform (VibM) yielded increased muscle strength, while the WBV-exercise on a balance board (VibF) showed improved TDPM. The WBV-exercise is a time-saving and safe method for rehabilitation of women with knee-OA.
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Effect of whole body vibration exercise on muscle strength and proprioception in
females with knee osteoarthritis
T. Trans
a
, J. Aaboe
a
, M. Henriksen
a
, R. Christensen
a
, H. Bliddal
a,
, H. Lund
b
a
Clinical Motor Function Laboratory, The Parker Institute, Frederiksberg Hospital, Denmark
b
Research Initiative for Physical Therapy, Institute of Sports Science and Biomechanics, University of Southern Denmark, Denmark
abstractarticle info
Article history:
Received 25 June 2008
Received in revised form 18 November 2008
Accepted 19 November 2008
Keywords:
Osteoarthritis
Whole body vibration
Muscle strength
Proprioception
Knee
The purpose of this study was to assess the effect of whole body vibration (WBV) exercise on muscle
strength and proprioception in female patients with osteoarthritis in the knee (knee-OA). A single blinded,
randomised, controlled trial was performed in an outpatient clinic on 52 female patients diagnosed with
knee-OA (mean age 60.4 years± 9.6). They were randomly assigned to one of 3 groups: 1. WBV-exercise on a
stable platform (VibM; n= 17 (mean age, 61.5± 9.2)), WBV-exercise on a balance board (VibF; n=18 (mean
age, 58.7 ± 11.0)), or control group (Con; n=18 (mean age, 61.1± 8.5)).
The WBV groups trained twice a week for 8 weeks, with a progressively increasing intensity. The WBV
groups performed unloaded static WBV exercise.
The following were measured: knee muscle strength (extension/exion) and proprioception (threshold
for detection of passive movement (TDPM)). Self-reported disease status was measured using WOMAC.
It was found that muscle strength increased signicantly (pb0.001) in VibM compared to Con. Isometric
knee-extension signicantly increased (p=0.021) in VibM compared to Con. TDPM was signicantly
improved (p=0.033) in VibF compared to Con, while there was a tendency (p= 0.051) for VibM to perform
better compared to Con. There were no effects in the self-reported disease status measures.
This study showed that the WBV-exercise regime on a stable platform (VibM) yielded increased muscle
strength, while the WBV-exercise on a balance board (VibF) showed improved TDPM. The WBV-exercise is a
time-saving and safe method for rehabilitation of women with knee-OA.
© 2008 Elsevier B.V. All rights reserved.
1. Introduction
Knee osteoarthritis (OA) is characterized by pain and impairment
in body functions such as muscle strength, proprioception and joint
stability [1,2]. In addition, knee OA has a major impact on physical
functioning in daily life and frequently leads to moderate to severe
limitations in participation [3,4].
Optimal neuromuscular function is suggested to be of critical
importance to development and/or progression of knee OA [2].
Compared to healthy participants, patients with knee OA have a
poorer joint position sense (JPS) and a higher threshold for detection
of passive movement (TDPM), i.e. a reduced proprioceptive function
of the affected joint [57]. Several studies and systematic reviews
have clearly indicated a short term effect of exercise on pain and
disability in OA patients [8,9], but this effect is not sustained in the
long term [10]. However, exercise, and strength training in particular,
could be potentially damaging to the OA affected joint if the load is
too high or malalignment is present [11]. Thus exercise performed
within the therapeutic window where the load is high enough to have
effect, but not high enough to deteriorate the osteoarthritis, would be
desirable.
Whole body vibration (WBV) exercise have been shown to
increase muscle strength [1214], and several studies have shown
that WBV is a time- saving, safe and effective interventi on for reducing
age-related decline in muscle strength and improve functional
capacity [1517] . Thus, WBV exercise could yield similar effects as
regular strength training but with lower loads on the affected joint,
due to low joint dynamics during exercise. In addition, WBV exercise
might also improve neuromuscular performance [18,19].WBV
training has typically been applied on a stable WBV-platform, but
recently a vibration platform built into a balance board has been
introduced, thus increasing the demand of stabilization and postural
control to the patient. The purpose of this study was to evaluate
whether WBV could improve muscle strength, proprioception,
decrease pain and disability on patients with knee OA. The current
paper presents the effect of WBV training on muscle strength and
proprioception.
The Knee 16 (2009) 256261
Corresponding author. The Parker Institute, Frederiksberg Hospital, Denmark. Tel.:
+45 38 16 41 55.
E-mail address: parker@frh.regionh.dk (H. Bliddal).
0968-0160/$ see front matter © 2008 Elsevier B.V. All rights reserved.
doi:10.1016/j.knee.2008.11.014
Contents lists available at ScienceDirect
The Knee
2. Materials and methods
2.1. Participants
Two-hundred and twelve women diagnosed with osteoarthritis
in one or both kneeswere invited by mail to participate in the study.
Sixty subjects volunteered to participate (Fig. 1). The patients were
recruited from the outpatient clinic and were all otherwise healthy,
without other medical diseases (e.g. diabetes mellitus, earlier
neurological disease, etc.), hip, ankle, neck or back pains. Fifty-two
patients (mean age: 60.4± 9.6 years) (Table 1) fullled the ACR
criteria for knee OA [20], including both clinical and radiographic signs
of OA, and all patients' diagnosis of knee OA had been made from 2 to
10 years before participating in this study. The patients had mild to
moderate OA, as indicated by both the Western Ontario and McMaster
Universities' OA index (WOMAC) [21]. Disease duration was from 2 to
10 years. The patients were either on no medication or on stable minor
pain medication, e.g. paracetamol and low-dose non-steroidal anti-
inammatory drugs not expected to inuence the sensory afferent
function, and none had been injected or received other invasive
therapies in their joints during the preceding 3 months. Weight and
height were measured during baseline measurements and body mass
index (BMI: weight [kg]/height
2
[m
2
]) was calculated.
The Scientic Ethics Committee for Copenhagen and Frederiksberg
(J. no. KF 01-077/02) approved the experimental protocol and each
participant signed an informed consent before participating in the
study.
2.2. Design
The study was designed as a single blinded, randomized, con-
trolled clinical trial. All subjects were randomly assigned to one of
three interventions: 1) balance board with built-in vibration (VibF), 2)
stable vibration platform (VibM) or 3) control group (Con). The
randomization was envelope based, with concealed allocation until all
baseline measurements were performed. The characteristics of the 52
subjects that completed all pre tests are given in Table 1. No signicant
differences in age, weight, height and BMI among all groups were
detected at the start of the study (Table 1). The two intervention
programs consisted of 16 training sessions within an 8-wk period.
Training frequency was twice a week with at least 2 days of rest
between two sessions. The control group did not participate in any
training.
