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Proprioception in knee osteoarthritis: A narrative review
Abstract
To give an overview of the literature on knee proprioception in knee osteoarthritis (OA) patients.
A literature search was performed and reviewed using the narrative approach.
(1) Three presumed functions of knee proprioception have been described in the literature: protection against excessive movements, stabilization during static postures, and coordination of movements. (2) Proprioceptive accuracy can be measured in different ways; correlations between these methods are low. (3) Proprioceptive accuracy in knee OA patients seems to be impaired when compared to age-matched healthy controls. Unilateral knee OA patients may have impaired proprioceptive accuracy in both knees. (4) Causes of impaired proprioceptive accuracy in knee OA remain unknown. (5) There is currently no evidence for a role of impaired proprioceptive accuracy in the onset or progression of radiographic osteoarthritis (ROA). (6) Impaired proprioceptive accuracy could be a risk factor for progression (but not for onset) of both knee pain and activity limitations in knee OA patients. (7) Exercise therapy seems to be effective in improving proprioceptive accuracy in knee OA patients.
Recent literature has shown that proprioceptive accuracy may play an important role in knee OA. However, this role needs to be further clarified. A new measurement protocol for knee proprioception needs to be developed. Systematic reviews focusing on the relationship between impaired proprioceptive accuracy, knee pain and activity limitations and on the effect of interventions (in particular exercise therapy) on proprioceptive accuracy in knee OA are required. Future studies focusing on causes of impaired proprioceptive accuracy in knee OA patients are also needed, taking into account that also the non-symptomatic knee may have proprioceptive impairments. Such future studies may also provide knowledge of mechanism underlying the impact of impaired proprioceptive accuracy on knee pain and activity limitations.
... In passive joint position sense (pJPS) testing, the participant is still required to remember an angle, but the tester then moves the joint through the range of motion until the participant states they are at the remembered angle [6]. Unfortunately, TDPM and JPS methods of measuring proprioception are not directly comparable [7,8]. TDPM has been previously shown to be a more reliable measurement of proprioception, but it has less ecological validity compared to aJPS, as it depends solely on processing sensory feedback [1,8]. ...
... TDPM has been previously shown to be a more reliable measurement of proprioception, but it has less ecological validity compared to aJPS, as it depends solely on processing sensory feedback [1,8]. The aJPS method may be more functional and indicative of true proprioceptive accuracy [7,9] because it requires both sensorimotor integration and motor control [8]. In the current study, we chose to look at aJPS because functional proprioception during daily tasks always includes both sensorimotor and motor control components. ...
... Evaluation of proprioception is important for rehabilitation, causing both clinicians and researchers alike to call for a new protocol to measure proprioception [7]. Proprioception is an increasingly important component of rehabilitation and has been shown to improve with targeted exercises [10]. ...
Proprioception can be defined as the ability of an individual to detect motion and position of the various joints in their bodies. Current tools for measuring proprioception lack consensus on their accuracy and validity; they also each have their own limitations, and, furthermore, present barriers to use for clinicians. We propose a new and reliable method for evaluating hip, knee, and ankle proprioception by utilizing a digital inclinometer app to measure joint position sense. The digital inclinometer app recorded the active joint position sense error after each of five trials for the hip and knee joint and ten trials for the ankle joint. To quantify the reliability of the digital inclinometer app, single-measurement and average-measurement intra-class correlation coefficients (ICC) along with the associated 95% confidence intervals (95% CI) were calculated for each joint’s position sense error across trials. Both the hip (ICC (2,k) = 0.849 (95% CI = [0.783–0.897])) and knee joint (ICC (2,k) = 0.837 (95% CI = [0.750–0.897])) were found to have moderate to good reliability when the middle three of five trials were analyzed. Unlike the hip and knee, moderate to good reliability for ankle proprioception (ICC (2,k) = 0.785 (95% CI = [0.539–0.893])) was only achieved with the middle eight of ten trials. The results of this study indicate that this digital inclinometer app is able to accurately record joint position sense at the hip, knee, and ankle when the appropriate number of trials are collected; thus, allowing this tool and methodology to be considered for use in both clinical and research environments to measure proprioception, and furthermore, quantify proprioceptive deficits.
... Proprioceptive defects and weakness of the quadriceps muscle can cause postural control and balance deterioration in patients with knee OA [10,11]. Pain sensation caused by joint inflammation prevents the formation of afferent proprioceptive stimuli and causes instability that limits the individual's functional status [12,13]. Therefore, management of balance loss is vital in patients with knee OA. ...
... In the current study, balance exercises provided a decrease in central sensitization among patients with OA and central sensitization was evaluated by CSI, which enabled a global assessment. The beneficial effects could be attributed to the increase in proprioceptive inputs with balance exercises, which in turn might have led to a blockage in repetitive nociceptive stimuli [13] and a decrease in pain hypersensitivity. To clarify this, further regression analysis was performed. ...
... This discrepancy may be related to the potential selective effects of balance exercises on the proprioceptors involved during activity [37]. Damage to mechanoreceptors due to the degenerative changes in the knee joint and loss of quadriceps muscle strength can deteriorate balance and proprioception [13,38]. Recent studies have shown that neuromuscular and balance exercises can significantly improve balance among patients with knee OA [15,38]. ...
The aim of this study was to evaluate the effectiveness of balance exercises on functional status, pain, balance, and central sensitization in patients with knee osteoarthritis (OA). Patients diagnosed with bilateral Kellgren–Lawrence grade ≥ 2 primary knee OA and associated central sensitization were included in the study. Patients were randomized into two groups. Both groups were provided with verbal and written information on knee OA. In addition, the intervention group received a supervised balance exercise program for 6 weeks, 3 days a week on alternating days. The outcome measures were the changes in the Central Sensitization Inventory (CSI), Visual Analog Scale (VAS) pain, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Berg Balance Scale, and Y Balance Test. Evaluations were performed at baseline, immediately after treatment (6th week) and at 12th week. The study included 40 patients, 20 patients in each group. At the end of the treatment period (6th week), the improvement in CSI score, WOMAC pain, WOMAC physical function, WOMAC total score, Y Balance Test scores, and VAS pain during activity was significantly greater in the intervention group than that in the control group (p < 0.001). Regarding the changes from baseline to the 12th week, the intervention group experienced greater improvement in most of the outcome measures. Yet, the change in WOMAC pain score, Berg Balance Scale score, and VAS pain at rest was similar between the study groups (p = 0.05, p = 0.257, and p = 0.385, respectively). A two-model multiple linear regression analysis revealed that the changes in VAS pain (during activity) after the treatment and at follow-up [(p = 0.004, adjusted R2: 0.346) and (p = 0.002, adjusted R2: 0.391), respectively], as well as changes in WOMAC pain from baseline to follow-up (p = 0.020, ΔR2 = 0.245) significantly affected central sensitization. However, changes in Y Balance Test and WOMAC total scores did not appear to have a significant impact on the improvement in central sensitization (p > 0.05). Balance exercises may provide improvement in central sensitization, functional status, and dynamic balance among patients with knee OA. The improvement in central sensitization depends mostly on the pain relief effect of balance exercises.
... Common symptoms of knee OA include pain, stiffness, muscle weakness, and fatigue. In addition, knee OA may lead to afferent and efferent neural deficits, expressed by reduced vibratory sense (Shakoor et al., 2008), reduced proprioception (Knoop et al., 2011), and poorer control over muscle force generation (Hortobágyi et al., 2004). These symptoms could lead to impaired stability during walking in individuals with knee OA (Mahmoudian et al., 2016a). ...
... In this study, we examined balance recovery response after moderate ML and AP perturbations in individuals with knee OA, and compared them to responses of healthy peers walking at a predefined, fixed speed. Given that individuals with knee OA show poorer proprioception (Knoop et al., 2011), larger postural sway during standing (Hassan et al., 2001;Hinman et al., 2002), and impaired balance recovery responses after experimentally induced trips (Elkarif et al., 2020;Pater et al., 2016), we hypothesized that, compared to healthy participants, individuals with knee OA would show a larger destabilization following perturbation, leading to a larger XCoM excursion and a lower MoS in the first step after both ML and AP perturbations. ...
... Given that knee OA leads to a reduced number of mechanoreceptors in the knee capsule and ligaments (Çabuk et al., 2017), reduced proprioception (Knoop et al., 2011), lower quadriceps strength (Hoops et al., 2012), and pain, it would be expected that individuals with knee OA have poorer stability than healthy older adults. While postural sway during quiet standing was indeed higher in individuals with knee OA (Hassan et al., 2001;Hinman et al., 2002), and local dynamic stability tended to be lower during unperturbed walking when compared to healthy adults (Mahmoudian et al., 2016a), these reported differences were relatively small. ...
... More recently, individuals with severe KOA displayed significantly lower rate of force development (RFD) that those with early KOA (Suzuki et al., 2022). Individuals with KOA have impaired proprioception compared to age-matched healthy controls (Knoop et al., 2011). Reduced proprioception can affect individuals' knee joint stability and coordination through reduced awareness of lower limb position and motion sense, significantly increasing the risk of falls in individuals with KOA (Bozbas et al., 2017). ...
... Comparatively poorer ankle joint proprioception, determined by position matching, is previously reported in individuals with repaired ruptured Achilles tendon (>12 months) versus healthy controls (Bressel et al., 2004). Furthermore, a reduction in lower limb proprioception can lead to excess movement outside the normal physiological range (Knoop et al., 2011), and potentially further joint damage. Excessive joint movements and joint instability may be attributed to soft tissue changes such as tendon stiffness, which is currently unexplored. ...
... Baert et al. (2013), demonstrated significantly poorer proprioception, measured by lower limb repositioning error, in individuals with established KOA compared to healthy controls and individuals with early-stage KOA. Furthermore, impaired proprioception may lead to excessive joint movements and instability, contributing to further functional decline (Knoop et al., 2011). Results of this study show that increased tendon stiffness is associated with reduced PPS, whereby alterations in the proprioceptors located in the tendon as a result of pathological changes may explain impaired proprioception. ...
... Osteoarthritis is a chronic, degenerative joint disease characterized by articular cartilage loss, marginal bone hypertrophy, and inflammatory involvement of periarticular tissue. 1 It is the most prevalent chronic rheumatic disease worldwide, strongly impacting individual and population health. 1 The knee is the most frequently affected joint, so knee osteoarthritis (KOA) represents almost four-fifths of the global burden of osteoarthritis and increases with obesity and age. 2 Symptoms of KOA are pain, stiffness, reduced range of motion, and muscle weakness, 3 although proprioception may also be affected, contributing to the associated functional limitation. 4 Proprioception is the afferent information arising from the internal peripheral areas of the body that contributes to postural control and dynamic joint stability. 5 This information is provided by joint, muscle, and skin mechanoreceptors, promoting motor planning and adaptive movement mechanisms. ...
... [26][27][28] This test consists of passively mobilizing a joint slowly, and then without sensory feedback, subjects must detect the onset of movement as early as possible. 4,49 The TTDPM has been shown to be reliable, 52,53 and in patients with KOA, the performance is inferior compared to unaffected knees of persons of the same age. 10 Furthermore, the greater the severity of KOA, the lower the proprioceptive accuracy. ...
... It is also interesting to mention that although the guidelines consistently express the benefits of ST on pain, functional performance, and quality of life, 16,23 they do not include the analysis of other relevant outcomes in physical therapy, such as proprioception, despite the evidence of its affectation in patients with KOA. 4 On the other hand, systematic reviews focused on physical exercise have considered greater clinical outcomes, including proprioception. 34,35 In this regard, Sheikhhoseini et al., in a 2023 meta-analysis that included 17 RCTs, analyzed the effect of exercise on knee proprioception in KOA. ...
Proprioception is significantly impaired in knee osteoarthritis (KOA), contributing to reduced functionality. Strength training (ST) is essential in KOA by improving muscle strength, although it may also be effective in improving proprioception. The purpose was to determine the effect of ST on knee proprioception in KOA patients. Pubmed, CINAHL, Scopus, WOS, and PEDro were searched for randomized controlled trials (RCTs) (inception to March 2023). Comparisons for ST were physical exercise different from ST, non-exercise-based interventions, and no intervention. Methodological quality was assessed using the PEDro scale, and risk of bias (RoB) using the Cochrane tool. Meta-analyses were performed by comparison groups using the standardized mean difference (SMD) (Hedge's g) with random effects models, also considering subgroups by proprioception tests. Finally, six RCTs were included. The mean PEDro score was 6.3, and the highest proportion of biases corresponds to performance, selection, and detection. The meta-analysis indicated that only when compared with non-intervention, ST significantly improved knee proprioception for the joint position sense (JPS) (active + passive), JPS (passive), and threshold to detect passive motion (TTDPM) subgroups (g = −1.33 [-2.33, −0.32], g = −2.29 [-2.82, −1.75] and g = −2.40 [-4.23, −0.58], respectively). However, in the knee JPS (active) subgroup, ST was not significant (g = −0.72 [-1.84, 0.40]). In conclusion, ST improves knee proprioception compared to non-intervention. However, due to the paucity of studies and diversity of interventions, more evidence is needed to support the effectiveness of ST. Future RCTs may address the limitations of this review to advance knowledge about proprioceptive responses to ST and contribute to clinical practice.
... [6][7][8] Although the causal role of these neuromuscular deficits in the pathogenesis of knee OA is still not proven, they most certainly contribute to the accelerated progression of joint degeneration and patients getting stuck in a vicious cycle of cause and effect. 3,9 Considering the three functions presumed for knee proprioception, namely protection against excessive movements, stabilization during static postures, and movement control and coordination, 10 it is possible that proprioceptive inaccuracy accelerates joint degeneration by impairing motor control and consequently sudden and excessive loading to the knee. 10 On the other hand, hindered recruitment of high-threshold motor units due to abnormal afferent feedback and inaccurate sensory information can lead to quadriceps muscle weakness, 11 which is known as a hallmark impairment of knee OA. 6 Since muscle strength also plays a major role in joint stabilization and shock absorption, it is reasonable to assume that muscle weakness also leads to aberrant dynamic joint loading and progression of the disease. ...
