Effects of Concurrent Exercise Combinations in Knee Osteoarthritis:

Istanbul University - Cerrahpasa45 enrolled

Overview

This study will include 3 different groups of intervention. First group of knee osteoarthritis patients will be applied both strengthening and 30 minutes bicycle exercises in the same session, 2 days strecthing exercises and 30 minutes walking will be given in seperate days as home program, Second group of knee osteoarthritis patients will be applied both stretching and 30 minutes bicycle exercises in the same session, strengthening exercises and 30 minutes walking will be given in seperate days as home program.Third group of knee osteoarthritis patients will be applied all stretching, strengthening and 30 minutes bicycle exercises in the same session, only 30 minutes walking will be given as home program. The primary outcome measures include the pain, function and the secondary outcome measures include the joint proprioception. The aim of this study is to investigate the effects on outcome measures increasing number of exercises in one session and to determine which exercise types are more suitable to prescribe as a home program.

This study will include 3 different groups of intervention. First group of knee osteoarthritis patients will be applied both strengthening and bicycle exercises in the same session and strecthing exercises and walking will be given as home program in the days other than treatment session. Second group of knee osteoarthritis patients will be applied both stretching and bicycle exercises in the same session and strengthening exercises and walking will be given as home program in the days other than treatment session. Third group of knee osteoarthritis patients will be applied all stretching, strengthening and bicycle exercises in the same session and only walking exercise will be given as home program in the days other than treatment session. The primary outcome measures include the pain, function and the secondary outcome measures include the joint proprioception. The aim of this study is to investigate the effects increasing number of exercises in one session on outcome measures consisting of pain, function and proprioception. The pain will be evaluated both subjectively with numeric pain scale and WOMAC scale and objectively with pressure algometer. The function will be subjectively evaluated with WOMAC scale. The evaluation of joint proprioception will be evaluated with inclinometer. All the groups will be treated 2 days per week. The duration of total treatment lasts 8 weeks. All the groups practice aerobic exercises 2 days with bicycle ergometer application in the clinic, and 2 days walking outside as home program. Strecthing exercises will be applied for knee flexor and knee extensor muscles. Isometric strengthening exercises will be applied for knee extensor muscles. Isotonic strengthening exercises will be applied for hip extensor, flexor, abductor muscles and knee extensor and flexor muscles. The treatment outcomes will be evaluated at the end of 8 weeks treatment.

Interventions

Stretching and Aerobic Exercise at ClinicOTHER

In this group of knee osteoarthritis patients will be applied both stretching and 30 minutes bicycle exercises in the same session, strengthening exercises and 30 minutes walking will be given in seperate days as home program.

Strenghthening and Aerobic ExerciseOTHER

In this group of knee osteoarthritis patients will be applied both strengthening and 30 minutes bicycle exercises in the same session, 2 days strecthing exercises and 30 minutes walking will be given in seperate days as home program.

Strengthening, Stretching and Aerobic Exercises at clinicOTHER

In this group of knee osteoarthritis patients will be applied all stretching, strengthening and 30 minutes bicycle exercises in the same session, only 30 minutes walking will be given as home program.

Eligibility

Sex: ALLMin age: 45 YearsMax age: 73 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Being diagnosed as knee osteoarthritis * Being between the ages 45-74 * Being at stage 2-3 according to Kellegren Lawrence Classification * Having body mass index lower than 30 * Being volunteer for participation to this study Exclusion Criteria: * Refusing to participation to study * Having another orthopeadic problem ralated to lower extremity * Having uncontrollable hypertension * Having arterial and venous disease * Having neurological disease * Having perceptual problem * Having cardiac pacemaker * Participation to physiotherapy program in the last 6 months for the same extremity * Taking injection from the same extremity in the last 6 months

Outcomes

Primary Outcomes

The Western Ontario and McMaster Universities Arthritis Index

The Western Ontario and McMaster Universities Arthritis Index is a questionnaire consisting of 24 items divided into 3 subscales: Pain (5 items): during walking, using stairs, in bed, sitting or lying, and standing upright Stiffness (2 items): after first waking and later in the day Physical Function (17 items): using stairs, rising from sitting, standing, bending, walking, getting in / out of a car, shopping, putting on / taking off socks, rising from bed, lying in bed, getting in / out of bath, sitting, getting on / off toilet, heavy domestic duties, light domestic duties. The increasing scores reflect improvement of the function.

Time frame: Change of The Western Ontario and McMaster Universities Arthritis Index scores from the beginning to the end of study (8 weeks)

Numeric Pain Rating Scale

The Numeric Pain Rating Scale is a segmented numeric version of the visual analog scale in which a respondent selects a whole number (0-10 likert type integers) that best reflects the intensity of his/her pain.The levels of pain felt at rest / activity / night will be evaluated. The increase in pain scores demonstrate that the health status get worse.

Time frame: Change of Numeric Pain Rating Scale scores from the beginning to the end of study (8 weeks)

Pain Pressure Treshold (PPT)

Pain Pressure Treshold is evaluated via algometric measurement that were taken from 4 point including the mid portion of patella, 3 cm medial to patellar midline, 3 cm lateral to patellar midline, 2 cm above to patellar upper boundary.The increase in algometric measurement demonstrate the development in the pain sensitivity.

Time frame: Change of Pain Pressure Treshold measurements from the beginning to the end of study (8 weeks)

Secondary Outcomes

Proprioception

Proprioception will be evaluated with digital inclinometer from 90 degree knee flexion to 30 degree knee flexion angle. The deviation from this interval reflects that the detoriation of knee joint proprioception. Therefore, decreasing deviation scores obtained from the inclinometer reflects better proprioceptive sensation.

Time frame: Change of Inclinometric measurements from the beginning to the end of study (8 weeks).

Knee Muscle Strength

Muscle strength for knee flexor and extensor muscles Knee joint muscle strength was measured by using hand-held dinamometer. The measurements had taken for quadrieps and hamstring muscles. the incresing muscle strength values reflects improvement of strength of muscles around knee joint.

Time frame: Change of muscle strength measurements from the beginning to the end of study (8 weeks)