2.3. Whole body vibration training
WBV training was performed on a conventional stable WBV-
platform (VibM, Xendon, Sweden) (VibM) or a balance board with a
built-in vibration device (Vibrosfäre, ProMedVi, Sweden) (VibF). Both
machines are applying whole-body vibration/oscillation muscle
stimulation to the lower extremities. The subject stands with bent
knees and hips on the platform, which oscillates with a sagittal axle,
giving thrusts to the legs alternately upwards and downwards. The
patients exed their knees until a position in which they could perform
the entire exercise bout without pain and fatigue. The amount of knee
exion was thus gradually progressed if the patients improved in
muscle strength, endurance and/or symptoms. The neuromuscular
system reacts to this vibration in a chain of rapid muscle contractions,
Fig. 1. Study ow chart. Test 1 is the baseline assessment. Test 2 is the assessment after
8 weeks of WBV-exercise or control. ITT: Intention to treat. PP: Per protocol.
Table 1
Demographic data and baseline observations in the self- reported questionnaire
(WOMAC), muscle strength and proprioception tests of each trial group
Characteristics Control
(n=17)
VibF
(n=18)
VibM
(n=17)
Total
(n=52)
Age, years 61. 8.5 58.7 ± 11.0 61.5±9.2 60.4 ± 9.6
Weight, kg 81.6± 15.4 80.0±18.7 80.6 ±14.4 80.7± 16.0
Height, cm 164± 5.3 165± 6.3 167 ± 5.9 165± 6.0
Body-mass index, kg/m
2
30.2± 5.4 29.1± 5.8 29.2 ±6.1 29.5 ± 5.7
WOMAC, pain 0100 mm 25.5± 20.7 30.9± 22.1 22.8±16.2 26.5± 19.8
WOMAC, disability 0100 mm 28.5± 19.0 29.5± 23.5 25.5± 18.6 27.9± 20.2
WOMAC, stiffness 0100 mm 43.3 ± 30.7 36.1 ± 32.0 30.7 ± 24.5 36.6 ± 29.1
Isokinetic muscle strength
Extension (Nm)
30°·s
1
63.8± 26.4 56.2 ± 28.9 69.5 ± 20.4 63.3 ± 25.4
60°·s
1
60.1± 21.3 48.3± 21.7 66.1 ± 17.3 58.5± 21.0
90°·s
1
60.1± 20.0 46.2 ± 21.2 65.8±14.1 57.7± 19.9
Flexion (Nm)
30°·s
1
36.2± 9.8 33.8±12.5 42.7 ± 12.0 37.6± 11.8
60°·s
1
38.3± 8.9 36.5±13.3 43.4 ± 12.5 39.5 ± 11.7
90°·s
1
36.6 ± 10.2 34.7± 13.4 44.2 ± 10.4 38.6 ± 11.8
Isometric muscle strength
Extension (Nm) 71.4± 26.4 61.1± 26.4 76.2 ± 17.9 69.8 ± 24.1
Flexion (Nm) 34.5± 12.0 31.5± 10.5 45.0 ± 13.4 37.1 ± 13.1
TDPM (s) 2.4 ± 1.1 3.0 ±1.1 2.1± 0.8 2.5± 1.0
The data are presented as a mean ±SD.
Table 2
WBV training program and progress
Week Day Frequency Time/rep. Exercise
1 Mon 25 Hz 30 s/6 Static
Thur 25 Hz 30 s/6 Static
2 Mon 25 Hz 40 s/6 Static
Thur 25 Hz 40 s/6 Static
3 Mon 25 Hz 50 s/6 Static
Thur 25 Hz 50 s/7 Static
4 Mon 25 Hz 60 s/7 Static
Thur 25 Hz 60 s/7 Static
5 Mon 30 Hz 40 s/7 Static
Thur 30 Hz 50 s/7 Static
6 Mon 30 Hz 50 s/8 Static
Thur 30 Hz 50 s/8 Static
7 Mon 30 Hz 60 s/8 Static
Thur 30 Hz 60 s/8 Static
8 Mon 30 Hz 70 s/8 Static
Thur 30 Hz 70 s/9 Static
257T. Trans et al. / The Knee 16 (2009) 256261
which are in fact reex muscle stimulation [18]. Both exercise groups
were similarly instructed to undergo static WBV-training, such that the
actual exercise time, intervals and intensity were identical. Training
volume and intensity were low at the beginning but progressed slowly
according to the overload principle. The training volume was increased
systematically over the 8-week training period by increasing the
number of repetitions in one session. The training intensity was
increased by increasing the frequency (24 Hz30 Hz) of the vibration
or the time/rep. on the vibrating platform (Table 2). The duration of
the WBV training program was a maximum of 10 1/2 min at the end of
week 8. The ratio between rest and training time was 1:1. The exercise
was administrated by a skilled physiotherapist. The subjects were
asked not to perform any physical training on their WBV training dayor
on the day of the tests. During all WBV training sessions, the training
clothes and shoes was standardized. The subjects were asked to report
negative side effects or adverse reactions in their training diary.
2.4. Outcomes
2.4.1. Muscle strength
Maximal voluntary muscle strength of hamstrings and the
quadriceps muscles was measured by isokinetic dynamometry at
30°/s, 60°/s, and 90°/s (Biodex System 3 PRO, Biodex Medical System,
NY, USA) as previously described [22].
2.4.2. Proprioception
Threshold for detection of passive movement (TDPM) was dened
as the participant's ability to recognize a passive movement of the
lower leg (knee extension), and was measured bilaterally. The method
is previously described [23].
In short, the patients should indicate when a passive extension of
the knee (1°/s) was recognized. The patients were instructed to press
a button when the passive movement was recognized. The time (in
milliseconds) from movement start to the button press was recorded
and dened the TDPM. A reliability study of knee TDPM was per-
formed before the actual measurements and showed an ICC (2.1) [24]
of 0.87, indicating an excellent reliability.
2.4.3. Self-reported disease status
The Western Ontario and McMaster Universities Osteoarthritis
Index (WOMAC) questionnaire was used to evaluate level of pain,
joint stiffness and functional capacity [25,26] on a 0100 mm Visual
Analogue Scale (VAS). The patients had mild to moderate OA, as
indicated by baseline WOMAC (Table 1). The WOMAC scores are
presented as the mean of the possible scores for each of the three sub-
scales (function, pain, and stiffness).
2.5. Statistical analysis
An estimate of the necessary sample needed to detect a minimal
relevant change in WOMAC pain of 20 points (SD 20), at a signicance
level of 0.05 and a power of 0.8 was calculated to be 17 subjects in each
group [27].