... 3,9 Considering the three functions presumed for knee proprioception, namely protection against excessive movements, stabilization during static postures, and movement control and coordination, 10 it is possible that proprioceptive inaccuracy accelerates joint degeneration by impairing motor control and consequently sudden and excessive loading to the knee. 10 On the other hand, hindered recruitment of high-threshold motor units due to abnormal afferent feedback and inaccurate sensory information can lead to quadriceps muscle weakness, 11 which is known as a hallmark impairment of knee OA. 6 Since muscle strength also plays a major role in joint stabilization and shock absorption, it is reasonable to assume that muscle weakness also leads to aberrant dynamic joint loading and progression of the disease. 12,13 Deficit in quadriceps strength, which is the primary dynamic stabilizer of the knee joint, can predict the level of functional disability. ...
... Since JPS, KFS, and TTDPM constitute different aspects of knee proprioception, they may stimulate different receptors. 10 It is believed that motion sense tests, especially at slow angular velocities, strongly stimulate articular receptors and also stimulate cutaneous and muscle receptors to a lesser extent. 3 It seems that in FS, potent inputs derived from tendon organs are activated by active muscle contraction that provides information about muscle tension. ...
Objectives: Impaired proprioception and muscle weakness may not only be a consequence of knee osteoarthritis (OA) but also part of its pathogenesis. Thus, the enhancement of quadriceps strength and proprioceptive accuracy can play a pivotal role in the man agement of knee OA. This study aimed to investigate the effects of Kinesio tape and flexible knee orthosis in terms of clinical and neuromuscular outcomes in patients with knee OA.
... As per literature, its show that joint proprioception reduced with injury, degeneration of joint and ageing. Decreased proprioception is associated with chronic knee OA, suggest that decreased joint proprioception may contribute to the onset or progression of chronic knee OA [8,10,11]. ...
... The association between OA and loss of proprioception, muscle weakness and pain has been reported [8,11,24,29]. These declines in sensory output from the knee joint affects sensorimotor function and may result in impairment functional activities [12,14,23]. ...
Background: Knee osteoarthritis (OA) is a chronic, debilitating condition that significantly impairs functional health status among affected individuals. Key challenges associated with chronic knee OA include persistent pain, diminished functional capabilities, and compromised balance. These factors highlight the critical need for effective intervention strategies. Recent research suggests that sensorimotor training may play a pivotal role in addressing these issues. However, there remains a gap in the literature regarding the specific effects of sensorimotor training on pain perception, proprioception, and overall functional levels in this population. Therefore, the aim of this study was to systematically investigate the impact of sensorimotor training on pain, proprioceptive abilities, and functional performance in individuals with chronic knee OA. Methods: Total 66 patients with chronic knee OA were divided into two equal groups. The control group received a traditional exercise programme and the experimental group received sensorimotor training in addition to traditional exercises. Blind assessment was conducted at the beginning of the study and after 4 weeks of training to measure pain by NPRS, proprioception acuity by passive – active joint position reproduction method, and functional disability by TUG & KOOS scale. Statistical analysis was performed using SPSS 23. Data were presented as mean, standard deviation (SD) and mean difference. Within groups compare we used Paired t test and between groups compare we used Independent t test with post data comparison in SPSS. The significance level was set at (p<0.05). Result: For experimental group and control group statistical significant (p<0.05) improvements were recorded in all measured parameters. Mean difference of KOOS in control group is 5.97% and experimental group is 17.63% and in mean difference of pain in control group is 2.33 and experimental group is 3.88 which shows that SMT is very effective than traditional exercise only. According to MCID of all outcomes, pain, KOSS and TUG test is clinically significant. The sensorimotor group produced significantly better improvement than the traditional group. Conclusion: Sensorimotor training along with traditional exercises is more effective then only traditional exercises for patients with chronic knee OA. The addition of sensorimotor training to traditional strengthening and stretching exercises could provide more motor control and help neuromuscular restoration of balance and subsequently improve the functional level of chronic knee OA subjects.
... Patients with knee OA experience knee muscle weakness and proprioception loss [6][7][8][9], which causes joint instability and joint stress, thus increasing pain and accelerating knee OA progression. Previous studies have reported the benefits of surgery [10,11] and glucocorticoid injection [12,13] for knee OA management in improving knee muscle strength, postural stability, and pain scores. ...
... Postural stability was assessed for dynamic balance ability using the Biodex Stability System (BSS), which employs a dynamic foot platform that tilts from 0 • to 20 • in any direction and allows for 360 • rotation, which is used to evaluate proprioception [7,29]. The test was performed in 2 trials, each lasting 20 s, with a rest period of 10 s between trials. ...
Background/Objective: This study aimed to compare the functional outcomes, such as knee muscle strength, dynamic postural stability, pain scores, and physical activity, in patients with knee osteoarthritis (OA) on stair climbing training with and without interferential electrotherapy (IFE) for 12 weeks. Methods: A total of 40 knee OA patients with Kellgren–Lawrence (K–L) grade ≤ 2 were enrolled (20 stair-climbing training with IFE vs. 20 stair-climbing training without IFE). The knee quadriceps and hamstring muscle strengths were measured using an isokinetic device. The dynamic postural stability was assessed using postural stabilometry. The pain score was evaluated using the visual analog scale (VAS). Physical activity was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results: The WOMAC score was significantly different (p < 0.019) between stair-climbing training with and without IFE in patients with knee OA, while knee muscle strength, dynamic postural stability, or pain score were not (all p > 0.05). Conclusion: Stair-climbing training with IFE was more beneficial for physical activity recovery than stair-climbing training without IFE. Therefore, clinicians and therapists should be aware that stair climbing, which can be practiced in daily life for the management of patients with knee OA, and the addition of IFE may improve physical activity.
... The main clinical manifestations of OA include pain, stiffness, tenderness, joint instability, crepitus, decreased mobility, joint deformity, swelling, and muscle weakness [7]. Also, proprioceptive deficits have been reported in patients with OA [8]. Therefore, from a comprehensive therapeutic perspective, it should be considered that this set of signs and symptoms not only negatively influences physical functional capacity but also the cognitive [9] and psychosocial dimensions of OA patients [10]. ...
... Proprioception is a key component of sensorimotor control, and its functions are related to joint protection, postural control, motor coordination, and motor learning [81], which are fundamental in locomotion [82]. It is recognized that patients with knee OA present proprioceptive deficits [8], which favors the risk of falls [83]. A recent meta-analysis shows that various exercise modalities (without exergames) significantly improve joint repositioning error in knee OA [84]. ...
Purpose: To analyze the effects of exergames on rehabilitation outcomes in osteoarthritis (OA) patients.
Materials and methods: A systematic review was reported according to the PRISMA statement. Randomized controlled trials (RCTs) were searched in Pubmed, Scopus, WoS, CINAHL, and PEDro (inception to November 2023). Studies that applied non-immersive exergames and assessed physical, functional, cognitive, pain, and psychosocial outcomes were included. Comparisons were other exercise modalities and non-intervention. Methodological quality was assessed with PEDro scale, and risk of bias (RoB) was assessed with Cochrane RoB-2 tool.
Results: Eight studies were included (total of participants = 401). The mean PEDro score was 6.1, and seven studies had high RoB. Seven studies involved knee OA and one cervical OA. The most frequent duration for interventions was four weeks. Exergames were more effective than controls in at least one outcome in all studies. The outcomes for which exergames were most effective were functional disability, postural balance, muscle strength, proprioception, gait, range of motion, pain, quality of life, depression, and kinesiophobia.
Conclusion: Non-immersive exergames constitute an effective strategy for optimizing several relevant outcomes in rehabilitation. However, more RCTs with high methodological quality are required to deepen the knowledge about the multidimensional effects of exergames in OA patients.
... Given the increasing life expectancy in numerous countries, it is anticipated that the global prevalence of OA will increasing life expectancy in numerous countries, it is anticipated that the global prevalence of OA will double by the year 2040 [2][3][4][5][6]. Recently, the impaired proprioceptive accuracy of joints has been proposed as a potential local factor in the onset and progression of OA [7,8]. Proprioceptive impairments could be a cause of joint pain or activity limitations in OA patients [7,8]. ...
... Recently, the impaired proprioceptive accuracy of joints has been proposed as a potential local factor in the onset and progression of OA [7,8]. Proprioceptive impairments could be a cause of joint pain or activity limitations in OA patients [7,8]. ...
Purpose:
Osteoarthritis (OA) is one of the most common chronic diseases in the world. It is frequently accompanied by high levels of persistent pain, as well as substantial impairments in function and functional capacity. This review aims to systematically analyze the changes in proprioception and related mechanoreceptors in OA patients.
Methods:
Studies from September 2013 to September 2023 were identified by conducting searches on the PubMed, Web of Science, and Scopus electronic databases following the PRISMA statement. One reviewer independently assessed and screened the literature, extracted the data, and graded the studies. The body of evidence underwent an evaluation and grading process using the ROBINS-I tool, which was specifically designed to assess the risk of bias in non-randomized studies of interventions. Results were summarized using descriptive methods.
Results:
A search through 37 studies yielded 14 clinical studies that were ultimately included. The primary focus of the studies was on the knee joint, particularly the posterior cruciate ligament (PCL). The studies found that PCL in OA patients had impaired proprioceptive accuracy, possibly due to changes in mechanoreceptors (Ruffini, Pacini, and Golgi Mazzoni corpuscles). This suggests that dysfunctional articular mechanoreceptors, especially in severe cases of OA, may contribute to reduced proprioception. Dynamic stabilometry also identified significant proprioceptive deficits in patients with knee articular cartilage lesions, underscoring the impact of such lesions on knee proprioception.
Conclusions:
Literature data have shown that proprioceptive accuracy may play an important role in OA, particularly in the knee PCL and cartilage. However, the role of proprioception and related mechanoreceptors needs to be further clarified. Future studies focusing on the relationship between proprioception, OA disease, and symptoms, considering age and gender differences, and exploring OA joints other than the knee should be conducted to improve clinical and surgical outcomes in cases where proprioception and mechanoreceptors are impaired in OA patients.
... Propriosepsiyonun 3 işlevi vardır, bunlar; 1. Eklemin aşırı yükten ve yaralayıcı hareketten korunması, 2. Statik postür sırasında eklem stabilizasyonu, 3. Hareket anında gerekli nöromüsküler koordinasyona yardımcı olmaktır (Jha et al., 2017;Knoop et al., 2011). ...
... Bu yönleriyle gelişmiş proprioseptif bilgiler statik veya dinamik durumlarda eklemlerin ve ilgili yapıların aşırı yükten korunmasına ve dolayısıyla yaralanmalardan kaçınılmasına yardımcı olur. Zayıf propriosepsiyon ise anormal yüklenme paternleri yoluyla yaralanma riskleri oluşturur (Knoop et al., 2011). ...
Günümüz spor dünyasında elit olma ve profesyonelleşmede artan rekabet,
yüksek sportif performansa ulaşılması ve elde edilen performansın
sürdürülebilmesi hususlarında bilim insanlarına olan beklenti ve talepleri
artırmaktadır. Bu talepler doğrultusunda, potansiyel başarılı sporcuların
belirlenmesi ve sportif başarıda ki devamlılığın artırılması açısından, gerekli
anahtar faktörlerin ortaya konulması noktasında ki bilimsel araştırmalarda hızla
artmaktadır. Özellikle son dönemde üzerinde sıkça durulan ve bu anahtar
faktörler içerisinde yer aldığı düşünülen proprioseptif duyu kavramının ve
optimum performanstaki etkilerinin bilim dünyası tarafından önemsendiği
görülmektedir. Bu doğrultuda, bu bölümde propriosepsiyon kavramı,
mekanizması, komponentleri ve sportif başarıdaki önemi incelenmiştir.
... In the population of people over 65 years of age, falls are the leading cause of injuries [1][2][3][4][5][6][7][8][9][10][11]. This is due to elderly people having impaired proprioception, eyesight, vestibular system, muscle weakness, and decreased power and endurance [1,2,4,6,7,10,11]. ...
... The development of the disease leads to the narrowing of the joint space, subchondral sclerotization, and the formation of degenerative geodes. Structural damage leads to impaired sensorimotor function, which undoubtedly affects postural stability [3,7,9,12,19,22,24]. Although the symptoms of these two types of rheumatic diseases can be similar, it is very important to distinguish between them in order to determine the effect on proprioception and balance. ...
Rheumatic diseases lead to postural problems, which increase the risk of falls and lead to greater disability. The aim of the present work is to evaluate posture disorders in patients with osteoarthritis (OA) and rheumatoid arthritis (RA), as well as to evaluate the influence of other factors. A total of 71 subjects were enrolled in this study. Joint position sense (JPS) and the functional assessment of proprioception on a balance platform for both lower limbs were examined. The Average Trace Error (ATE), test time (t), and Average Platform Force Variation (AFV) were calculated. Additionally, an equilibrium test was carried out in the one-legged standing position (Single Leg Stance—SLS). The results were compared in several ways and revealed the following: (1) A JPS of 10° plantar flexion in RA obtained significantly worse results when repeating the movement than OA; the ATEs were significantly lower in RA; and RA needed more support during SLS assessment. (2) RA patients with higher DAS28 had statistically significantly higher values in JPS, with 5° plantar flexion and 10° dorsal flexion, SLS assessment, and stabilometric rates. A statistically significant correlation between DAS28 and RA was found in a JPS of 10° plantar flexion. The VAS ruler demonstrated a significant moderate correlation with t. (3) Patients who experienced at least one fall demonstrated higher JPS and t. Our study shows that proprioception is the most influenced by the nature of the disease and the level of disease activity. We can see that the stability and balance functions are also greatly influenced by the patient’s falling experience and the level of pain. These findings may be useful in designing an optimal proprioception-enhancing movement training plan.
... Studies have reported that individuals with knee OA show deficits in standing balance and proprioception, as observed through both clinical assessments and laboratory measurements (4,(10)(11)(12)(13)(14)(15). Insufficient or inaccurate proprioceptive feedback from the knee joint negatively impacts both static and dynamic balance control in these individuals. ...
