Improvement in Pain and Function Following a Physiotherapy Program in Older Adults With Knee Osteoarthritis
Improvement in Pain and Function Following a Therapeutic Exercise Program and Dry Needling in Older Adults With Knee Osteoarthritis: A Randomized Double-blind Multicenter Controlled Clinical Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Therapeutic exercise and dry needling each relieve pain and improve function, but they are different treatment tools.
Therapeutic exercise takes a multitude of forms and results in numerous systemic and local effects, some of which have been investigate among people with knee osteoarthritis. Therapeutic exercise covers a range of targeted physical activities that directly aim to improve muscle strength, neuromotor control, joint range of motion and aerobic fitness. One of the main aims of this therapeutic approach is to improve muscle strength, given that weakness is common in knee osteoarthritis. Enhanced strength of the lower limb may lessen internal knee forces, reduce pain and improve physical function.
Primary knee osteoarthritis provokes pain and disfunction is thought mediated by joint damage and changes in joint homeostasis. Recently, investigations focused in impaired neuromuscular system as a contribution to the above mentioned symptoms in the knee osteoarthritis syndrome explore the use of dry needling. Dry needling is a therapeutic approach for decreasing pain and improve function with high recommended evidence (grade A) effectiveness for upper-quarter myofascial pain, but poorly understood in knee osteoarthritis patients.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Madrid
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Alcorcón, Madrid, Spain, 28922
- Universidad Rey Juan Carlos
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Participants aged 62 years and older.
- Unilateral or bilateral disfunction and/or knee pain.
- Primary knee ostearthritis fulfilling the American College of Rheumatology criteria for clinical and radiographic diagnostic.
- At least 1 pain point elicited by palpation ipsilateral to the painful knee situated in a taut band of a skeletal muscle of the lower limbs, which usually have referred pain.
Exclusion Criteria:
- Prior diagnoses or prescriptions in the medical record for myopathy or lumbo-sacral neuropathy.
- Previous knee or hip joint replacement surgery of the affected joint.
- Any other surgical procedure of the lower limbs in the previous 6 months.
- Rheumatoid arthritis.
- Initiation of opioid analgesia or cortico-steroid or analgesic injection intervention for hip or knee pain within the previous 30 days.
- Alcohol or drugs consumption.
- Uncontrolled hypertension or moderate to high risk for cardiac complications during exercise.
- Conservative or invasive physical therapy (previous 6 months or during follow-up).
- Taking antiaggregant or anticoagulant medications.
- Physical impairments unrelated to the hip or knee preventing safe participation in exercise, walking or stationary cycling, such as: vision problems that affect mobility, body weight greater than 155 kg, neurogenic disorder, primary or significantly limiting back pain, advanced osteoporosis, or inability to walk 10 metres without an assistive device.
- Inability to comprehend and complete study assessments or comply with study instructions.
- Stated inability to attend or complete the proposed course of intervention and follow-up schedule.
- Fibromyalgia syndrome or other altered affective/cognitive modulation processes of pain perception. .
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
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Experimental: Exercise and dry needling
24 therapeutic exercise sessions (twice a week) of a land-based therapeutic exercise program consisting of aerobic exercise (20-25 min warm-up), lower limbs muscle strengthening (20-25 min) and lower limbs muscles stretching (10-15 min). 6 dry needling sessions (once a week) at all the pain points of the involved symptomatic lower limb/s using Hong's fast-in and fast-out technique with multiple rapid needle insertion. |
20-25 minutes aerobic exercise, 20-25 minutes strength exercise and 10-15 minutes stretch exercise.
Dry needling needle AGUPUNT®
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Active Comparator: Exercise and sham dry needling
24 therapeutic exercise sessions (twice a week) of a land-based therapeutic exercise program consisting of aerobic exercise (20-25 min warm-up), lower limbs muscle strengthening (20-25 min) and lower limbs muscles stretching (10-15 min). 6 sham dry needling sessions (once a week) at all the pain points of the involved symptomatic lower limb/s using a park sham device consists of a base with a hole in the centre and sticky tape on the bottom. From the top of the base extends a double tube, continuing the central hole in the base. |
20-25 minutes aerobic exercise, 20-25 minutes strength exercise and 10-15 minutes stretch exercise.
Sham dry needling DONGBANG-ACUPRIME®
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Western Ontario and McMaster Osteoarthritis Index (WOMAC) change assessment.
Time Frame: Base line, through study completion (3 months); and 3, 6 and 12 months follow-up
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The disease-specific questionnaire WOMAC is the most widely used instrument created and validated to evaluate both the symptomatology and function on osteoarthritis of the hip or knee.
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Base line, through study completion (3 months); and 3, 6 and 12 months follow-up
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Numeric Pain Rating Scale (NPRS)
Time Frame: Base line, through study completion (3 months); ; and 3, 6 and 12 months follow-up
|
Pain intensity will be assessed using a NPRS of 11 points (from 0, no pain, to 10, maximum pain).
The patient determined their subjective pain intensity of the painful knee by pointing with 1 of their fingers to mark the level of pain on the scale. .
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Base line, through study completion (3 months); ; and 3, 6 and 12 months follow-up
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Barthel Index
Time Frame: Base line, through study completion (3 months); and 3, 6 and 12 months follow-up
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The Barthel Index is considered to be the best of the activities of daily living measurement scales.
The modified scoring of the Barthel Index by Shah achieved greater sensitivity and improved reliability than the original version, without causing additional difficulty or affecting the implementation time.
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Base line, through study completion (3 months); and 3, 6 and 12 months follow-up
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The Timed Up & Go Test
Time Frame: Base line, through study completion (3 months); and 3, 6 and 12 months follow-up
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The patient is asked to perform the rise from a standard arm chair, walk to a line on the floor 3 meters away, turn, return, return and sit down again.
The score given is the time taken in seconds to complete the test.
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Base line, through study completion (3 months); and 3, 6 and 12 months follow-up
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Mini-Mental State Examination (MMSE)
Time Frame: Base line and 12 months follow-up
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It's a 30-point questionnaire that is used extensively in clinical and research settings to measure cognitive impairment and to screen for dementia.
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Base line and 12 months follow-up
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EuroQol-5
Time Frame: Base line, through study completion (3 months); and 3, 6 and 12 months follow-up
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It provides a simple descriptive profile and a single index value for health status through rating of 5 items.
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Base line, through study completion (3 months); and 3, 6 and 12 months follow-up
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Total number of falls change assessment.
Time Frame: At Baseline and 1 year follow-up.
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Total number of falls at 1 year follow-up, and to compare with number of falls at one year before the participation on the study.
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At Baseline and 1 year follow-up.
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Eleuterio Atanasio Sánchez Romero, PT, MSc, Universidad Rey Juan Carlos
Publications and helpful links
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 13/2015
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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