The baseline data are presented as means ± standard deviation
(SD). The longitudinal changes (presented as mean± standard error
(SE)) of the dependent variables were evaluated by 1-factor analysis
of covariance (ANCOVA), with the value at baseline applied as a
covariate and group allocation as a factor (with 3 levels). In case of
Fig. 2. Isokinetic peak torque pooled and overall pooled. Forest plot of isokinetic peak
torque pooled for both knee extension and knee exion and also overall pooled for both
knee extension and knee exion at angular velocities 30°/s, 60°/s and 90°/s after the
training period. indicates weighted mean difference (WMD) in Nm between VibF and
Con (VibFCon). indicates weighted mean difference (WMD) in Nm between VibM
and Con (VibMCon). Errorb ars represent SE. The results are showed both as
differences between groups for each angular velocities (30°/s, 60°/s and 90°/s), and
as a pooled result. Pooled results are showed as enlarged symbols. The two pooled
results for each angular velocity are collected as an overall pooled result, which are
showed at the bottom of the gure. Values are not adjusted for baseline.
Fig. 3. Isometric knee extension and knee exion peak torques. Baseline and follow-up averagepeak torques (Nm) after 8 weeks in the VibF, VibM, and Con groups. Errorbars are SE.
Left: Extension. Right: Flexion. p= 0.021. The values are adjusted for baseline.
258 T. Trans et al. / The Knee 16 (2009) 256261
missing data, the baseline observation carried forward (i.e. BOCF)
method was used as the intention to treat (ITT) population in the
analyses; all statistical analyses were performed using the Generalized
Linear Model (GLM) using SAS
®
statistical software (version 8; SAS
institute Inc., Cary, NC, USA). The signicance level was set at Pb0.05
(two-tailed) for all the comparisons.
2.5.1. Isokinetic muscle strength using repeated measures analysis
In order to pool the available data for isokinetic muscle strength,
comparing VibF vs. Con and VibM vs. Con explicitly we applied a
hierarchical model. In analogy to a meta-analysis, this can be il-
lustrated using a forest plot, although multiple measurements on the
same individual would probably violate the assumption of indepen-
dence. The multiple isokinetic measurements on the same individual
would be expected to be correlated. We applied a repeated-measures
mixed-model with various angular velocities and directions handled
as time points in the so-called Diggle model [28], which allowed
interpretation on various levels of the model, as presented in Fig. 2.
3. Results
In the VibF and VibM groups, subjects got acquainted very rapidly to the exercise
protocol. There were no reports of adverse side effects. During the rst weeks of the
study, 8 subjects dropped out (16%); 4 subjects from the VibF, 3 subjects from the VibM
and 1 subject from the control group. All of these drop-outs were related to matters that
had nothing to do with the training program (e.g. liver cancer (1), scheduled knee-
replacement (1), uteral surgery (1), slipped disc (1), depression (1), moving to another
city (1), holiday during the training period (2).
All remaining subjects of the training groups performed 16 training sessions and
attended respectively 83% and 86% of the exercise sessions for VibF and VibM. The
characteristics of the 44 subjects that completed all pre and post tests are given in
Table 1. There were no signicant differences in any of the baseline characteristics (age,
weight, height, BMI, WOMAC, muscle strength and TDPM) between the WBV exercise
groups and the control group (Table 1).
3.1. Isokinetic knee extension and knee exion peak torque overall pooled
Isokineticpeak torque overall pooled, are thepooled peak torque values for both knee
extension and exion at angular velocities 30°/s, 60°/s and 90°/s. For isokinetic peak
torqueoverall pooled we founda signicant difference between VibM and Con (weighted
mean difference 7.6 Nm (95% CI 3.5:11.6) pb0.001) (Fig. 2), whereas no signicant
difference was found between VibFand Con (weighted meandifference 1.4 N m ( 95 % CI
5.9:3.1) p=0.5472).
3.2. Isometric peak torque knee extension and knee exion
Regarding isometric strength a signicant difference was found between VibM and
Con concerning knee extension (weighted mean difference 11.9 Nm (95% CI 1.9:22.0)
p=0.021), whereas no signicant difference was found between VibF and Con
(weighted mean difference 8.1 Nm (95% CI 2.3:18.4) p=0.1232) (Fig. 3A). No
differences were observed in knee exion VibM and Con and VibF and Con respectively
(weighted mean difference 1.6 Nm (95% CI 5.8:8.9) p=0.6713 and weighted mean
difference 1.8 (95% CI 5.3:8.8) p=0.6162) (Fig. 3).
3.3. Proprioception
In the VibF group a signicant improvement in TDPM compared to Con was found
(weighted mean difference 0.59 s (95% CI 1.13: 0.05) p= 0.0326) (Table 3).
Furthermore there was a tendency of an improved TDPM in the VibM group compared
to Con (weighted mean difference 0.52 s (95% CI 1.04:0.00) p=0.0511). There was
no signicant difference between VibF and VibM (weighted mean difference 0.07 s
(95% CI 0.64:0.50) p= 0.8052) (Fig. 4).
3.4. Self-reported disease status
The longitudinal intra group changes from baseline to the follow-up measurement
are shown in Table 3. No signicant differences between groups were observed.
4. Discussion
This is the rst randomized controlled trial investigating the effects
of WBV-training on knee muscle strength, proprioception, and self-
reported disease status, in subjects with knee-OA. The results of this
study show that while knee muscle strength was signicantly im-
proved after WBV training on a stable platform (VibM) and pro-
prioception (TDPM) improved signicantly after WBV training on a
vibrating balance board (VibF), no effects on self-reported disease
status were observed in either group compared to the control group.
The observed effects cannot be considered as immediate training
effects because the post-test measurements were performed at least
72 h after the last training session. Earlier training studies on knee-OA
patients have shown signicantly improved muscle strength and
proprioceptive performance [12,13,2932]. Similar ndings have been
reported following WBV-training studies on untrained young women
and postmenopausal women [33].
The improved muscle strength in VibM found in the present study
is comparable to previous results of increased muscle strength after a
WBV training period [12,13,32,34]. In contrast, no increase in muscle
strength after two-legged WBV training has also been reported [35],
which is supported by a study that found no differences between the
combination of WBV training and conventional resistance training
and conventional resistance training alone [36]. The subjects in the
before mentioned negative studies were young, healthy and physically
active, while the subjects in our study were patients with knee-OA.
This indicates that the training status is important for the outcome of
the WBV training effects. As mentioned above we found signicantly
improved muscle strength in VibM but only a tendency in VibF. The
reason for this may be due to the mixed therapeutic interventions in
the VibF (balance and vibrations).
During a whole body vibration loading, skeletal muscles undergo
small changes in muscle length. Vibrations elicit a response called
tonic vibration reex, including activation of muscle spindles,
mediation of the neural signals by Ia afferents, and activation of
muscle bres via large α-motor neurons. The tonic vibration reex is
also able to cause an increase in recruitment of the motor units through
activation of muscle spindles and polysynaptic pathways [37]. It is well
Fig. 4. Threshold for detection of passive movements (TDPM). Baseline and follow-up
average TDPM values (seconds) after 8 weeks in the VibF, VibM, and Con groups.