Objective: This study aimed to assess the link between radiological and ultrasonographic changes and balance disorders in patients with knee osteoarthritis (OA). Materials and Methods: Clinically and radiologically diagnosed 97 patients with knee OA, 33 age and sex matched healthy volunteers were included in the study. Balance was analyzed utilizing the Berg Balance Scale (BBS) and Timed Up and Go Test (TUG). Kellgren Lawrence (KL) scale was used for radiographic staging of knee OA. Mean Femoral cartilage (FC), quadriceps femoris muscle thickness (QFMT), thigh subcutaneous fat thickness (TSFT), QFMT/TSFT, QF tendon, proximal and distal patellar tendon thickness were evaluated using ultrasonography. The functional level and pain severity of the patients was determined by Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score and Visual Analog Scale (VAS). Results: In individuals with knee OA BBS scores were discovered to be lower and TUG scores were higher (p
... An exercise approach is needed in which open and closed kinetic chain exercises have the same effect on improving proprioceptive sense but combine various exercises to achieve effective clinical results. Muscle spindles are considered to be the strongest proprioceptors and are always stimulated, even during active movements, as a result of alpha-gamma activation [54,55]. In the SE program we designed, there are closed kinetic chain weight shift exercises for the shoulder area such as prone iso-abdominal exercises or ball circumduction against the wall, as well as open kinetic chain exercises such as prone rowing with dumbbells. ...
Objectives. Shoulder protraction is frequently seen in office workers because of working with excessive trunk flexion for a long time. This study aimed to compare the effectiveness of stabilization exercises (SE) given in addition to office exercises (OE). Methods. Sixty office workers with shoulder protraction were divided into SE + OE (n = 30) and OE (n = 30) groups by stratified random sampling for 8 weeks and followed up for 4 weeks. Shoulder protraction was assessed with a caliper, muscle strength with a hand-held dynamometer, proprioception with an isokinetic dynamometer, vibration sense with a vibrometer and upper extremity functional performance with the closed kinetic chain upper extremity stability test. Results. There were significant improvements in all parameters in the OE + SE group, while increases in the strength of the upper trapezius, pectoralis major and infraspinatus muscles and in upper extremity functional performance were also found in the OE group (p < 0.05). During detraining, shoulder protraction, muscle strength, proprioception and upper extremity performance showed longer-term improvement with SE + OE (p < 0.05). Conclusion. The results obtained with the exercises demonstrate the importance of SE + OE in terms of maintaining proper posture and improving shoulder proprioception, muscle strength and functional performance.
... Previous studies have shown that muscle activation failure, also known as arthrogenic muscle inhibition (AMI), occurs after TKA [3][4][5] . AMI occurs postoperatively with structural damage, such as TKA, and reduces output from afferent sensory receptors [15][16][17] . Knoop et al. reported that muscle weakness possibly impaired proprioceptive accuracy and that there was a relationship between knee pain and proprioceptive accuracy. ...
The single-joint hybrid assistive limb (HAL-SJ), an exoskeletal robotic suit, offers functional improvement. In this prospective randomized controlled trial, we investigated the therapeutic effects of knee extension exercises using the HAL-SJ after total knee arthroplasty (TKA). Seventy-six patients with knee osteoarthritis were randomly assigned to HAL-SJ or conventional physical therapy (CPT) groups. The HAL-SJ group underwent exercise using the HAL-SJ for 10 days postoperatively, in addition to CPT; the CPT group underwent only CPT. Pain intensity and active and passive knee extension angles were evaluated preoperatively and on postoperative days 1–10 and weeks 2 and 4. Performance tests and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were evaluated preoperatively and at postoperative weeks 2 and 4. Statistical analysis showed that the HAL-SJ group significantly improved active and passive knee extension angles compared with the CPT group. The HAL-SJ group showed immediate improvement in active knee extension angle through day 5. There were no significant differences in results between the performance tests and KOOS. Knee extension exercises with the HAL-SJ improved knee pain and the angle of extension in the acute phase after TKA.
... 13,14 In addition, through postural control and the activation of mechanical stress, musculoskeletal proprioception at the joint is regulated, thereby improving body balance function and reducing pain. 15,16 Importantly, effective TCE can reduce low-grade chronic inflammation in the development of OA. 11,17,18 In addition, some studies have reported that TCE can help reduce anxiety, stress, and depression; improve mental health; and increase the social participation of OA patients. 19 Bibliometrics is a literature research method that focuses on literature systems and bibliometric characteristics and can measure the contribution of individuals, institutions, or countries/regions to a specific field, which provides an important reference for researchers to find suitable partners. ...
Background
Osteoarthritis (OA) is a common disease in geriatric rehabilitation medicine caused by the progressive destruction of articular cartilage. Traditional Chinese exercise (TCE) is an important component of traditional sports in China and aims to stretch the musculoskeletal tract and relieve joint pain. Bibliometrics can help researchers find suitable partners and understand the research hotspots and trends in a certain field. However, there is still a lack of bibliometric analysis in the field of TCE and OA.
Methods
All the literature was obtained from the Web of Science Core Collection database. The last search was performed on July 28, 2023. The bibliometric indicators, such as publications, citations, and H-index, were recorded. Bibliometrix and CiteSpace were used for visualization analysis. In addition, randomized controlled trials were included to summarize the exercise prescription of TCE for OA.
Results
A total of 170 articles were included. The field of OA with TCE had great development potential and was in the rising period. The countries, institutions, and authors with the most publications were the United States, Tufts Medical Center, and Harvey WF, respectively. The most popular journal was Osteoarthritis and Cartilage. The recent burst keywords in this field were mainly “hip”, “pilot”, and “risk”. Tai Chi was the most studied TCE with the most detailed content of exercise prescription, followed by Baduanjin and Wuqinxi.
Conclusion
Our study provides a basis for researchers in this field to choose appropriate partner and academic journals. Moreover, pain, muscle strength, and quality of life management of elderly OA patients are research hotspots in this field. The intervention of hip OA risk through TCE is expected to become a research direction for emerging teams. The TCE prescription we summarized can better provide researchers with more treatment details.
... To date, there is no proven treatment method that can reverse the course of KOA [3]. Current therapeutic strategies for KOA are focus on improving muscle strength or relieving pain, including medication, physical exercise, intra-articular injection, etc. Clinical guidelines recommend physical exercise as one of the most critical nonpharmacological treatments of KOA [4], which has been proven to improve knee function effectively [5]. ...
Background
Quadriceps training is necessary in function and activity of daily living for patients with knee osteoarthritis (KOA). However, it did not reduce the rate of surgical treatment for end-stage KOA in the long term. This may be related to brain structure changes and maladaptive plasticity in KOA patients. Transcranial Magnetic Stimulation (TMS) could enhance the functional connectivity of brain regions and improves maladaptive plasticity. However, the synergistic effect of the combination of the two for treat KOA is still unclear. Therefore, the purpose of this study is to investigate whether the High-Frequency rTMS combined with quadriceps strength training can improve the pain and function in KOA more effectively than quadriceps training alone and explore the mechanism of action.
Methods
This study is an assessor-blind, sham-controlled, randomized controlled trial involving 12 weeks of intervention and 6 months follow-up. 148 participants with KOA will receive usual care management and be randomized into four subgroups equally, including quadriceps strength training, high-frequency rTMS training, sham rTMS and quadriceps strength training, high-frequency rTMS and quadriceps strength training. The rehabilitation interventions will be carried out 5 days per week for a total of 12 weeks. All outcomes will be measured at baseline, 4 weeks, 8 weeks, and 12 weeks during the intervention and 1 month, 3 months and 6 months during the follow-up period. The effectiveness outcomes will be included visual analog scale, isokinetic knee muscle strength, Knee Injury and Osteoarthritis Outcome score and 36-Item Short-Form Health Survey score; The act mechanism outcomes will be included motor evoked potential, grey matter density, white matter, subcortical nuclei volumes, cortical thickness and functional connectivity by MRI. Two-way of variance with repeated measures will be used to test the group and time effect for outcome measures.
Discussion
The study will be the first protocol to examine whether there are synergistic effects following high-frequency rTMS combined with quadriceps strength training for treat KOA and clarify the mechanism of action. High-frequency rTMS can be added into the training program for KOA patients if it is proven effective.
Trial registration
Chinese Clinical Trial Registry ChiCTR2300067617. Registered on Jan.13,2023.
... Motor control deficits are known for patients with knee OA resulting from different nociceptive and non-nociceptive sensory processing [70,71]. Impaired proprioception has also been reported for OA [72,73]. This could be a relevant factor for the results found in the present study as well. ...
Background
Quadriceps strength deficits are known for patients with knee osteoarthritis (OA), whereas findings on hamstrings are less clear. The Adaptive Force (AF) as a special neuromuscular function has never been investigated in OA before. The maximal adaptive holding capacity (max. isometric AF; AFisomax) has been considered to be especially vulnerable to disruptive stimuli (e.g., nociception). It was hypothesized that affected limbs of OA patients would show clear deficits in AFisomax.
Methods
AF parameters and the maximal voluntary isometric contraction (MVIC) of hamstrings were assessed bilaterally comparing 20 patients with knee OA (ART) vs. controls (CON). AF was measured by a pneumatically driven device. Participants were instructed to maintain a static position despite an increasing load of the device. After reaching AFisomax, the hamstrings merged into eccentric action whereby the force increased further to the maximum (AFmax). MVIC was recorded before and after AF trials. Mixed ANOVA was used to identify differences between and within ART and CON (comparing 1st and 2nd measured sides).
Results
AFisomax and the torque development per degree of yielding were significantly lower only for the more affected side of ART vs. CON (p ≤ 0.001). The percentage difference of AFisomax amounted to − 40%. For the less affected side it was − 24% (p = 0.219). MVIC and AFmax were significantly lower for ART vs. CON for both sides (p ≤ 0.001). Differences of MVIC between ART vs. CON amounted to − 27% for the more, and − 30% for the less affected side; for AFmax it was − 34% and − 32%, respectively.
Conclusion
The results suggest that strength deficits of hamstrings are present in patients with knee OA possibly attributable to nociception, generally lower physical activity/relief of lower extremities or fear-avoidance. However, the more affected side of OA patients seems to show further specific impairments regarding neuromuscular control reflected by the significantly reduced adaptive holding capacity and torque development during adaptive eccentric action. It is assumed that those parameters could reflect possible inhibitory nociceptive effects more sensitive than maximal strengths as MVIC and AFmax. Their role should be further investigated to get more specific insights into these aspects of neuromuscular control in OA patients. The approach is relevant for diagnostics also in terms of severity and prevention.
... Evidence from the literature has shown that patients with knee OA experience losses of proprioception and postural stability, which may result in an increased risk of falling [33,34,35]. A randomized controlled trial that examined postural stability and fall risk using the Biodex Balance System and the TUG test reported that patients with bilateral knee OA had impaired balance; moreover, this impairment was more pronounced in patients with moderate knee OA than with mild OA [36]. ...
Background:
Many formulations and dosing regimens are available for hyaluronic acid (HA).
Objective:
To compare different doses of linear, high-molecular weight (HMW) HA injections among patients with knee osteoarthritis (OA).
Methods:
Hundred patients were included in this randomized, single-blinded trial and randomly divided into three HA injection groups. The first group received five weekly 20 mg HA injections, the second group received three weekly 32 mg HA injections, and the third group received a single 48 mg HA injection. Patients were evaluated at baseline, 1, 3, and 6 months after the last injection for pain, stiffness, and function using the visual analog scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. Quality of life, patient's global assessment, and Timed Up and Go (TUG) test scores were also evaluated.
Results:
There was significant improvement in the WOMAC, VAS-pain, quality of life, patient's global assessment, and TUG test mean scores at all follow-up time points (p< 0.001). However, the groups showed no significant differences in WOMAC, VAS-activity pain, and patient global scores at any follow-up point.
Conclusion:
Intra-articular injections of different doses of linear HMW HA can improve pain, stiffness, function, and quality of life in patients suffering from knee OA over a six-month period.
... of the knee. In addition, patients with knee OA may experience knee pain or activity restrictions due to proprioceptive impairments [7]. Exercise is suggested as a successful method in conservative treatment in international clinical guidelines that take the management of knee OA into account more generally. ...
Background: knee osteoarthritis (OA) is one of the most aging problems that causes many problems such as pain, reduced balance, difficulty of walking, up & down stairs and may result in inability to move and dependency. Dynamic balance has been found to be affected in patients with knee OA. Purpose: The aim of this study was to evaluate and compare the effect of weight bearing (WB) and non-weight bearing (NWB) strengthening exercises on dynamic balance, pain and proprioception in knee OA patients. Subjects & Methods: Sixty patients from both genders, diagnosed with bilateral knee OA mild to moderate (according to Kellgran and Lawrence classification) divided equally into three groups G I (control), G II (WB) and G III (NWB), their mean value of age were 59.7 ± 4.5, 60.6 ± 4 and 60.1 ± 4.9 years respectively and body mass index were 28.8 ± 1, 28.6 ± 0.8and 28.2 ± 1.6 kg/m2 respectively. G I received conventional treatment (TENS and stretching exercises for quadriceps, hamstring and calf muscles), G II received the conventional treatment and WB strengthening exercises while G III received the conventional treatment and NWB strengthening exercises. Interventions were performed for 12 sessions (3 sessions/ week) over a period of four weeks. Outcomes were assessed at the beginning and at the end of the fourth week using biodex balance system for dynamic balance, visual analogue scale (VAS) for pain intensity and bubble inclinometer for joint repositioning error (JRE) for measuring proprioception. Result: G II was improved in all measurements with significant difference between the pre and post measurements of all measured variables, while G II were significant difference of BBS and VAS and G I there was significance difference of VAS only. There were significance differences between G II and G I in VAS, BBS and JRE measurements and between G II and G III in VAS and JRE only with superiority to G II, while there were significance differences between G I and G III in VAS and BBS with superiority to G III. Conclusion: Both WB and NWB exercises are effective in improving dynamic balance and pain in patients with knee OA. With superiority to WB exercises in improving proprioception.
... The number of studies showed that knee proprioception accuracy tends to be a modifiable risk factor in knee. 11 In this study only 8.02% subjects had affected proprioception. A recent prospective study found that increased the likelihood of subsequent knee osteoarthritis because of a previous knee injury/ surgery. ...