Errorbars are SE. p= 0.0326; #p= 0.0511. The data are adjusted for baseline.
Table 3
Summaries of the results in self-reported questionnaire (WOMAC) and TDPM results
Per protocol VibF vs. Con VibM vs. Con
WMD 95% CI p-value WMD 95% CI p-value
WOMAC pain,
0100 m m
6.8 (20.1;6.6) 0.41 1.4 ( 14.6;11.9) 0.96
WOMAC disability,
0100 m m
2.7 (14.8;9.4) 0.83 1.2 (13.3;10.9) 0.96
WOMAC stiffness,
0100 m m
5.6 (8.7;19.8) 0.58 1.3 (13.2;15.9) 0.97
TDPM (s) 0.59 (1.13 ;0.05) 0.03 0.52 (1.04;0.00) 0.05
The data are presented as a weighted mean difference (WMD) between groups, with
95% condence interval (95% CI) and level of signicant (p-value) after 8 wk in the VibF
(n=13), VibM (n=14) and Con (n= 15) groups. The values are adjusted for baseline.
259T. Trans et al. / The Knee 16 (2009) 256261
known that the input of proprioceptive pathways (Ia, IIa and probably
IIb) play an important role in the production of isometric contractions
[13,32]. The increase in isometric strength after WBV training with
extensive sensory stimulation might be the result of a more efcient
use of the positive proprioceptive feedback loop. It may be speculated
that increased muscle strength after WBV is due to neural adaptation.
The exact mechanism by which muscle strengthis improved is beyond
the ndings of this study.
Improved TDPM was only observed in the VibF group, while the
VibM group showed a tendency. The statistical power (type II error) in
the VibM group was 35%, and based on the present results a signicant
difference would require a study with 64 patients in each group [27],
indicating that a type II error is likely to have occurred. Since the VibF
and VibM groups received similar doses of vibrations during exercise,
the proprioceptive improvement in VibF may be attributed to the
balance board. To the bestof our knowledge, no study has investigated
the effects of WBV training on proprioception before. Studies have
investigated the effect of other training types on proprioception in
older women and patients with knee-OA. In a comparison between
two types of training (kinaesthesia and balance training vs. resistance
training) in patients with knee-OA improved joint position sense was
detected in both groups, while the group that trained kinaesthesia and
balance exercises had an additional improved functional capacity and
motor control [33]. The results from the present study corroborate
this. Earlier WBV-studies have generally used higher training doses,
considering both frequency and amplitude [16,38,39], than used in the
present study. Nevertheless, the data fromour study suggest that even
with low WBV-training doses female patient with knee-OA can
improve muscle strength and neuromuscular performance.
This study shows that WBV training is a safe (no adverse effects),
suitable (no drop-outs due to the intervention) and effective
(increased muscle strength) training methodand potentially a
feasible intervention for those patients that cannot participate in
conventional strength training. The ndings of this study indicate that
WBV training has potential for strength gain in female patients with
mild to moderate knee-OA. Additionally, WBV training could yield
similar effects as regular strength training [13,32], but with lower
loads on the affected joint.
The lack of effects on self-reported disease status is in contrast to
earlier RCT studies, which have described effects of WBV on muscle
strength, functional tasks and self reported health scores in elderly
people [4042]. Several factors may explain these different ndings.
Firstly, the applied WBV-exercise may not have the potential to alter
physiological mechanisms to an extent that inuences self-reported
disease status, and the applied exercise dose may have been to low to
have clinical effects of WBV-exercise. Secondly, the low number of
subjects could result in a type II error. Finally, we did not measure
clinical variables related to knee-OA characteristics (such as align-
ment, range of motion, degree of muscle wasting, radiographic
grading of knee-OA), and it is possible that such characteristics may
have inuenced the effects of the exercise, and masked the results.
In conclusion, this is the rst study that demonstrates a WBV
training effect in patients with knee-OA. The ndings of this study
indicate that quadriceps strength, and more specically isometric and
isokinetic quadriceps strength, improves after 8 weeks of WBV training
on a stable platform (VibM) in patients with knee-OA. Additionally, the
data also suggest that proprioception (TDPM) may be improved after
WBV training on a balance board with built in vibration (VibF). While
strength and proprioceptive improvements were found, no effects in
self-reported clinical effects were observed. Further research is needed
to investigate the mechanism of strength gain and improved
proprioception, and their relationships with clinical outcomes.
5. Conicts of interest
None.
Acknowledgments
This study was supported by The Oak Foundation.
In the study period, the equipment for whole body vibration was
lent for free by Xendon, Sweden and ProMedVi, Sweden.
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... The summary of the included studies for the current systematic review is shown in (27), Denmark (28), and Iran (29). In order to assess for knee OA, 8 studies used the American College of Rheumatology guidelines (14,16,19,20,22,24,26,28), 2 studies used Kellgren and Lawrence classification (27,29), 3 studies used Lequesne index (15,23,25), and 1 study used Ahlbäck classification (21). ...
... The summary of the included studies for the current systematic review is shown in (27), Denmark (28), and Iran (29). In order to assess for knee OA, 8 studies used the American College of Rheumatology guidelines (14,16,19,20,22,24,26,28), 2 studies used Kellgren and Lawrence classification (27,29), 3 studies used Lequesne index (15,23,25), and 1 study used Ahlbäck classification (21). ...
... Twelve studies used vertical vibration (15,16,(19)(20)(21)(22)(23)(25)(26)(27)(28)(29), and 2 studies used multi-directional vibration Studies included in meta-analysis (n = 10) ...
Article
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Introduction: Knee osteoarthritis is a leading cause of disability and medical costs. The effect of whole-body vibration is still controversial in knee osteoarthritis. The aim of this study was to assess the effects and safety of whole-body vibration on pain, stiffness, physical function, and muscle strength in patients with knee osteoarthritis. Methodology: Pubmed, Scopus, Web of Science, Physiotherapy Evidence Database (PEDro) and EMBASE databases were searched (date last accessed on April 1, 2021) using the keywords "vibration" and "knee osteoarthritis", to identify all randomized controlled trials related to WBV and knee osteoarthritis. Outcomes related to pain, stiffness, physical function, muscle strength, adverse events were included. The risk of bias and quality were assessed by the Cochrane collaboration tool and PEDro scale. Systematic review and meta-analysis were performed. Subgroup analysis was performed for low- and high-frequency interventions. Results: Fourteen randomized controlled trials involving 559 patients with knee osteoarthritis met the inclusion criteria. 9 studies were good quality trials (PEDro score = 6-8), 5 studies were fair quality trials (PEDro score = 4-5). 10 studies were included in the meta-analysis. One study showed negative effects of WBV on knee osteoarthritis. The duration of WBV treatment ranged from 4 to 24 weeks. Meta-analysis revealed that WBV with strengthening exercises has a significant treatment effect in pain score (SMD=0.46 points, 95% CI=0.20-0.71, p=0.0004), The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC-function) (SMD=0.51 points, 95% CI= 0.27-0.75, p<0.0001), timed up and go (TUG) test (SMD=0.82 points, 95% CI=0.46-1.18, p<0.00001), extensor isokinetic peak torque (SMD=0.65 points, 95% CI=0.00-1.29, p=0.05), peak power (SMD=0.68 points, 95% CI=0.26-1.10, p=0.001), and extensor isometric strength (SMD=0.44 points, 95% CI=0.13-0.75, p=0.006). Both low-frequency (10-30 Hz) and high-frequency (30-40 Hz) WBV were associated with significant changes in pain, physical function, and knee extensor strength (p<0.05). WBV was not associated with significant changes in stiffness, balance ability, quality of life, and knee flexor strength. No adverse events were reported. Conclusion: Meta-analysis showed that low-frequency and high-frequency whole-body vibration had additional positive effects compared to strengthening exercises alone on pain, knee extensor muscle strength, and physical function in individuals with knee OA. whole-body vibration with strengthening exercises can be incorporated into treatment protocols.