Background: India has higher worldwide proliferative osteoarthritis (OA) rate and prevalence of knee osteoarthritis in India is 22-39%. Many risk factors have been through playing a significant role in triggering osteoarthritis. Such risk factors can be classified as modifiable and non-modifiable. There are very fewer preventive strategies for modifiable risk factors. Because the prevalence rate is increasing very high especially in Asian population – if prevent the modifiable risk factors of knee OA, then prevalence will automatically reduce. Objectives: To find out the prevalence of risk factors of knee OA present in young adult population and to determine ranking and categorize the modifiable and non-modifiable risk factors. Methodology: An observational study was conducted in Ashok & Rita Patel Institute of Physiotherapy (ARIP), Changa. Depending on the selection criteria, participants were selected and informed consent was signed. The respondents were then requested to offer their demographic information. Assessment of risk factors in young adults was completed. The data was analyzed using SPSS version 23.0. Descriptive analysis was performed which includes frequency, mean and standard deviation. Result: Highest frequency of risk factor which present in subject was malalignment (69.62%), followed by physical activity (66.66%), muscle strength (64.56%), BMI (32.06%), socioeconomic status (10.55%), proprioception (8.02%), history of knee injury (7.59%), risk factor related footwear (1.68%) and history of surgery in knee (0.42%). Conclusion: The prevalence of modifiable risk factors was high in this group. Effective preventive strategy must take to minimize the burden of the disease. Key words: Knee osteoarthritis, Prevalence, modifiable & non modifiable risk factor, Guidelines, young adult.
... In the population with osteoarthritis of the knee joint, pain and impaired function are the main highlighted problems that cause mobility impairments, that renders difficulty in carrying out daily life activities, resulting in poor quality of life [6]. The sufferers also presented impaired proprioception, that could potentially hamper individual's postural stability and increase fall risk [7][8][9][10]. ...
Background:
Exercise therapy can potentially relieve symptoms and improve functional status of the knee osteoarthritis population. Despite the proved practical benefits, there is no standard, comprehensive physiotherapeutic protocol available targeting the physical and physiological impairment cluster associated with disease. Osteoarthritis is a whole joint disease, affecting joint cartilage, ligaments, menisci and joint associated muscles, from variable pathophysiological processes. Hence, there is a need to develop a physiotherapy protocol to address the multi-structural physical, physiological and functional impairments associated with the disease.
Objective:
The objective of the present study is to evaluate the efficacy of designed, therapist supervised, patient education, progressive resistance exercises, passive stretching exercises, soft tissue manipulation, muscle energy technique, Maitland mobilization, aerobic exercise, and neuromuscular training physiotherapy protocol on pain, disability, balance, and physical functional performance in knee osteoarthritis patients.
Methodology:
The preliminary study was conducted on a (n = 60) sample of convenience. The samples were randomly allocated into two study groups, intervention, and control group. The control group was advised on a basic home program. On the other hand, the treatment of the intervention group was designed with a therapist supervised Physiotherapy Protocol. The outcome variables studied were the Visual Analogue Scale, Modified WOMAC Scale, Timed Up and Go Test, Functional Reach Test, 40 m Fast Paced Walk Test, Stair Climb Test, 30 s Chair Stand Test.
Results:
The results of the study revealed a significant improvement among most of the studied outcome measures in the intervention group, hence the designed supervised physiotherapy protocol was found effective in relieving multiple physiological impairments associated with this whole joint disease.
... Thus, proprioception has been defined as an individual's ability to integrate the sensory signals from various mechanoreceptors to thereby determine body position and movements in space [6,7]. It is widely believed that during daily activities as well as during sports, the proprioceptive inputs are very important for normal individuals because it plays an essential role in the precise movement of joints to prevent excessive range of motion and joint damage through the proprioceptive reflex [8,9]. Thus, assessment of proprioceptive sensibility is valuable for the identification of any proprioceptive deficits that may be a major risk factor for recurrent injuries even after the restoration of injured muscles and ligaments [10]. ...
... Balance in the human body is dependent on the mutual participation and collaboration of the sensory and motor systems, which are under the control of the central nervous system, and abnormalities in any of these components can easily result in a loss of balance [3]. Balance de cits in KOA patients are exacerbated by decreased muscle strength in the lower extremities, decreased proprioception, and decreased joint range of motion [4,5]. It has been demonstrated that the duration of disease, BMI, pain level, and daily functional mobility of KOA patients are related to indicators of dynamic and static balance, and that patients have a higher risk of falling due to their increased visual dependence on dynamic and static balance [6]. ...
Background
Knee osteoarthritis (KOA) is a long-term, worsening knee disease that affects a lot of people in their middle years and later years. Its main symptoms are joint pain, limited movement, and a loss of proprioception. This makes it hard for older people to keep their balance, which makes them more likely to fall. This study looks at how well electroacupuncture and exercise therapy work together to treat early to mid-stage KOA. It also looks into how electroacupuncture and exercise therapy work together to improve balance in patients with KOA.
Methods
This protocol for a randomized, single-blind, controlled clinical study is proposed for this investigation. Sixty-six patients were to be admitted and randomly assigned to one of two groups: the treatment group (electroacupuncture plus exercise therapy) or the control group (exercise therapy). In the treatment group, electroacupuncture will be used in conjunction with exercise therapy: acupuncture was applied to the Dubi(ST35),Neixiyan (EX-LE4), Xuehai(SP10), Liangqiu(ST34), Yanglingquan(GB34), and Zusanli(ST36) for 20 minutes, followed by exercise therapy (muscle strength training and knee mobility training). The treatment schedule was identical for both groups: three times per week for four weeks, totaling 12 sessions. Before the first treatment session, after the first treatment session, after the 12th treatment session, and one month after the completion of treatment, static balancer function was measured, and VAS and WOMAC scales were recorded at the above 4 time points.
Discussion
The dynamic and static balance function test in the clinic is easy to perform, reliable, effective, and time-saving, which provides a basis for quantitative studies of clinical balance ability and can better complete the test that meets the aforementioned conditions and objectively evaluate the improvement of pain and functional impairment prior to and after treatment of KOA. It creates conditions for the establishment of a Chinese medicine rehabilitation treatment plan for KOA with certain efficacy and distinction.
Trial registration
This trial has been approved by the Ethics Committee of the China Clinical Trials Registry, (approval number: ChiCTR2300071577).Date of Registration:18 May 2023.
... Chronic OA is also characterized by significant impact in physical function, motor control, action planning, and proprioceptive changes. 28, 55 We 9 and others 21,36 have shown anatomical dissimilarities in the thalamus, putamen, and caudate in patients with knee OA vs controls. ...
The neural mechanisms for the persistence of pain after a technically successful arthroplasty in osteoarthritis (OA) remain minimally studied, and direct evidence of the brain as a predisposing factor for pain chronicity in this setting has not been investigated. We undertook this study as a first effort to identify presurgical brain and clinical markers of postarthroplasty pain in knee OA. Patients with knee OA (n = 81) awaiting total arthroplasty underwent clinical and psychological assessment and brain magnetic resonance imagining. Postoperative pain scores were measured at 6 months after surgery. Brain subcortical anatomic properties (volume and shape) and clinical indices were studied as determinants of postoperative pain. We show that presurgical subcortical volumes (bilateral amygdala, thalamus, and left hippocampus), together with shape deformations of the right anterior hippocampus and right amygdala, associate with pain persistence 6 months after surgery in OA. Longer pain duration, higher levels of presurgical anxiety, and the neuropathic character of pain were also prognostic of postsurgical pain outcome. Brain and clinical indices accounted for unique influences on postoperative pain. Our study demonstrates the presence of presurgical subcortical brain factors that relate to postsurgical persistence of OA pain. These preliminary results challenge the current dominant view that mechanisms of OA pain predominantly underlie local joint mechanisms, implying novel clinical management and treatment strategies.
... According to the literature, neuromuscular training can enhance unconscious motor responses by optimizing afferent signals and the integration of information at the level of the cerebral cortex, favoring dynamic control of the joints [19]. Recently, neuromuscular training programs have been developed in people with knee and hip osteoarthritis (OA) [20,21], in addition to interventions aimed at improving postural balance and the risk of falls in older people. However, the literature is still limited when reporting the benefits that neuromuscular training can generate on physical performance. ...
This systematic review aimed to assess the available evidence on the effects of neuromuscular training on physical performance in older adults. A literature search was conducted across four databases (Psychology and Behavioral (EBSCO), Scopus, Web of Science and PubMed). The PRISMA guidelines were followed. The PEDro scale and Cochrane risk of bias tool were used to assess the quality of and risk of bias in the studies, respectively. The protocol was registered in PROSPERO (code: CRD42022319239). The outcomes were muscle strength, cardiorespiratory fitness, postural balance and gait speed. From 610 records initially found, 10 were finally included in the systematic review, involving 354 older people with a mean age of 67.3 years. Nine of them reported significant changes in at least one variable related to physical performance in the intervention compared to the control groups. The neuromuscular training caused significant improvements in postural balance, flexibility, cardiorespiratory fitness, strength power of the upper and lower limbs and autonomy. The available evidence indicates that neuromuscular training has a positive effect on some variables of physical performance, especially in postural balance; however, the methodological quality and certainty of the evidence in the available literature are limited. Therefore, a greater number of high-quality studies are required to draw definitive conclusions.
... One theory is that emotional stress can lead to increased inflammation in the body, which may exacerbate knee OA symptoms 11 . Additionally, depression and anxiety can lead to reduced physical activity, which can worsen knee OA symptoms over time 12 . Furthermore, pain and limited mobility associated with knee OA can contribute to negative affect, which can lead to a vicious cycle of worsening symptoms and emotional distress 13 . ...
Background: By 2050, Indias 60 and older population is expected to encompass 323 million people, a number greater than the total US population in 2012. Osteoarthritis is the growing cause of social and economic burden to our aging society. It has been seen psychosocial status of patient with osteoarthritis have an impact on pain, functional ability and quality of life. The emotional status of osteoarthritis patient can have poor outcome on his/her Quality of life making the person disabled in their activities and functions. The majority of osteoarthritis pharmacological and rehabilitation treatments are geared toward alleviating pain due to disease severity in the joint therefore, it appears important to optimize treatment for people who have pain beyond peripheral sources. Objective: This study will help to understand the association of emotional status, pain, radiographic severity and quality of life in patients with knee osteoarthritis so that a more holistic approach will be developed towards osteoarthritis. Methodology: Study design was a cross sectional observational study. 100 subjects were assessed in the study. Participants were included in the study after screening for inclusion and exclusion criteria. All subjects were evaluated according to the assessment proforma for the following Pain on Visual Analogue Scale (VAS), Positive And Negative Affect Scale and Knee function on Knee Injury and Osteoarthritis Outcome Score (KOOS). Conclusion: The findings of this study suggest an association between emotional status and pain, emotional status and quality of life. But no association is seen between emotional status and Kellgren Lawrence Scale.
... These ligaments would have tended to reduce femoral movement (Girgis et al., 1975;Kivlan et al., 2013;Tsai & Holliday, 2015) and provide proprioceptive information (Johansson et al., 1991;Knoop et al., 2011). ...
Nothronychus graffami was a large therizinosaur from the Upper Cretaceous of North America. Much of the skeleton is well-preserved and relatively undistorted. The synovial capsule, extracapsular, and intracapsular tendons are reconstructed in Nothronychus graffami using existing scars and comparison with the hips of extant theropods and models of extinct theropods. The iliofemoral, pubofemoral, and ischiofemoral ligaments are all modelled. Soft tissue, especially the ischiofemoral and pubofemoral ligaments reduced possible protraction/retraction of the femur at the hip, while stabilizing the joint. Therefore, most hindlimb movement took place at the knee. Weight-bearing function in Nothronychus was transferred from the supra-acetabular crest to the pubic peduncle and associated labrum at rest. The femur possessed an intermediately angled neck, convergent with titanosaurs. Therefore, some lateral abduction is proposed, requiring a well-developed meniscus at the knee. Such a posture would result in considerable mediolateral stress along the femoral shaft, resulting in increased transverse ossification. The femur is considered somewhat abducted from the midline, especially when maximally pronated, as the preacetabular ala is more extensive than the post-acetabular ala. This trait would probably result in a laterally divergent femur, as in many birds, resulting in a broad-gauge trackway with wider separation between left and right footprints than observed in many theropod trackways. Limb ratios and ossification patterns suggest a slow, waddling gait. A standard digitiform pose is reconstructed as is common for theropods, but a plantigrade stance cannot be firmly rejected. This article is protected by copyright. All rights reserved.
... Also, localizing a tactile stimulation requires the combination of proprioceptive inputs and information obtained from somatosensory receptors (Canzoneri et al., 2014). Moreover, knee OA may cause deficits in proprioception sense even a lack of an OA diagnosis within the contralateral extremity (Knoop et al., 2011). Also, alteration within the primary somatosensory cortex has been associated with two-point discrimination threshold impairments (Pleger et al., 2005). ...
Background:
Left/right judgment task (LRJT) performance and tactile acuity are impaired in chronic pain conditions, however, evidence is limited for knee osteoarthritis (OA).
Objective:
To compare LRJT performance and the two-point discrimination threshold (TPDT) of chronic knee OA patients with asymptomatic knee and pain-free controls.
Design:
Cross-sectional study.
Methods:
Fifty knee OA patients and 50 age and gender-matched pain-free controls were assessed using the Recognize® application by displaying knee images and a digital caliper for the TPDT of the medial and lateral knee joint line.
Results:
TPDTs over the lateral joint line in symptomatic (mean difference [MD]: 13.59 mm; 95% confidence interval [CI]: 8.72, 18.46; d = 1.40) and asymptomatic knee (MD: 10.15 mm; 95% CI: 5.08, 15.22; d = 0.99) were significantly increased compared to pain-free controls. Similarly, TPDTs of the medial joint line were significantly increased in symptomatic (MD: 12.19 mm; 95% CI: 7.59, 16.79; d = 1.31) and asymptomatic knee (MD: 7.64 mm; 95% CI: 3.64, 11.64; d = 1.31) compared to pain-free controls. Patients with knee OA were less accurate (MD: 7.80%; 95% CI: 15.32, -0.27; d = 0.52) recognizing images of their symptomatic knee. No correlation was found between pain severity, pain duration, LRJT performance, and TPDTs. Post-hoc analysis revealed no differences in LRJT and TPDTs between patients with and without clinically relevant symptoms of central sensitization.
Conclusion:
Chronic knee OA is associated with increased TPDT for medial and lateral knee joint lines and decreased recognition accuracy performance which should be considered during treatment process.
... Intra-articular injection of MIA produced an obvious reduction in motor performance and muscle coordination as evidenced by the reduced fall-off latency in the rotarod test. Loss of proprioception reflex and subsequent loss of postural balance is reported in knee OA (Knoop et al., 2011). Similarly, progressive motor deficits were observed in OFT after MIA injection demonstrated by significant reduction in total distance travelled, mean speed and rearing frequency. ...
Osteoarthritis (OA) is a chronic debilitating degenerative disorder leading to structural, and functional anomaly of the joint. The present study tests the hypothesis that overexpression of the basic fibroblast growth factor (FGF-2) via direct rAAV-mediated gene transfer suppresses monosodium iodoacetate (MIA)-induced knee OA in rats relative to control (reporter rAAV-lacZ vector) gene transfer by intra-articular injection. Rats were treated with 20 μl rAAV-hFGF-2 on weekly basis; on days 7, 14, and 21 after single intra-articular injection of MIA (3 mg/50 μl saline). FGF-2 reduced knee joint swelling and improved motor performance and muscle coordination as evidenced by increased distance travelled, mean speed, rearing frequency in open field test (OFT) as well as fall-off latency in rotarod test together with reduced immobility time in OFT. Moreover, FGF-2 attenuated MIA-related radiological and histological alterations. Indeed, FGF-2 decreased knee joint inflammatory biomarker as demonstrated by reduced mRNA expression of toll like receptor (TLR)-4 and its downstream mediators such as tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1β) and high motility group box (HMGB) 1. In parallel, FGF-2 attenuated knee joint degradation biomarkers as reflected by the downregulation of ADAMTS-5 mRNA expression and matrix metalloproteinase 13 (MMP-13) content together with the up-regulation of tissue inhibitor of metalloproteinase (TIMP)-1 mRNA expression. These findings suggest a potential therapeutic role for FGF-2 against MIA-induced knee OA in rats via inhibition of TLR4 signaling and activating TIMP-1, resulting in down-regulation of ADAMTS-5 and MMP-13.
... Thus, 30 adult women with knee osteoarthritis were divided into two groups of intervention (massage) and control, with an equal number of 15 people in each. A hand-held, portable MMT device was used to measure the voluntary isometric strength of the quadriceps muscles (8). One of the sub-assessments of knee proprioception is the assessment of the sense of joint position. ...
People with knee osteoarthritis suffer from profound proprioception impairment and
decreased muscle strength. Massage is mentioned as an intervention that can relieve the
symptoms of osteoarthritis. Therefore, this study aimed to evaluate the effect of four
weeks of Swedish massage on knee joint proprioception, muscle strength of quadriceps,
and osteoarthritis symptoms in adult women with knee osteoarthritis. Thirty women were
included by the purposive, convenience sampling (age 52.60±7.30 years old, height
1.57±0.05 m, body mass 74.40±9.60 kg). The participants were randomly divided into two
control group (n=15) and intervention groups (n=15). The intervention group received the
Swedish massage for 4 weeks (12 sessions). During this period, the control group did not
receive any interventional protocol. Symptoms of osteoarthritis, muscle strength of
quadriceps, and knee joint proprioception were analyzed in the pre-and post-test using the
WOMAC questionnaire, handheld dynamometer, and joint angle reconstruction,
respectively. A mixed repeated measure test was used for comparison between and within
groups. The results showed a significant improvement in the desired variables of the
intervention group compared to the control group (P <0.05). Therefore, osteoarthritis
symptoms were significantly improved (P =0.001), and quadriceps muscle strength (P =0.001) and knee joint proprioception (P =0.001) were significantly increased. Based
on the findings of this study, massage can increase the strength of quadriceps muscles and
improve knee joint proprioception in women with knee osteoarthritis by decreasing
pain and improving physical function. Therefore, it is recommended to use this
intervention in order to improve strength, joint proprioception, and symptoms in women
with knee osteoarthritis.
... Pain has been commonly assessed by the Western Ontario and McMasters Osteoarthritis Index (WOMAC) (Sisante et al., 2020). Proprioception is closely related to the developmental process of KOA (van der Esch et al., 2007), and the impairment of proprioception of the knee and ankle joints led to decreased lower extremity joint balance and coordination among older adults with KOA (Hassan et al., 2001;Knoop et al., 2011). Although KOA affects mostly the knee joint, ankle proprioception is closely related to balance control (Han et al., 2015). ...
Background: Knee osteoarthritis (KOA) is one of the most common chronic progressive diseases with degenerative destruction of articular cartilage and bone, leading to knee pain, impaired proprioception, and reduced functional performance. This study was to investigate the effects of an 8-week Traditional Chinese herb hot compress (TCHHC) combined with therapeutic exercise (TE) on pain, proprioception, and functional performance among older adults with KOA.
Methods: Twenty-seven older adults with KOA were recruited and randomly assigned to the TCHHC + TE or TE groups. Thirteen participants received TCHHC + TE, and fourteen received TE. At pre- (week 0) and post-intervention (week 9), their pain, joint proprioception, and functional performance were measured. Two-way ANOVA with repeated measures was adopted to analyze the data.
Results: Compared with week 0, the pain score, proprioception thresholds of knee extension and ankle plantarflexion, and the times of TUG and 20-m walk tests decreased more significantly in the TCHHC + TE group than in the TE group at week 9.
Conclusion: Compared with TE, the 8-week TCHHC + TE was superior in relieving pain, recovering proprioception, and improving functional performance among older adults with KOA. It is recommended that TCHHC should be adopted prior to TE to enhance the effects of KOA rehabilitation.
... On the other hand, proprioceptive acuity is also affected by muscle activity [8]. Knoop et al. reported that muscle weakness along with damage in the mechanoreceptors contributes to a decreased sense of position in patients with arthritis [9]. Thus, improving muscle function may help to enhance proprioceptive function. ...
Objective
To investigate the effect of cervical stabilization exercises on cervical position error in patients with axial spondyloarthritis (axSpA).Materials and methodsThirty-nine patients with axSpA were randomly allocated to two groups as exercise group (n = 20, 11 males) and control group (n = 19, 12 males). The exercise group performed a progressive home-based cervical stabilization exercise program, while the control group did not receive any exercise intervention. To control exercise adherence and progression, text messages and video instructions were delivered via a freeware and cross-platform messaging service on a weekly basis. All patients were evaluated regarding physical characteristics, disease activity (Bath Ankylosing Spondylitis Disease Activity Index), functional status (Bath Ankylosing Spondylitis Functional Index), and spinal mobility (Bath Ankylosing Spondylitis Metrology Index). Cervical position error was evaluated in flexion, extension, rotation, and lateral flexion directions. All evaluations were performed at baseline and after 6 weeks.ResultsBaseline physical and disease-related characteristics were similar between the groups (p > 0.05). After 6 weeks, significant improvements were observed in cervical position error in all directions in the exercise group (p < 0.05), whereas no improvements were detected in the control group (p > 0.05).ConclusionA 6-week home-based cervical stabilization exercise program seems to be beneficial for improving impaired cervical proprioception in patients with axSpA.
Background: Knee osteoarthritis (KOA) significantly affects mobility and quality of life in older adults. Objectives: This clinical trial aimed to evaluate the effects of an eight-week aquatic therapy program on gait speed and knee proprioception in this population. Methods: A randomized, single-blind clinical trial was conducted with 34 female participants diagnosed with KOA. They were randomly assigned to either an aquatic therapy group or a control group. The intervention consisted of structured aquatic therapy sessions conducted over eight weeks. Pre- and post-intervention assessments were performed to evaluate knee proprioception using a digital goniometer and gait speed using the 10-Meter Walk test (10MWT) under simple walking and cognitive task conditions. Results: ANCOVA analyses showed significant improvements in both gait speed and knee proprioception following the intervention. Gait speed under normal conditions improved significantly [F (1, 31) = 37.75, P < 0.001], with aquatic therapy accounting for 54.9% of the variance in improvements. The average gait speed of the aquatic therapy group was significantly greater than that of the control group. Additionally, knee proprioception scores improved significantly [F (1, 32) = 10.316, P = 0.003], with aquatic therapy explaining 25% of the variance in improvement. Conclusions: The findings indicate that an eight-week aquatic therapy program is an effective non-pharmacological intervention for enhancing gait speed and proprioception in older women with KOA. This study highlights the therapeutic value of aquatic therapy in improving functional outcomes and quality of life in this population.
Amaç: Yaşam kalitesi (YK) sağlık durumuna ait kişisel değerlendirmeyi içermekte ve diz osteoartritli (OA) hastalarda azalmaktadır. Bu çalışma diz OA'lı hastalarda YK ile klinik parametreler arasındaki ilişkiyi değerlendirmek amacıyla planlandı. Gereç ve Yöntem: Çalışmaya evre 2-3 diz OA'lı (ortalama yaş 56,5±5,84 yıl) 42 kadın hasta katıldı. Yaşam kalitesi (SF-12 fiziksel ve mental bileşen puanları), vücut kütle indeksi (VKİ), ağrı şiddeti (VAS), izokinetik diz ekstansör ve fleksör kas kuvveti, denge, eklem pozisyon hissi (EPH), fonksiyonel performans, WOMAC ve ultrasonografik vastus lateralis (VL) kas mimarisi değerlendirmeleri yapıldı. Verilerin analizinde korelasyon testleri ve regresyon analizi kullanıldı. Bulgular: SF-12 fiziksel bileşen puanı ile WOMAC (tutukluk, fiziksel fonksiyon, toplam) puanları arasında zayıf (p<0,05); 20° ve 70° diz fleksiyonunda EPH sapma açısı arasında orta düzeyde (p<0,01); SF-12 mental bileşen puanı ile WOMAC (ağrı, fiziksel fonksiyon, toplam) puanları arasında zayıf (p<0,05); gözler-kapalı denge sonuçları arasında orta düzeyde ilişki olduğu saptandı (p<0,01). Yaş, VKİ, VAS, izokinetik kas kuvvetleri, gözler-açık denge, fonksiyonel performans ve VL kas mimarisi değerlendirme sonuçları ile SF-12 puanları arasında ise bir ilişki gözlenmedi (p> 0,05). Tek değişkenli ve çoklu doğrusal regresyon analizleri sonucunda da EPH, WOMAC puanı, gözler-kapalı denge sonuçları ve VL kalınlığının YK üzerinde etki oluşturduğu belirlendi. Sonuç: Çalışma sonunda; diz OA’lı hastalarda yaşam kalitesinin kas yapısı, propriyosepsiyon, WOMAC skoru gibi bir çok faktör ile ilişkili olabileceği, aynı zamanda bu ilişkiyi, diğer parametreler arasındaki etkilenimlerin de etkileyebileceği, diz OA’lı hastalarla çalışan profesyonellerin hastaların YK’lerinin yönetiminde çok yönlü, çok faktörlü çalışmaların yapılmasına ihtiyaçları olduğu, bu çalışmanın bu alandaki çalışmalara yol gösterici olacağı sonucuna varılmıştır.
Increased intestinal leakiness and associated systemic inflammation are potential contributors to osteoarthritis (OA) and postural imbalance in the geriatric population. To-date, no successful treatment to correct postural imbalance in OA is known. We aimed to explore the effects of a multistrain probiotic upon postural imbalance in OA-affected patients. In this randomized, double-blind trial with a placebo group, 147 patients suffering from knee OA (age-span = 64-75 years) were divided into placebo (n=75) and probiotics (n=72) study groups. Vivomix 112 billion, multistrain probiotic was given once a day for 12 weeks. The outcomes of study variables were determined first at baseline and later after 12 weeks of intervention. These were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee flexion range-of-movement (ROM), pain intensity by visual analogue scale (VAS), handgrip strength (HGS), gait speed, and balance control assessed in standing, semi-tandem, and tandem stances. We determined plasma zonulin, to determine intestinal leak along with c-reactive protein (CRP) and 8-isoprostanes levels. A total of 136 OA patients taking placebo (n=71) and probiotics (n=65) were analyzed. The probiotics group exhibited a reduction in pain intensity, disease severity, and WOMAC scores along with improvement in balance scores, HGS, and walking speed (p<0.05 for all), no change in ROM, resting pain, and 8-isoprostanes levels. The correlation analysis revealed a robust association of balance scores with plasma markers of intestinal leakiness and inflammation in probiotics but not in the placebo group. Probiotics reduce postural imbalance in OA patients partly due to a reduction in intestinal leakiness.
Целта е да се представят терапевтичните възможности на Whole Body Vibration (WBV) за повлияване на функционалната активност на мускулатурата при възрастово обусловени промени в колянната става. Материали и методи: За целта на това ревю беше направен преглед на актуалните публикации в достъпните научни бази с данни, касаещи приложението и терапевтичните ефекти на Whole Body Vibration терапията при дегенеративни, възрастови промени в коляното. Резултати: Откриха се научни публикации, които показват, че WBV води до механична стимулация на мускулно-скелетната система. Заключение: Прилагането на Whole Body Vibration може да се разглежда като алтернативна терапия за подобряване на мускулната функция при коленен остеоартрит.
Ключови думи: Вибрационна терапия, мускулна активация, остеоартрит на коляното, проприоцепция, постурален баланс, упражнения.
The aim is to present the therapeutic possibilities of Whole Body Vibration (WBV) for influencing the functional activity of the muscles in age-related changes in the knee joint. Materials and methods: For the purpose of this report, a review of current publications in available scientific databases concerning the application and therapeutic effects of Whole Body Vibration therapy in degenerative, age-related changes in the knee was performed. Results: Scientific publications were found showing that WBV leads to mechanical stimulation of the musculoskeletal system. Conclusion: The application of Whole Body Vibration therapy can be considered as an adjuvant therapy to improve muscle function in knee osteoarthritis.