... Out of the included studies, seven studies used Fitvibe vertical vibration device (Abbasi et al., 2017;Avelar et al., 2011;Bokaeian et al., 2016;Simao et al., 2019;Simão et al., 2012;Sobhani et al., 2018;Zahedi et al., 2017), three studies used Side-alternating vibration device (Moreira-Marconi et al., 2020;Moura-Fernandes et al., 2020;Osugi et al., 2014), three studies used PowerPlate® vertical vibration device (Salmon et al., 2012;Tsuji et al., 2014;Wang et al., 2016), and one study used Vibrosphere® vibration device (Trans et al., 2009), one study used unstable shoes with Fitvibe vertical vibration device (Sobhani et al., 2018), other studies used other different WBV devices. The characteristics of the 17 included studies are tabulated in Table 1 & Table 2. ...
... This review found only one study which assessed muscle strength using unstable surface with WBV in KOA. Trans et al. (2009) assessed the effects of unstable (Vibrosphere®) and stable surface WBVT on quadriceps and hamstring strength using isokinetic dynamometry in 52 females with KOA. For Isokinetic peak torque, there was a significant difference between the stable surface WBV and control groups (weighted mean difference 7.6 Nm (95% Confidence interval -3.5:11.6) ...
... As a result this study concluded that proprioception improved immediately after WBV at 60 Hz in both healthy and KOA group. Trans et al. (2009) assessed the effects of unstable (Vibrosphere®) and stable surface WBVT on proprioception in 52 females with KOA. They found improvement in threshold for detection of passive move-ment (TDPM) in the Vibrosphere® group as compared to control (weighted mean difference −0.59 s (95% CI −1.13:−0.05) ...
Article
Introduction Whole body vibration (WBV) has received much attention in recent years but there is lack of consensus as far as its effects are concerned. It is usually applied on stable surface but its effects on unstable surface are also being explored. However, only a few studies have described the efficacy of using unstable surface on WBV platform in knee osteoarthritis (KOA) and this lack of information generates uncertainties regarding the efficacy of stable and unstable WBV training in KOA. Objective To identify the efficacy of stable and unstable surface WBV training in KOA. Methods Comprehensive searches, combining “whole body vibration”, “knee osteoarthritis”, and “unstable surface” were conducted on PubMed, Web of Science, Science Direct, Cochrane library and Google Scholar. Randomized control trials focusing on outcomes muscle activity, strength, proprioception, balance and pain using unstable and stable platform WBV in KOA were included. Data were charted and narrative synthesis applied. Results 17 studies were included. There is no consensus on the effects of stable surface WBV in KOA. Only limited studies used unstable platform WBVT in KOA. Majority of studies in KOA either using stable or unstable surface WBV failed to provide the exact mechanism of WBV. Conclusions Stable surface WBV improve strength, balance, sEMG activity, proprioception, and provide mild degree of instability while higher degree of instability would be given when WBV is performed on unstable surface and may positively stress the neuromuscular system to a greater extent than the stable WBV by various mechanisms.
... Vibration therapy may reduce the effects of AMI by altering somatosensory input to articular and cutaneous mechanoreceptors. In the context of orthopedic injury, both whole-body and local muscle vibration have enhanced various aspects of muscle function among individuals with ACLR, 134-138 experimental effusion, 139 knee OA, [140][141][142][143][144] total knee arthroplasty, 145 knee pain, 146 and chronic ankle instability. 147 Vibration has been conventionally applied in short bouts (30-60 s) either indirectly via platform (whole-body) or directly to a muscle-tendon unit (local) during therapeutic exercise or a series of isometric squats with protocols ranging from 1 to 24 sessions over 8 to 12 weeks. ...
... 147 Vibration has been conventionally applied in short bouts (30-60 s) either indirectly via platform (whole-body) or directly to a muscle-tendon unit (local) during therapeutic exercise or a series of isometric squats with protocols ranging from 1 to 24 sessions over 8 to 12 weeks. In several studies, individuals with knee OA and knee pain experienced improvements in quadriceps strength [142][143][144]146 with broader effects described among those with experimental effusion and ACLR. A series of studies 139,148 demonstrated that single bouts of vibration can result in immediate improvement in quadriceps strength, rate of torque development, muscle activity, voluntary activation, and corticospinal excitability in these populations. ...
Article
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Context: Arthrogenic muscle inhibition (AMI) impedes the recovery of muscle function following joint injury, and in a broader sense, acts as a limiting factor in rehabilitation if left untreated. Despite a call to treat the underlying pathophysiology of muscle dysfunction more than three decades ago, the continued widespread observations of post-traumatic muscular impairments are concerning, and suggest that interventions for AMI are not being successfully integrated into clinical practice. Objectives: To highlight the clinical relevance of AMI, provide updated evidence for the use of clinically accessible therapeutic adjuncts to treat AMI, and discuss the known or theoretical mechanisms for these interventions. Evidence acquisition: PubMed and Web of Science electronic databases were searched for articles that investigated the effectiveness or efficacy of interventions to treat outcomes relevant to AMI. Evidence synthesis: 122 articles that investigated an intervention used to treat AMI among individuals with pathology or simulated pathology were retrieved from 1986 to 2021. Additional articles among uninjured individuals were considered when discussing mechanisms of effect. Conclusion: AMI contributes to the characteristic muscular impairments observed in patients recovering from joint injuries. If left unresolved, AMI impedes short-term recovery and threatens patients' long-term joint health and well-being. Growing evidence supports the use of neuromodulatory strategies to facilitate muscle recovery over the course of rehabilitation. Interventions should be individualized to meet the needs of the patient through shared clinician-patient decision-making. At a minimum, we propose to keep the treatment approach simple by attempting to resolve inflammation, pain, and effusion early following injury.