Keywords: Vibration therapy, muscle activation, knee osteoarthritis, proprioception, postural balance, exercise.
Osteoarthritis (OA) is a common chronic disease largely driven by mechanical factors, causing significant health and economic burdens worldwide. Early detection is challenging, making animal models a key tool for studying its onset and mechanically-relevant pathogenesis. This review evaluate current use of preclinical in vivo models and progressive measurement techniques for analysing biomechanical factors in the specific context of the clinical OA phenotypes. It categorizes preclinical in vivo models into naturally occurring, genetically modified, chemically-induced, surgically-induced, and non-invasive types, linking each to clinical phenotypes like chronic pain, inflammation, and mechanical overload. Specifically, we discriminate between mechanical and biological factors, give a new explanation of the mechanical overload OA phenotype and propose that it should be further subcategorized into two subtypes, post-traumatic and chronic overloading OA. This review then summarises the representative models and tools in biomechanical studies of OA. We highlight and identify how to develop a mechanical model without inflammatory sequelae and how to induce OA without significant experimental trauma and so enable the detection of changes indicative of early-stage OA in the absence of such sequelae. We propose that the most popular post-traumatic OA biomechanical models are not representative of all types of mechanical overloading OA and, in particular, identify a deficiency of current rodent models to represent the chronic overloading OA phenotype without requiring intraarticular surgery. We therefore pinpoint well standardized and reproducible chronic overloading models that are being developed to enable the study of early OA changes in non-trauma related, slowly-progressive OA. In particular, non-invasive models (repetitive small compression loading model and exercise model) and an extra-articular surgical model (osteotomy) are attractive ways to present the chronic natural course of primary OA. Use of these models and quantitative mechanical behaviour tools such as gait analysis and non-invasive imaging techniques show great promise in understanding the mechanical aspects of the onset and progression of OA in the context of chronic knee joint overloading. Further development of these models and the advanced characterisation tools will enable better replication of the human chronic overloading OA phenotype and thus facilitate mechanically-driven clinical questions to be answered.
To observe the clinical effect of electroacupuncture (EA) combined with exercise therapy on balance function in patients with knee osteoarthritis (KOA).
Seventy patients with KOA were randomly divided into a treatment group and a control group, with 35 cases in each group. The treatment group was treated with EA combined with exercise therapy. EA was applied to Dubi (ST35), Neixiyan (EX-LE4), Xuehai (SP10), Liangqiu (ST34), Yanglingquan (GB34), and Zusanli (ST 36). Exercise therapy (muscle strength training and knee mobility training) was applied after EA. The control group only received the same exercise therapy as the treatment group. The two groups were treated with the same course of treatment, 3 times a week for 4 consecutive weeks, 12 times in total, and followed up for 1 month. The Pro-Kin254P balance test system was used to measure the balance function parameters at 4 time points, including before treatment, after 1 session of treatment, after 12 sessions of treatment, and at 1-month follow-up after treatment. The visual analog scale (VAS) and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores were recorded.
The markedly effective rate and total effective rate in the treatment group were higher than those in the control group (P<0.01). The Romberg area, Romberg length, and VAS scores of the two groups decreased significantly after 1 session of treatment, 12 sessions of treatment, and 1 month after treatment, and the differences between different time points in the same group were statistically significant (P<0.01). There were significant differences between the two groups at the same time point (P<0.05). The total WOMAC scores of the two groups after 1 session of treatment, 12 sessions of treatment, and 1 month after treatment decreased significantly, and there were significant differences between different time points in the same group (P<0.05), but there was no significant difference between the two groups at the same time point (P>0.05).
EA combined with exercise therapy or exercise therapy alone can enhance the balance function, relieve joint pain, and improve joint function in patients with KOA. EA combined with exercise therapy is superior to exercise therapy alone in improving balance function and pain, but the two treatment protocols have similar effects in improving joint function.
Background of the Study: Osteoarthritis of knee is defined as a degenerative disorder of muscular and skeletalregion that causes pain, stiffness and increasing loss of function cause decreased Balance and Quality of Life (QoL).Studies has also found that an increased chances of fall risk in patients with OA knee. Balance training impacts theimprovement of functional ability and the quality of life in patients with osteoarthritis knee.Purpose: The main purpose of this study was to evaluate how well balance training affected the quality of life inOA knees.Methods: 30 participants with knee osteoarthritis (OA) who matched certain inclusion requirements participatedin the study. These subjects were randomly selected from two groups: Group A and B. Group A participated inconventional exercises, while Group B received a combination of conventional exercises and balance training. Toassess the impact of the interventions, the Time Up and Go (TUG) test was used to gauge balance, and the subjects’Quality of Life (QoL) was measured using the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC). These measurements were taken before and after the eight-week intervention period. During thestudy, each treatment regimen was administered three times a week for a total of eight weeks. The purpose of thisresearch was likely to evaluate the effects of conventional exercises and balance training on balance and quality oflife in individuals with knee osteoarthritis.Result: At the completion of the intervention session, subjects who had Balance training had statistically betterimprovement of Balance and Quality of Life (QoL) , group B, WOMAC (mean=61.13, SD= 1.59) and p value=0.0001)& TUG (mean=15.20, SD=2.41 and p value=0.0001).Conclusion: The study concluded that the combination of conventional exercise with Balance training showsbetter outcomes in improving quality of life among patients with knee OA.
The single-joint hybrid assistive limb (HAL-SJ), an exoskeletal robotic suit, offers functional improvement. In this prospective randomized controlled trial, we investigated the therapeutic effects of knee extension exercises using the HAL-SJ after total knee arthroplasty (TKA). Seventy-six patients with knee osteoarthritis were randomly assigned to HAL-SJ or conventional physical therapy (CPT) groups. The HAL-SJ group underwent exercise using the HAL-SJ for 10 days postoperatively, in addition to CPT; the CPT group underwent only CPT. Pain intensity and active and passive knee extension angles were evaluated preoperatively and on postoperative days 1–10 and weeks 2 and 4. Performance tests and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were evaluated preoperatively and at postoperative weeks 2 and 4. Statistical analysis showed that the HAL-SJ group significantly reduced pain intensity and improved active and passive knee extension angles compared with the CPT group. The HAL-SJ group showed immediate improvement in knee extension angle through day 5. There were no significant differences in results between the performance tests and KOOS. Knee extension exercises with the HAL-SJ improved knee pain and the angle of extension in the acute phase after TKA.
Background:
The measurement tool used for an accurate balance assessment should produce valid and reliable results in the population in which it is used.
Objectives:
To examine whether two performance-based task tests are a reliable and valid measurement test to assess balance in patients with early and advanced knee osteoarthritis (KO).
Design:
Reliability and concurrent validity research.
Method:
Test-retest reliability by calculating the intraclass correlation coefficient (ICC) between the first and second trial periods of performance-based task tests (Alternate Step Test & Pen Pick up Test); their correlations with the Timed Up and Go Test (TUGT) were calculated and their concurrent validity in balance assessment were examined.
Results:
A total of 100 patients (75% women, 25% men, mean 59 ± 10 years) with KO, 50 early (54 ± 7 years, 34 women, 16 men) and 50 advanced (64 ± 9 years, 41 women, 9 men), participated in the study. The ICC values for the Alternate Step Test (AST) and Pen Pick up Test (PPT) in patients with early KO are 0.881 (0.747-0.939, 95% confidence intervals) and 0.815 (0.689-0.892, 95% confidence intervals), respectively, while it is 0.852 (0.752-0.913, 95% confidence intervals) and 0.861 (0.756-0.922, 95% confidence intervals) in patients with advanced KO. Pearson correlation coefficient between AST & PPT times and TUGT time in patients with early and advanced KO was in the range of 0.535-0.746 (p < 0.01).
Conclusions:
Both task tests are reliable and valid clinical measurement tests that can be used to assess balance in patients with both early and advanced KO.
Background and aims: Today, various methods are used to evaluate the severity of knee instability in patients with knee osteoarthritis (KOA). The aim of this study was to compare the state of brain waves related to balance, pain, and proprioception among KOA women with and without knee instability.
Methods: In this cross-sectional study, 60 female KOA patients were selected, and based on the instability index scores, were divided into two groups of 30 people with and without knee instability. The pain was evaluated with visual analog scales (VAS), knee proprioception with angle reconstruction error and goniometer, balance with Berg Balance Scale (BBS), and brain wave analysis with the ProComp Infiniti device. The Fitzgerald scale was also used to assign subjects to groups with and without knee instability. Then, the two groups were compared.
Results: There was no significant difference between the mean scores of brain waves related to balance between the two groups. However, there was a significant difference between the two groups in knee proprioception at the target angles of 45° (both legs: p=0.0001) and 70° (right leg: p=0.003 and left leg: p=0.001). Also, a significant difference was observed between the two groups in balance scores (p=0.0001).
Conclusion: The evaluation of brain waves associated with balance in KOA patients cannot provide useful and practical information to identify people with knee instability. However, the sense of proprioception and balance in these people are distinct and can be factors to identify people prone to knee instability in these patients.
Background: Quadriceps training is necessary in function, activity of daily living and quality of life for patients with knee osteoarthritis (KOA) but it did not reduce the rate of surgical treatment (replacement of knee) for end-stage KOA in the long term. This may be related to brain structure changes and maladaptive plasticity in KOA patients. Transcranial magnetic stimulation (TMS), as a non-invasive brain stimulation technique, which uses magnetic pulse on the central nervous system, stimulates the excitability of nerve cells, enhances the functional connectivity of brain regions and improves maladaptive plasticity. However，the therapeutic effect of two rehabilitation techniques combination in patients with KOA remains unclear. Therefore, the purpose of this study is to investigate whether the high-frequency rTMS combined with quadriceps strength training can improve the function in KOA more effectively than quadriceps training alone and explore the brain mechanism of this combined rehabilitation.
Methods: This study is an assessor-blind, sham-controlled, randomized controlled trial involving 12 weeks intervention and 6 months follow-up. One hundred and twelve participants with KOA will be received usual care management and randomized into four subgroups including quadriceps strength training (QT); high-frequency rTMS training (HT); sham rTMS and quadriceps strength training (ST+Q); high-frequency rTMS and quadriceps strength training (HT+Q). The rehabilitation interventions in four groups will be carried out 5 days per week for a total of 12 weeks. All outcomes will be measured at baseline, 4 weeks, 8 weeks, and 12 weeks during intervention and 1 months, 3 months and 6 months during follow-up period. The primary outcomes are visual analog scale (VAS) and isokinetic muscle strength test. Secondary outcomes are include Knee Injury and Osteoarthritis Outcome Score (KOOS)，36-Item Short-Form Health Survey (SF-36), rTMS and magnetic resonance imaging (MRI).
Discussion: The study will provide evidence for the effects and brain mechanism of high frequency rTMS on improving function in KOA patients. High frequency rTMS can be added into the muscle training program for KOA patients as a supplementary therapy content if it is proved to be effective.
Trial registration: Chinese Clinical Trial Registry ChiCTR2300067617. Registered on Jan.13,2023.
Background:
Many comparative articles studied mobile-bearing (MB) and fixed-bearing (FB) total knee arthroplasties (TKAs). Meta-analyses found no difference in survival or biomechanical outcome. This study aimed to compare long-term clinical results between fixed-bearing (FB) and mobile-bearing (MB) total knee arthroplasty (TKA) as well as patients' adaptation to their artificial joints.
Method:
TKAs performed with the same surgical protocol divided into categories according to the insert design preferred. 70 MB design TKAs were compared with 70 FB design TKAs utilizing propensity matching for parameters; gender, age, body mass index, coronal plane deformity, range of motion (ROM) and appropriateness criteria. Forgotten Joint Score-12 (FJS-12) was used to assess patients' ability to forget their artificial joints in daily life.
Results:
Patients had a mean follow-up of 15.6 (±2.2) years. No difference was observed between groups for post-operative ROM, WOMAC, Knee Society Knee and Function Scores. The FJS-12 in the MB and FB groups were 66.1 and 72.8, respectively (P = 0.026). There was no significant difference in survival between both designs.
Conclusion:
This study suggests that in TKA, joint awareness is higher in MB compared to FB design. FJS-12 appears to be a sensitive measuring tool when comparing two designs and should be implemented in long-term follow-up.
Background:
Cerebral palsy (CP) is the most common brain injury in the pediatric population. CP patients present different affectations such as decreased muscle strength, gait deviations, impaired proprioception, and spasticity. Isokinetic strengthening programs combined with an intensive rehabilitation may improve muscle strength and therefore gait efficiency. Clinical Trials: The protocol has been accepted by the French National Ethics Committee (IDRCB: 2022-A00431-42).
Objective:
The primary aim of this randomized controlled trial is to compare the effect of an intensive rehabilitation combined with a non-functional isokinetic progressive strengthening program to an intensive rehabilitation alone on gait parameters and muscle strength in CP patients. Another goal of the current study is to determine whether adding an isokinetic program to an intensive rehabilitation is more effective than an intensive reha-bilitation alone on decreasing spasticity and improving joint position sense in CP patients.
Methods:
Thirty adolescents with spastic diplegia CP (GMFCS level I to III) will be randomized, by an independent researcher, into a 3-week intensive rehabilitation and isokinetic pro-gressive strengthening group or an intensive rehabilitation control group. Gait param-eters, muscle strength, spasticity and knee joint position sense will be assessed. These variables will be evaluated at baseline (T0) and at the end of the intervention (T1). The intensive rehabilitation will consist of physiotherapy sessions twice a day and hydro-therapy and virtual reality gait training once a day. The isokinetic training group will have a total of 9 supervised isokinetic strength training focusing on knee flexors and extensors with different execution speeds.
Results:
The protocol has been accepted by the French National Ethics Committee in October 2022. Inclusion of patients will start in November 2022.
Conclusions:
The combination of an intensive rehabilitation with an isokinetic program on knee flexors and extensors have not been studied yet. The findings of this study may determine if an isokinetic strength training program of knee flexors and extensors is benefic to improve gait parameters, muscle strength, spasticity, and joint position sense in adolescents with spastic diplegia.