... Regarding the changes and consequent neuromuscular modifications of the hands, to our knowledge, there are no studies that have reported this in RA population. However, Krol et al. [34] and other researches demonstrated an increase in the neuromuscular efficiency and concluded that vibration exercise can be useful to stimulate the neuromuscular system in healthy population [14,19,20,36]. ...
... WBV exercise is reported to represent an alternative exercise for the treatment of RA due to its ability in promoting lower joint impact and greater neuromuscular modifications. Previous studies have reported satisfactory results of using WBV training that ranged from 24 [13,35,36]. Nevertheless, the current WBV parameters (frequency: 45 Hz; amplitude: 2 mm, acceleration: 159.73 m·s -2 ) of 5 minutes continuous WBV were selected based on previous research [19,20,22,23]. ...
Article
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Objective: Rheumatoid arthritis (RA) causes progressive changes in the musculoskeletal system compromising neuromuscular control especially in the hands. Whole-body vibration (WBV) could be an alternative for the rehabilitation in this population. This study investigated the immediate effect of WBV while in the modified push-up position on neural ratio (NR) in a single session during handgrip strength (HS) in women with stable RA. Methods: Twenty-one women with RA (diagnosis of disease: ±8 years, erythrocyte sedimentation rate: ±24.8, age: 54± 11 years, BMI: 28 ± 4 kg·m-2) received three experimental interventions for five minutes in a randomized and balanced cross-over order: (1) control-seated with hands at rest, (2) sham-push-up position with hands on the vibration platform that remained disconnected, and (3) vibration-push-up position with hands on the vibration platform turned on (45 Hz, 2 mm, 159.73 m·s-2). At the baseline and immediately after the three experimental interventions, the HS, the electromyographic records (EMGrms), and range of motion (ROM) of the dominant hand were measured. The NR, i.e., the ratio between EMGrms of the flexor digitorum superficialis (FDS) muscle and HS, was also determined. The lower NR represented the greater neuromuscular efficiency (NE). Results: The NR was similar at baseline in the three experimental interventions. Despite the nonsignificance of within-interventions (p = 0.0611) and interaction effect (p = 0.1907), WBV exercise reduced the NR compared with the sham and control (p = 0.0003, F = 8.86, η 2 = 0.85, power = 1.00). Conclusion: Acute WBV exercise under the hands promotes neuromuscular modifications during the handgrip of women with stable RA. Thus, acute WBV exercise may be used as a preparatory exercise for the rehabilitation of the hands in this population. This trial is registered with trial registration 2.544.850 (ReBEC-RBR-2n932c).
... It is still being investigated whether WBV has a positive effect on proprioception, and data from studies conducted are not unambiguous. Trans et al. (2009) report that WBV training on a stable platform (VibM) leads to an increase in knee muscle strength (extension/flexion), while WBV on a balance platform improves proprioception (threshold for detection of passive movement). Segal et al. (2013) reported that the addition of vibration therapy to a 12-week exercise program did not significantly improve the strength or power of the lower limb, compared to exercise programe without vibration therapy. ...
Article
Full-text available
Osteoarthritis (OA) is one of the most common musculoskeletal diseases, which has a negative impact on patients, and is a major cause of disability and reduced quality of life. The purpose of this article is to review published scientific studies concerning the use of Whole-body vibration (WBV) and therapeutic benefits in the rehabilitation of patients with knee joint osteoarthritis (KOA). Materials and methods: For this article, a review of available scientific articles examining the use of WBV therapy in patients with osteoarthritis of the knee joint was made with the aim to investigate the therapeutic impact of vibration therapy on muscle strength, balance, proprioception, pain, and functional activity in gonarthritis. Results: The review of the available literature revealed evidence of a positive effect of WBV therapy on one or more observed indicators, including muscle strength, postural balance, proprioception, pain, and functional activity in KOA. Depending on the applied therapeutic program (with or without performing therapeutic exercises) and the type of vibration platform used and the frequency of vibrations, there is ambiguity in the achieved therapeutic results. Data from studies that report increased muscle strength, improved balance, improved proprioception, and reduced pain have been reported, although there are data from other studies that show no significant changes after WBV training. Conclusion: Whole-Body Vibration is a therapeutic modality that is ussed to stimulate mechanically the musculoskeletal system. The inclusion of WBV in the rehabilitation program in patients with KOA can effectively: increase muscle strength, improve balance and proprioception, reduce pain, and increase functional activity. Although there are data from studies that do not reveal significant changes after WBV application, vibrotherapy is used as a potentially efficiently and safe neuromuscular training in KOA, but the results are not unambiguous, and the studies need to be continued.
... [36] The WBV showed improvement in the proprioception of female patients with knee osteoarthritis. [37] According to Stambolieva, et al., mechanical vibration also improves tactile sensation by improving signals and transmission of senses. [22] Further research is required to discover the actual pathway for the improvement in balance measures. ...
Article
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Purpose: The aim of the study was to evaluate the effect of whole-body vibration (WBV) with balance training on strength and functional ability in patients with diabetic peripheral neuropathy (DPN). Materials and Methods: Forty (19 males and 21 females) patients with DPN participated in the study. The patients were randomly allocated to experimental group (age = 57.3 ± 7.3) and control group (age = 57.1 ± 6.5). The experimental group performed WBV with balance training, whereas the control group performed only balance exercises for three weeks (five days/week). Outcome measures included neuropathy disability score (NDS), numeric pain rating scale (NPRS), timed up and go test (TUGT), Tinetti performance-oriented mobility assessment (Tinetti POMA) scale, strength of quadriceps, and tibialis anterior and reaction time. Results: Demographic characteristics and outcome measures at baseline were found to be nonsignificant between the groups. NDS, Tinetti POMA, quadriceps, and tibialis anterior strength showed significant time effect (P ≤ 0.016) and time × group interaction (P ≤ 0.008) whereas group effect was found to be nonsignificant. TUGT only showed significant time effect (P < 0.001). NPRS and reaction time showed significant time × group interaction (P ≤ 0.002). Conclusion: The WBV with balance exercise showed improvement in the NDS, functional balance, functional mobility, and strength of the lower limb muscles when compared with balance exercises only.
Article
Background Mechanical-based therapies are not yet recommended to manage osteoarthritis (OA). This systematic review and meta-analysis aim to assess the effects of passive mechanical-based therapies (isolated or combined with other therapies) on patients with knee OA compared to placebo, other isolated or combined interventions. Methods Pubmed, Cochrane, Web of Science and EMBASE were searched up to December 2020. We included randomized and non-randomized trials using therapeutic ultrasound, phonophoresis, extracorporeal shockwave therapy (ESWT) and vibration (single or combined with other therapies) compared to placebo, and/or other physical therapies groups. Biochemical, patient-reported, physical and imaging outcome measures were retrieved. We judged risk of bias using the RoB2 tool for randomized studies, the ROBINS-I tool for non-randomized studies, and the GRADE to interpret certainty of results. Results We included 77 clinical studies. Ultrasound and ESWT statistically improved pain and disability comparing to placebo (combined or not with other therapies), and when added to other therapies versus other therapies alone. Ultrasound was statistically inferior to phonophoresis (combined or not with other therapies) in reducing pain and disability for specific therapeutic gels and/or combined therapies. Vibration plus exercise statistically improved pain relief and function versus exercise alone. All meta-analyses showed very-low certainty of evidence, with 15 of 42 (38%) pooled comparisons being statistically significant (weak to large effect). Conclusions Despite the inconsistent evidence with very-low certainty, the potential benefits of passive mechanical-based therapies should not be disregard and cautiously recommended that clinicians might use them in some patients with knee OA.
Article
Background: Knee osteoarthritis (OA) is a musculoskeletal disorder that causes pain and increasing loss of function, resulting in reduced proprioceptive accuracy and balance. Therefore, the goal of this systematic review and meta-analysis is to evaluate the effectiveness of balance training on pain and functional outcomes in knee OA. Methods: “PubMed”, “Scopus”, “Web of Science”, “Cochrane”, and “Physiotherapy Evidence Database” were searched for studies conducted between January 2000 and December 2021. Randomized controlled trials (RCTs) that investigated the effectiveness of balance training in knee OA, as well as its effects on pain and functional outcome measures, were included. Conference abstracts, case reports, observational studies, and clinical commentaries were not included. Meta-analysis was conducted for the common outcomes, i.e., Visual Analog Scale (VAS), The Timed Up and Go (TUG), Western Ontario and McMaster Universities Arthritis Index (WOMAC). The PEDro scale was used to determine the quality of the included studies. Results: This review includes 22 RCTs of which 17 articles were included for meta-analysis. The included articles had 1456 participants. The meta-analysis showed improvement in the VAS scores in the experimental group compared to the control group [ I ² = 92%; mean difference= -0.79; 95% CI= -1.59 to 0.01; p<0.05] and for the WOMAC scores the heterogeneity ( I ² ) was 81% with a mean difference of -0.02 [95% CI= -0.44 to 0.40; p<0.0001]. The TUG score was analyzed, the I ² was 95% with a mean difference of -1.71 [95% CI= -3.09 to -0.33; p<0.0001] for the intervention against the control group. Conclusions: Balance training significantly reduced knee pain and improved functional outcomes measured with TUG. However, there was no difference observed in WOMAC. Although due to the heterogeneity of the included articles the treatment impact may be overestimated. Registration: The current systematic review was registered in PROSPERO on 7th October 2021 (registration number CRD42021276674 ).
Article
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Osteoarthritis (OA) has a very high incidence worldwide and has become a very common joint disease in the elderly. Currently, the treatment methods for OA include surgery, drug therapy, and exercise therapy. In recent years, the treatment of certain diseases by exercise has received increasing research and attention. Proper exercise can improve the physiological function of various organs of the body. At present, the treatment of OA is usually symptomatic. Limited methods are available for the treatment of OA according to its pathogenesis, and effective intervention has not been developed to slow down the progress of OA from the molecular level. Only by clarifying the mechanism of exercise treatment of OA and the influence of different exercise intensities on OA patients can we choose the appropriate exercise prescription to prevent and treat OA. This review mainly expounds the mechanism that exercise alleviates the pathological changes of OA by affecting the degradation of the ECM, apoptosis, inflammatory response, autophagy, and changes of ncRNA, and summarizes the effects of different exercise types on OA patients. Finally, it is found that different exercise types, exercise intensity, exercise time and exercise frequency have different effects on OA patients. At the same time, suitable exercise prescriptions are recommended for OA patients.
Article
The purpose of this study was to determine the effects of proprioception training with kinesio taping (PTKT) of the knee joints on the proprioception, balance and gait in Stroke Patients. The subjects were randomly divided into the PTKT group and control group, with subjects assigned to each group. In the PTKT group, proprioception training with kinesio taping was performed for 4 weeks. The control group was conducted in the same method except placebo kinesio taping. Proprioception error measure using the electrogoniometer.. The balance ability was measure using the pressure plate. Gait ability was evaluated using G-Walk. The proprioception error, balance ability, and gait were significantly more improved in the PTKT group than in the control group (p<0.05). These findings suggest that proprioception training with kinesio taping of the knee joints for proprioception, balance and gait in stroke patients.
Article
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We measured joint position sense in the knee by a new method which tests the proprioceptive contribution of the joint capsule and ligaments. The leg was supported on a splint, and held in several positions of flexion. The subjects' perception of the position was recorded on a visual analogue model and compared with the actual angle of flexion. Eighty-one normal and 45 osteoarthritic knees were examined, as were 10 knees with semi-constrained and 11 with hinged joint replacements. All were assessed with and without an elastic bandage around the knee. There was a steady decline in joint position sense with age in subjects with normal knees. Those with osteoarthritic knees had impaired joint position sense at all ages (p less than 0.001). Knee replacement improved the joint position sense slightly (p less than 0.02); semi-constrained replacement had a greater effect than hinged replacement. The effect of an elastic bandage in subjects with poor position sense was dramatic, improving accuracy by 40% (p less than 0.001). It is proposed that reduced proprioception in elderly and osteoarthritic subjects may be responsible for initiation or advancement of degeneration of the knee.
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The term ‘repeated measures’ refers to data with multiple observations on the same sampling unit. In most cases, the multiple observations are taken over time, but they could be over space. It is usually plausible to assume that observations on the same unit are correlated. Hence, statistical analysis of repeated measures data must address the issue of covariation between measures on the same unit. Until recently, analysis techniques available in computer software only offered the user limited and inadequate choices. One choice was to ignore covariance structure and make invalid assumptions. Another was to avoid the covariance structure issue by analysing transformed data or making adjustments to otherwise inadequate analyses. Ignoring covariance structure may result in erroneous inference, and avoiding it may result in inefficient inference. Recently available mixed model methodology permits the covariance structure to be incorporated into the statistical model. The MIXED procedure of the SAS® System provides a rich selection of covariance structures through the RANDOM and REPEATED statements. Modelling the covariance structure is a major hurdle in the use of PROC MIXED. However, once the covariance structure is modelled, inference about fixed effects proceeds essentially as when using PROC GLM. An example from the pharmaceutical industry is used to illustrate how to choose a covariance structure. The example also illustrates the effects of choice of covariance structure on tests and estimates of fixed effects. In many situations, estimates of linear combinations are invariant with respect to covariance structure, yet standard errors of the estimates may still depend on the covariance structure. Copyright © 2000 John Wiley & Sons, Ltd.