Clinicaltrial:
The protocol has been accepted by the French National Ethics Committee (IDRCB: 2022-A00431-42).
Current methods of measurement of proprioceptive function depend on the ability to detect passive movement (kinaesthesia) or the awareness of joint position (joint position sense, JPS). However, reports of proprioceptive function in healthy and pathological joints are quite variable, which may be due to the different methods used. We have compared the validity of several frequently used methods to quantify proprioception. Thirty healthy subjects aged between 24 and 72 years underwent five established tests of proprioception. Two tests were used for the measurement of kinaesthesia (KT1 and KT2). Three tests were used for the measurement of JPS, a passive reproduction test (JPS1), a relative reproduction test (JPS2) and a visual estimation test (JPS3). There was no correlation between the tests for kinaesthesia and JPS or between the different JPS tests. There was, however, a significant correlation between the tests for kinaesthesia (r = 0.86). We conclude therefore that a subject with a given result in one test will not automatically obtain a similar result in another test for proprioception. Since they describe different functional proprioceptive attributes, proprioceptive ability cannot be inferred from independent tests of either kinaesthesia or JPS.
Muscle functions to generate force-producing movement and also has a role in proprioception. If ageing compromises these sensorimotor functions of muscle, the ability of older subjects to detect and correct postural sway may be impeded, resulting in impairment of functional performance.
To see if age-related changes occurred and, if so, what their effects might be. Quadriceps strength, proprioception, postural stability and functional performance were assessed in young (n = 20, mean age 23 years), middle-aged (n = 10, mean age 56 years) and elderly (n = 15, mean age 72 years) subjects.
With increasing age there were decreases in quadriceps strength (r = -0.511; P < 0.001), acuity of joint position sense (r = -0.603; P < 0.001) and postural stability (ANOVA < 0.002) during stance conditions which placed a greater reliance on muscle proprioceptors. These changes may decrease postural stability confidence, resulting in impaired performance of common activities of daily living (r = 0.635; P < 0.001).
The age-related deterioration in sensorimotor function of muscle may contribute to the increased fear and frequency of falls in elderly subjects, thereby decreasing independence.
The purpose of this study was to clarify whether osteoarthritis (OA) patients have a localized or a generalized reduction in proprioception. Twenty one women with knee OA (mean age [SD]: 57.1 [12.0] years) and 29 healthy women (mean age [SD]: 55.3 [10.1] years) had their joint position sense (JPS) and threshold to detection of a passive movement (TDPM) measured in both knees and elbows. JPS was measured as the participant's ability to actively reproduce the position of the elbow and knee joints. TDPM was measured as the participant's ability to recognize a passive motion of the elbow and knee joints. The absolute error (AE) for JPS (i.e., absolute difference in degrees between target and estimated position) and for TDPM (i.e., the difference in degrees at movement start and response when recognizing the movement) was calculated. For TDPM a higher AE (mean [SE]) was found in the involved knees in patients than in the matched knees of healthy participants (AE: 2.41 degrees [0.20 degrees] versus 1.47 degrees [0.14], p=0.001). The same held true for the non-involved knees between OA and healthy subjects (AE: 2.20 degrees [0.20 degrees] versus 1.57 degrees [0.14 degrees], p=0.016). Furthermore TDPM was higher in OA patients' right elbows compared to healthy participants' right elbows (AE: 2.15 degrees [0.20 degrees] versus 1.45 degrees [0.15 degrees], p=0.011). No significant difference between healthy women and OA patients regarding the left elbow for TDPM, or JPS was observed. The present age-controlled, cross-sectional study suggests that there is an increase in threshold to detection of a passive motion in knees and elbows for patients with knee OA. This indicates that OA may be associated with a generalized defect in proprioception with possible implications for the pathogenesis of the joint degeneration.
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.
The objective of this study was to determine the extent to which stair walking in persons with osteoarthrosis of the knee is influenced by age, weight, height, pain, clinical status, and position sense. The subjects were six women with severe knee joint disease who attended a single test session at which clinical status, disease severity, pain, position sense and stair-walking time was assessed. The results of correlation analyses revealed significant correlations of r = 0.84 and r = 0.95 (p < 0.05) between the measurements of stair-walking time and pain and between the measurements of stair-walking time and position sense, respectively. There was no relationship between stair-walking time and age, height, weight, clinical status or disease severity. It is concluded that knee pain and positional sense are strong determinants of the stair-walking ability of individual osteoarthrotic patients. In treating stair-walking problems in this group, it is recommended that effort be directed to improving proprioception as well as to reducing pain.
The purpose of this study was to identify associations between specific medical conditions in the elderly and limitations in functional tasks; to compare risks of disability across medical conditions, controlling for age, sex, and comorbidity; and to determine the proportion of disability attributable to each condition.
The subjects were 709 noninstitutionalized men and 1060 women of the Framingham Study cohort (mean age 73.7 +/- 6.3 years). Ten medical conditions were identified for study: knee osteoarthritis, hip fracture, diabetes, stroke, heart disease, intermittent claudication, congestive heart failure, chronic obstructive pulmonary disease, depressive symptomatology, and cognitive impairment. Adjusted odds ratios were calculated for dependence on human assistance in seven functional activities.
Stroke was significantly associated with functional limitations in all seven tasks; depressive symptomatology and hip fracture were associated with limitations in five tasks; and knee osteoarthritis, heart disease, congestive heart failure, and chronic obstructive pulmonary disease, were associated with limitations in four tasks each.
In general, stroke, depressive symptomatology, hip fracture, knee osteoarthritis, and heart disease account for more physical disability in noninstitutionalized elderly men and women than other diseases.
We examined the test-retest reliability and the construct validity of the measurement of knee position sense for describing the functional weightbearing performance of women with osteoarthritis (OA) of the knee.
For the purpose of this study, position sense was defined as the error occurring when subjects attempted to reproduce a criterion angle in standing with visual cues eliminated. Five such tests were recorded photographically on 3 different occasions. On each occasion the 10 subjects also completed a self-paced walking test over a 13 m indoor walkway.
The photographic measurements were reproducible (r = 0.90) and there was no change in positioning accuracy across sessions. There was a significant (p < 0.05) inverse correlation of 0.70 between the standard deviation of the mean individual measurements of position sense (precision of the test) and those of walking speed.
Our study demonstrates good measurement reliability and a comparable mean angular error with repeated tests. It also suggests the amplitude of the variability of this error is a strong determinant of an individual OA patient's functional performance in walking.
The objective of this study was to quantify the effect of degenerative joint change on the proprioceptive acuity of women with osteoarthritis (OA) of the knee. Middle-aged women with OA of the knee, age-matched healthy women, and younger healthy women were studied. Tests examined the ability of subjects to correctly reproduce knee angles in weightbearing and non-weightbearing situations. The knee angles were photographed and measured in degrees. The absolute error (AE) of each matching test was calculated and the mean AE of two tests was used as the criterion variable in a three-way analysis of variance (ANOVA). The relationship between the reproduction error and the osteoarthritic subjects' self-paced walking speed was also examined. Under both test conditions the AE of the osteoarthritic subjects was greater than that of the healthy subjects (p < .05). There was, however, no significant relationship between the AE measurements of the patients and their walking speed. These data indicate that while women with OA may have poorer proprioception than healthy controls, this impairment may not affect their walking ability.
Failure of conservative treatment is the usual indication for the reconstruction of a knee with deficiency of the anterior cruciate ligament (ACL) and this depends on subjective judgement. The ability of muscles to protect the subluxing joint by reflex contraction could provide an objective measurement. We have studied 30 patients with unilateral ACL deficiency by measuring the latency of reflex hamstring contraction. We found that the mean latency in the injured leg was nearly twice that in the unaffected limb (99 ms and 53 ms respectively). There was a significant correlation between the differential latency and the frequency of 'giving way' indicating that functional instability may be due, in part, to loss of proprioception. Measures of proprioception, including reflex hamstring latency, may be useful in providing an objective assessment of the efficacy of conservative treatment and the need for surgery.
Rehabilitation continues to evolve with the increased emphasis on patient management and proprioceptive training. Proprioception can be defined as a specialized variation of the sensory modality of touch that encompasses the sensation of joint movement (kinesthesia) and joint position (joint position sense). Numerous investigators have observed that afferent feedback to the brain and spinal pathways is mediated by skin, articular, and muscle mechanoreceptors. Examining the effects of ligamentous injury, surgical intervention, and proprioceptively mediated activities in the rehabilitation program provides an understanding of the complexity of this system responsible for motor control. It appears that this neuromuscular feedback mechanism becomes interrupted with injury and abnormalities, and approaches restoration after surgical intervention and rehabilitation. Rehabilitation programs should be designed to include a proprioceptive component that addresses the following three levels of motor control: spinal reflexes, cognitive programming, and brainstem activity. Such a program is highly recommended to promote dynamic joint and functional stability. Thus far, current knowledge regarding the basic science and clinical application of proprioception has led the profession of sports medicine one step closer to its ultimate goal of restoring function.
The knee joint position sense of a control group of healthy women was compared with that of women diagnosed as having severe osteoarthritis (OA) of the knee. Movements monitored were multi-joint when weightbearing on one leg. All subjects completed two angle rematching tests on two separate test occasions, and the criterion and reproduction angles which lay in the range of 15-45 degrees knee flexion were recorded photographically on each occasion. The results showed that the OA group performed the rematching tests with less accuracy than the controls (p < 0.05). Additionally, the OA group displayed significantly higher average flexion error magnitudes than the controls. These results suggest that joint position sense is less accurate and may be systematically distorted during multi-joint movements of the affected legs of a high proportion of women with severe knee OA. They further suggest that to improve their functional performance, patients with knee OA probably require a carefully constructed sensorimotor rehabilitation programme in which pain, effusion and fatigue are minimised.
Muscles are essential components of our sensorimotor system that help maintain balance and perform a smooth gait, but it is unclear whether arthritic damage adversely affects muscle sensorimotor function. Quadriceps sensorimotor function in patients with knee osteoarthritis (OA) was investigated, and whether these changes were associated with impairment of functional performance.
Quadriceps strength, voluntary activation, and proprioceptive acuity (joint position sense acuity) were assessed in 103 patients with knee OA and compared with 25 healthy control subjects. In addition, their postural stability, objective functional performance (the aggregate time for four activities of daily living), and disabilities (lequesne index) were also investigated.
Compared with the control subjects, the patients with knee OA had weaker quadriceps (differences between group mean 100N, CI 136, 63N), poorer voluntary activation (20% CI 13, 25%) that was associated with quadriceps weakness, and impaired acuity of knee joint position sense (1.28 degrees, CI 0.84, 1.73 degrees). As a group the patients were more unstable (p = 0.0017), disabled (10, CI 7, 11), and had poorer functional performance (19.6 seconds, CI 14.3, 24.9 seconds). The most important predictors of disability were objective functional performance and quadriceps strength.
In patients with knee OA, articular damage may reduce quadriceps motoneurone excitability, which decreases voluntary quadriceps activation thus contributing to quadriceps weakness, and diminishes proprioceptive acuity. The arthrogenic impairment in quadriceps sensorimotor function and decreased postural stability was associated with reduced functional performance of the patients.
Objectives: To investigate whether a “standard” sized (that is, a size that would be prescribed by a physiotherapist) elastic bandage (S-bandage) around the knee of subjects with knee osteoarthritis (OA) would, in the short term (a) reduce pain, (b) improve knee joint proprioception, and (c) decrease sway in comparison with a looser (L-bandage).
Methods: In a cross over, within-subject study, 68 subjects (49 women, 19 men; mean age 67.1, range 36–87) with symptomatic and radiographic knee OA were randomly assigned to either an S-bandage or an L-bandage. Two weeks later they were assigned to the opposite bandage size. Knee pain (10 cm visual analogue scale (VAS)), knee proprioception, and static postural sway were assessed for each bandage two weeks apart. During each visit assessments were performed at baseline, after 20 minutes of bandage application, and immediately after bandage removal.
Results: The S-bandage did not have any effect on knee pain, proprioception, or postural sway. The L-bandage reduced knee pain significantly (pre-bandage application: median VAS 4.36, IQR 3.84 –4.90; after 20 minutes of bandage application: median VAS 3.80, IQR 3.3–4.3, p<0.001), improved static postural sway (pre-bandage: median sway 4.50, IQ range 3.5–6.4; bandage applied: median sway 4.45, IQ range 3.4–6.3, p=0.027), but had no significant influence on knee proprioception.
Conclusions: In subjects with knee OA application of an elastic bandage around the knee can reduce knee pain and improve static postural sway. This outcome depends on the size of applied bandage.
Objective: A systematic review of studies describing the course of functioning in patients with osteoarthritis (OA) of hip or knee, and identifying potential prognostic factors. Methods: A systematic search was carried out. Studies in patients with hip or knee OA, > 6 months follow-up and outcome measures on functional status or pain, were included. Methodological quality was assessed using a standardized set of 11 criteria and a qualitative data analysis was performed. Results: Approximately 6500 titles and abstracts were screened and 48 publications were considered for inclusion. Finally 18 studies, of which four met the criteria of high methodological quality, were included. In hip OA, limited evidence was established that functional status and pain do not change during the first three years of follow-up. After three years, however, a worsening of functional status and pain was seen. In knee OA, conflicting evidence was found for the first three years and limited evidence for worsening of pain and functional status after three years. Furthermore, limited evidence was established for negative associations between future functional status and laxity, proprioceptive inaccuracy, age, BMI, and knee pain intensity. Muscle strength, mental health, self-efficacy, social support and aerobic exercise, on the other hand, are protective factors in the first three years. Conclusion: Pain and functional status in hip or knee OA are slowly deteriorating, with evidence for worsening after three years of follow up. In specific subgroups, the prognosis is either worse or better as both risk factors and protective factors were identified. Prognostic factors included biomechanical factors, psychological factors, clinical factors and treatment modalities. To strengthen the evidence, however, there is a need for further high-quality prognostic research on functioning in hip or knee OA. (aut. ref.)
Falls lead to significant morbidity and mortality in persons older than 65 years of age. Impaired proprioception may be a contributing factor to falls, and this may be influenced by the level of habitual physical activity. The primary purpose of this study was to investigate knee joint proprioception among young volunteers and active and sedentary elderly volunteers. Knee joint proprioception was measured through reproduction of static knee angles using a Penny and Giles™ electrogoniometer. The secondary purpose of this investigation was to test the reproducibility of the Penny and Giles™ electrogoniometer in measuring static knee angles. Sixteen young subjects (age range, 19-27 years) and 24 elderly subjects (age range, 60-86 years) participated. Subjects were given a screening history and physical examination to exclude neuromuscular or vestibular disorders or lower limb injuries. Knee joint proprioception was measured two times during one week. The elderly group was separated into active and sedentary subgroups based on their level of activity during the past year. The electrogoniometer was placed laterally across the dominant knee joint. From the prone position each subject attained one of ten randomly predetermined knee joint angles from 10° to 60°. The subject then returned to the starting position and reproduced the test angle. The absolute angular error (the absolute difference between the test angle and subject perceived angle of knee flexion) was determined. A positive correlation was found between control visits for all subjects (r = 0.88), and significant differences were observed between young (mean, 2.01 ± 0.46°) and active-old (mean, 3.12 ± 1.12°; P < 0.001), young and sedentary-old (mean, 4.58 ± 1.93°; P < 0.001), and active-old and sedentary-old (P < 0.03). These findings demonstrate that the Penny and Giles™ electrogoniometer is a reproducible device for measuring knee joint angles in both young and elderly subjects. Furthermore, we found that proprioception is diminished with age and that regular activity may attenuate this decline. One strategy to reduce the incidence of poor proprioception and fall with ageing may be regular exercise.
Objective. To test the hypotheses that 1) knee position sense declines with age; 2) patients with osteoarthritis (OA) have worse knee position sense than elderly controls; and 3) knee position sense is correlated with functional status.
Methods. The threshold for detection of knee joint displacement was measured in 30 patients with bilateral knee OA (Kellgren/Lawrence grade ⩾2 in both knees), 29 elderly controls (who met clinical and radiographic criteria for exclusion of OA), and 25 young controls. Range of motion, laxity, radiographic severity, and functional status were also assessed.
Results. A moderate correlation was found between joint displacement detection threshold and age (r = 0.598 and r = 0.501 for the right knee and the left knee, respectively). The threshold was substantially and significantly different between the OA patients and the elderly controls. Proprioceptive impairment was associated with worse disease-specific functional status.
Conclusion. Proprioception declines with age, and is further impaired in elderly patients with knee OA. Poor proprioception may contribute to functional impairment in knee OA.
Studying knee osteoarthrosis proprioceptive deficits play a growing role. However, the methods for the detection of these deficits using joint position sense measurements have been criticized recently. Therefore, we developed a new method for the measurement of knee-joint kinaesthesia. At 5 different angular velocities of passive knee movement both movement and stop detection were tested. Tests were performed both in 25 patients with osteoarthrosis of the knee and in a control group of 20 age related normal subjects. In addition to the measurements of movement detection and stop-detection thresholds, a specific detection-failure analysis was performed in our study. In addition to a significant improvement of proprioceptive abilities with increasing angular velocities, detection failure analysis brought about significant differences between patients with knee osteoarthrosis and normal subjects yielding a significant proprioceptive deficit in osteoarthrosis of the knee. In contrast, in case of correct movement detection or stop-detection there were no significant differences in the detection-threshold values between normal and ostheoarthrotic knees. In conclusion, both the lack of differences in detection thresholds between the arthrosis and the control-groups and the increased detection failure rates in arthrosis patients gave evidence for these proprioceptive differences being a result of central nervous dysregulation in knee osteoarthrosis.
In der vorliegenden Studie wurden propriozeptiven Fähigkeiten der Kniegelenke an 23 Patienten mit einem isoliertem Riß des medialen Meniskus untersucht; 13 Patienten wurden präoperativ getestet und 10 Patienten nach der arthroskopischen Teilresektion des verletzten Meniskus. Zusätzlich wurde der Einfluß einer elastischen Kniebandage untersucht. Als Kontrollgruppe dienten 30 gesunde Probanden mit anamnestisch und klinisch unauffälligen Kniegelenken. Zur Dokumentation der propriozeptiven Fähigkeiten der untersuchten Kniegelenke diente ein Winkelreproduktionstest. In der präoperativen Gruppe fiel eine signifikant schlechtere Propriozeption im Vergleich zur Kontrollgruppe auf. Die postoperative Patientengruppe zeigte einen signifikant besseren Stellungssinn im Kniegelenk als die präoperativen Patienten. Die postoperativen Resultate zeigten keinen signifikanten Unterschied zu denen der Kontrollgruppe. Es konnte keinerlei Einfluß der elastischen Kniebandage auf die Winkelreproduktionsfähigkeit der verletzten Kniegelenke festgestellt werden.
In the study presented, knee joint proprioception of 17 patients with primary degenerative joint disease of the knee joint
was evaluated. As a control group, the proprioception of 30 healthy volunteers with clinical and anamnestically inconspicuous
knee joints was examined. We tested the proprioceptive capability of the subjects with an angle reproduction test. Additionally,
all knee joints were measured with and without an elastic knee bandage. The study showed significantly more deterioration
in knee joint proprioception in patients with gonarthrosis than in the control group. Even the proprioception of the contralateral,
healthy knee joint was worse than the results of the control group. However, after using an elastic knee bandage, significant
improvement in the proprioceptive abilities of the injured knee joint was documented.
Proprioception and accompanying neuromuscular feedback mechanisms provide an important component for the establishment and maintenance of functional joint stability. Neuromuscular control and joint stabilisation is mediated primarily by the central nervous system. Multisite sensory input, originating from the somatosensory, visual and vestibular systems, is received and processed by the brain and spinal cord. The culmination of gathered and processed information results in conscious awareness of joint position and motion, unconscious joint stabilisation through protective spinal-mediated reflexes and the maintenance of posture and balance. Clinical research aimed at determining the effects of articular musculoskeletal injury, surgery and rehabilitation, on joint proprioception, neuromuscular control and balance has focused on the knee and ankle joints. Such studies have demonstrated alterations in proprioception subsequent to capsulo-ligamentous injury, partial restoration of proprioceptive acuity following ligamentous reconstruction, and have suggested beneficial proprioceptive changes resulting from comprehensive rehabilitation programmes.
Proprioceptive deficits occur with knee osteoarthritis (OA) and improving proprioception may slow joint degeneration by allowing more appropriate joint loading. Stochastic resonance (SR) stimulation improves balance and the sensitivity of specific mechanoreceptors. Our purpose was to evaluate the effects of SR electrical stimulation combined with a knee sleeve on proprioception in subjects with knee OA. Joint position sense (JPS) was measured in 38 subjects with knee OA during four conditions in both a partial weight-bearing (PWB) and non weight-bearing (NWB) task: no electrical stimulation/no sleeve, no electrical stimulation/sleeve, 50 μA-RMS stimulation/sleeve, and 75 μA-RMS stimulation/sleeve. Subjects also reported their knee pain, stiffness, functionality (WOMAC), and instability. Repeated measures ANOVA and Spearman correlations were performed to investigate differences between the conditions and relationships among the outcome measures. JPS during the 75 μA-RMS stimulation/sleeve and sleeve alone conditions was significantly improved compared to the control condition in the PWB task. However, the 75 μA-RMS stimulation/sleeve and the sleeve alone conditions did not differ from each other. A moderate correlation was found between the improvements with the 75 μA-RMS stimulation/sleeve condition compared to the JPS of the control condition in the PWB task. No differences in JPS were found between the four conditions in the NWB task. Significant correlations were found between the control JPS and WOMAC indices (p<0.005). Improved proprioception during the PWB task was achieved with a sleeve alone and in combination with SR stimulation. The observed correlations suggest that subjects with larger proprioceptive deficits may benefit most from these therapies.
Impaired quadriceps strength and joint position sense (JPS) have been linked with knee osteoarthritis (OA) cross-sectionally. Although neither has been independently associated with incident radiographic OA, their combination may mediate risk. The purpose of this study was to determine whether better sensorimotor function protects against the development of incident radiographic or symptomatic knee OA.
The Multicenter Osteoarthritis study is a longitudinal study of adults aged 50–79 yr at high risk for knee OA. Participants underwent bilateral, weight-bearing, fixed-flexion radiographs, JPS acuity tests, and isokinetic quadriceps strength tests. The relationships between combinations of the tertiles of sex-specific baseline peak strength and mean JPS and development of incident radiographic (Kellgren–Lawrence (KL) grade Q2) or symptomatic knee OA (KL grade Q2 and frequent knee pain or stiffness) at a 30-month follow-up were evaluated. Secondary analyses defined JPS as the variance during the 10 JPS trials and also assessed the interaction of strength and JPS in predicting each outcome.
The study of incident radiographic knee OA included 1390 participants (age = 61.2 ± 7 .9 yr and body mass index = 29.4 ± 5.1 kg·m−²), and the study of incident symptomatic knee OA included 1829 participants (age = 62.2 ± 8.0 yr and body mass index = 30.0 ± 5.4 kg·m−²). Greater strength at baseline protected against incident symptomatic but not radiographic knee OA regardless of JPS tertile. There was no significant relationship between the strength–JPS interaction and the development of radiographic or symptomatic knee OA.
The finding that quadriceps strength protected against incident symptomatic but not radiographic knee OA regardless of JPS tertile suggests that strength may be more important than JPS in mediating risk for knee OA.
The purpose of this study was to investigate the effect of massage applied to the thigh muscles on joint repositioning error (JRE) in patients suffering from osteoarthritis (OA).We hypothesized that stimulating massage of the muscles around an osteoarthritic knee joint, could improve the neuromuscular function and thereby optimize the positive and minimize the negative performance factors in relation to an exercise program.
In a cross-over design, 19 patients with knee osteoarthritis, mean age of 73.1 years (SD: 9.4; range 56 to 88 years), recruited from the local department of rheumatology, were randomly allocated to either receive massage and a week later, act as controls or vice versa. The applied massage consisted of stimulating massage of the quadriceps femoris, sartorious, gracilus, and hamstrings muscles for 10 min on the affected leg. Participants had their JRE measured before and immediately after the 10 min massage and control sessions. Data were analyzed by using paired t-test.
No significant change in JRE was observed (95% CI: -0.62 degrees to 0.85 degrees, p = 0.738).
Massage has no effect on the immediate joint repositioning error in patients with knee osteoarthritis, ie, if an improved JRE is important for improving the performance factors when exercising, stimulating massage may not be recommendable to use.
The aim of this study was to investigate the short-term effects of intra-articular injection of hyaluronan (Hylan G-F 20) on proprioception, isokinetic muscle force, self reported pain, and functional condition in patients with knee osteoarthritis (OA).
63 patients with stage II-III bilateral knee OA were included in this randomized, placebo controlled, and prospective study. Subjects were randomized with 42 of them into the treatment group and 21 of them into the placebo group. Hyaluronan was intraarticularly injected into both knees of the subjects which were in the treatment group, whereas physiological saline was intraarticularly injected to the subjects which were in the placebo group. Proprioception and the isokinetic muscle force measurement were performed. Visual analogue scale (VAS) and WOMAC scale were used to evaluate pain and physical function.
Statistical analysis was performed on 120 knees of 60 patients completing the trial. The average absolute angular error (AAAE) value showing the proprioceptive error level in the treatment group was detected to be statistically significantly lower compared to placebo at the measurements performed after the 3rd injection (p = 0.02) and after one week (p = 0.01). While there was no inter-group difference in isokinetic measurements performed at 180 and 240 degrees/sec, a significant difference was detected at the measurement performed at 60 degrees/sec in favor of the treatment group (p = 0.02). Activity and resting VAS-pain values, WOMAC parameters (except the WOMAC stiffness) were detected to be significantly lower in the treatment group. Local adverse events were not reported in any patient.
In this study, it was demonstrated that intraarticular injection of hyaluronan in patients with knee OA led to a short-term increase in proprioception and isokinetic muscle force, and also significant improvements in the functional conditions of patients. Long-term studies are needed.
Although cross-sectional studies have reported impaired proprioceptive acuity in people with osteoarthritis (OA), there have been no longitudinal studies to evaluate whether those with such impairments increase the risk of OA or its worsening.
We studied subjects from the Multicenter Osteoarthritis Study study, a longitudinal study of people with or at high risk of knee OA. At baseline, we quantified acuity as the amount of a subject's error when attempting to reproduce a test knee flexion angle (a measure of joint position sense). We tested proprioception 10 times in the right leg and used a person's worst score as their proprioceptive acuity. At baseline and the 30-month followup, we assessed the presence of frequent pain, obtained Western Ontario and McMasters Universities OA Index (WOMAC) scores, and acquired posteroanterior and lateral weight-bearing knee radiographs read for Kellgren/Lawrence grade and individual radiographic features. We examined the relation of baseline proprioceptive acuity in quartiles with baseline knee pain (frequent pain yes/no), WOMAC pain score, self-reported physical function, and radiographic OA, and with changes from baseline in pain, physical function, and radiographic OA adjusted for age, sex, body mass index, and quadriceps strength.
At baseline, proprioceptive acuity was associated with the presence and severity of knee pain but not with the presence of radiographic OA. However, among the 2,243 subjects with baseline acuity assessments and 30-month followup, there were no strong associations between proprioceptive acuity and development of adverse OA outcomes. Acuity was not significantly associated with the new onset of frequent knee pain. Those with the worst acuity at baseline had slightly greater worsening of WOMAC pain scores (0.47 on a 20-point scale) and physical function scores (by 1.5 points on a 0-68-point scale) compared with those with the best proprioceptive acuity, whose pain and physical function score deteriorated less (for pain P = 0.05; for physical function P = 0.02). Radiographic worsening was not significantly associated with proprioceptive acuity.
Proprioceptive acuity as assessed by the accuracy of reproduction of the angle of knee flexion had modest effects on the trajectory of pain and physical functional limitation in knee OA.