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We longitudinally followed 237 participants, of whom 7 (3%) did not return at 18 months; 5 had died, and 2 could not be reached. Of the 230 remaining participants, 171 did not have advanced osteoarthritis in any compartment of either knee. Among these 171 participants (126 women, 45 men), mean age (±SD) was 64.0 ± 11.0 years and mean BMI (±SD) was 30.0 ± 5.5 kg/m². At baseline, no participants had a Kellgren and Lawrence grade of 0 for right knee osteoarthritis severity, 11 had a grade of 1, 110 had a grade of 2, 50 had a grade of 3, and none had a grade of 4. Sixty-three participants had no joint space narrowing in the right knee at baseline, 60 had mild narrowing, 48 had moderate narrowing, and none had severe narrowing. Mean right-limb quadriceps strength (±SD) was 51.8 ± 28.5 ft-lb, and mean laxity (±SD) was 5.32 ± 2.03 degrees. Right knees were varus in 79 participants, valgus in 71 participants, and neutral in 21 participants. No participants had a knee effusion. These assessments were similar in the left knees. All analyses incorporated data from both knees, using generalized estimating equations. We excluded 14 knees that had previously been replaced, leaving 328 knees for analysis.
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Arch Phys Med Rehabil. 1998 Nov;79(11):1421-7. The effects of a physical training program on patients with osteoarthritis of the knees. Røgind H, Bibow-Nielsen B, Jensen B, Møller HC, Frimodt-Møller H, Bliddal H. Department of Rheumatology, Copenhagen Municipal Hospital, Denmark. Abstract OBJECTIVE: To investigate physical function in patients with severe osteoarthritis (OA) of the knees during and after a general physical training program. DESIGN: Randomized control trial, blinded observer, follow-up at 3 months and 1 year. SETTING: Outpatient clinic. PATIENTS: Consecutive sample of 25 patients (3 men, 22 women) with OA of the knees according to the criteria of the American College of Rheumatology (ACR). Two patients (8%) failed to complete the study. There were no withdrawals for adverse effects. INTERVENTION: Twelve patients received training in groups of 6, twice a week for 3 months. Training focused on general fitness, balance, coordination, stretching, and lower extremity muscle strength, and included a daily home exercise program. MAIN OUTCOME MEASURES: Muscle strength across the knee (extension and flexion), Algofunctional Index (AFI), pain (0 to 10 point scale), walking speed, clinical findings. RESULTS: Patients participated in 96 of 96 assessments (100%) and in 218 of 280 training sessions (77.9%). From baseline to 3 months, isokinetic quadriceps strength (30 degrees/sec) improved 20% (confidence interval [CI] 2alpha = .05, 8% to 50%) in the least affected leg; isometric strength improved 21%. By 1 year, AFI had decreased 3.8 points (CI2alpha = .05, 1.0 to 7.0), pain had decreased 2.0 points (CI2alpha = 05, 0.0 to 4.0), and walking speed had increased 13% (CI2alpha = .05, 4% to 23%). There was an increase in the frequency of palpable joint effusions (p < .01) on the most affected side. Frequency of crepitus decreased on the least affected side (p < .01). CONCLUSIONS: General physical training appears to be beneficial to patients with OA of the knee. As shown by the high compliance and low dropout frequency, such a program is feasible even in patients with severe OA of the knee. PMID: 9821904 [PubMed - indexed for MEDLINE]
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For the purposes of classification, it should be specified whether osteoarthritis (OA) of the knee is of unknown origin (idiopathic, primary) or is related to a known medical condition or event (secondary). Clinical criteria for the classification of idiopathic OA of the knee were developed through a multicenter study group. Comparison diagnoses included rheumatoid arthritis and other painful conditions of the knee, exclusive of referred or paraarticular pain. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop sets of criteria that serve different investigative purposes. In contrast to prior criteria, these proposed criteria utilize classification trees, or algorithms.
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Current international treatment guidelines recommending therapeutic exercise for people with symptomatic hip OA report are based on expert opinion only. To determine whether land-based therapeutic exercise is beneficial for people with hip OA in terms of reduced joint pain and/or improved physical function. Five databases were searched from 1966 up until August 2008. All randomised controlled trials (RCTs) recruiting people with hip OA and comparing some form of land-based therapeutic exercise (as opposed to exercises conducted in the water) with a non-exercise group. Three reviewers independently extracted data and assessed methodological quality. All analyses were conducted on continuous outcomes. Combining the results of the five included RCTs demonstrated a small treatment effect for pain, but no benefit in terms of improved self-reported physical function. Only one of these five RCTs exclusively recruited people with symptomatic hip OA. The limited number and small sample size of the included RCTs restricts the confidence that can be attributed to these results. Adequately powered RCTs evaluating exercise programs specifically designed for people with symptomatic hip OA need to be conducted.
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Biomechanical factors, such as reduced muscle strength and joint malalignment, have an important role in the initiation and progression of knee osteoarthritis (OA). Currently, there is no known cure for OA; however, disease-related factors, such as impaired muscle function and reduced fitness, are potentially amenable to therapeutic exercise. To determine whether land-based therapeutic exercise is beneficial for people with knee OA in terms of reduced joint pain or improved physical function. Five electronic databases were searched, up until December 2007. All randomized controlled trials randomising individuals and comparing some form of land-based therapeutic exercise (as opposed to exercises conducted in the water) with a non-exercise group. Two review authors independently extracted data and assessed methodological quality. All analyses were conducted on continuous outcomes. The 32 included studies provided data on 3616 participants for knee pain and 3719 participants for self-reported physical function. Meta-analysis revealed a beneficial treatment effect with a standardized mean difference (SMD) of 0.40 (95% confidence interval (CI) 0.30 to 0.50) for pain; and SMD 0.37 (95% CI 0.25 to 0.49) for physical function. There was marked variability across the included studies in participants recruited, symptom duration, exercise interventions assessed and important aspects of study methodology. The results were sensitive to the number of direct supervision occasions provided and various aspects of study methodology. While the pooled beneficial effects of exercise programs providing less than 12 direct supervision occasions or studies utilising more rigorous methodologies remained significant and clinically relevant, between study heterogeneity remained marked and the magnitude of the treatment effect of these studies would be considered small. There is platinum level evidence that land-based therapeutic exercise has at least short term benefit in terms of reduced knee pain and improved physical function for people with knee OA. The magnitude of the treatment effect would be considered small, but comparable to estimates reported for non-steroidal anti-inflammatory drugs.
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Reliability coefficients often take the form of intraclass correlation coefficients. In this article, guidelines are given for choosing among 6 different forms of the intraclass correlation for reliability studies in which n targets are rated by k judges. Relevant to the choice of the coefficient are the appropriate statistical model for the reliability study and the applications to be made of the reliability results. Confidence intervals for each of the forms are reviewed. (23 ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved).