End-range Mobilization on Knee Osteoarthritis

End-range Mobilization Effecting Pain and Physical Function in the Management of Knee Osteoarthritis

Different manual therapy techniques and conservative therapy have been used separately for alleviation of pain and improvement of physical function in patients with knee osteoarthritis (KOA). However, no study has reported the effect of combination of these treatment modalities in the management of KOA. The aim of this study was to investigate the effect of end-range mobilization added to conservative therapy versus conservative therapy alone on decrease of pain and improvement of functional status in KOA.

Study Overview

• Status: Completed
• Conditions: Osteo Arthritis Knee
• Intervention / Treatment: Procedure: Conservative therapy; Procedure: Manual therapy

Detailed Description

Knee osteoarthritis (KOA) is a musculoskeletal condition affecting older people. It is characterized by pain and loss of physical function, which has a negative impact on patients' quality of life. The different international guidelines recommend several non-invasive treatment modalities for the management of KOA. Conservative therapy including land-based exercises, aquatic exercises, Transcutaneous Electro Neuro Stimulation (TENS) therapy and balneotherapy has been reported positively in the management of patients with KOA (1, 2). Manual therapy is also a preferred treatment modality with the aim of alleviation of pain, improvement of joint mobility and therefore the physical condition (1, 2). Out of manual therapy techniques, end-range mobilization is a well applied treatment technique in the management of different musculoskeletal conditions (3). Till date, the effect of end-range mobilization has not been investigated so far in knee OA.

Therefore, the aim of this study was to investigate the effect of end-range mobilization added to conservative therapy versus conservative therapy alone on decrease of pain and improvement of functional status in KOA.

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Hungary
  • Please Select
    • Harkány, Please Select, Hungary, 7815
      • Zsigmondy Vilmos Spa and Balneological Hospital of Harkány

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 60 years to 90 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• KOA according to the American College of Rheumatology
• categorization as End Of Range Problem based on Maitland's classification.
• at least half year existing and at least 3 pain scores measured with Visual Analogue Scale (VAS) during weight-bearing activities
• bilateral, moderate-to-severe symptomatic tibiofemoral knee OA with radiographic evidence
• at least 90 degree passive knee flexion range
• sufficient mental status

Exclusion Criteria:

• acute inflammation of the knee
• intraarticular injections within the last 3 months
• total knee replacement in the opposite side
• class II. obesity (body mass index, BMI>35kg/m2)
• severe degenerative lumbar spine disease (e.g. spondylolisthesis)
• systemic inflammatory arthritic or neurological condition
• physiotherapy and other balneotherapy attendance within 6 months
• contraindication for conservative and manual therapy
• unstable heart condition
• complex regional pain syndrome

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NON_RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: End-range mobilization; End-range mobilization applied 6 times for 2*2 min in end-range of flexion and extension end-range of the tibiofemoral and patellofemoral joint beside the same conservative therapy, as used for the Control	Procedure: Conservative therapy; Conservative therapy including aquatic exercises, land-based exercises, balneotherapy, TENS therapy; Procedure: Manual therapy; End-range mobilization
ACTIVE_COMPARATOR: Control; Conservative therapy including aquatic exercises (5-times), land-based exercises (3-times), balneotherapy (5-times) and TENS therapy (3-times)	Procedure: Conservative therapy; Conservative therapy including aquatic exercises, land-based exercises, balneotherapy, TENS therapy

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
general pain intensity	measuring of general pain intensity with Visual Analogue Scale	at the end of the 3-week rehabilitation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
pain intensity during getting up from a chair	measuring of pain intensity during getting up from a chair with Visual Analogue Scale	at the end of the 3-week rehabilitation
pain intensity during getting in car	measuring of pain intensity during getting in car with Visual Analogue Scale	at the end of the 3-week rehabilitation
pain intensity during turning while walking	measuring of pain intensity during turning while walking with Visual Analogue Scale	at the end of the 3-week rehabilitation
pain intensity during stair descending	measuring of pain intensity during stair descending with Visual Analogue Scale	at the end of the 3-week rehabilitation
Flexion and extension passive range of motion	Flexion and extension passive range of motion of the tibiofemoral joint	at the end of the 3-week rehabilitation
Quadriceps and hamstring muscles peak muscle force	Quadriceps and hamstring muscles peak muscle force of both knees	at the end of the 3-week rehabilitation
6-minute walk test	6-minute walk test measuring functional capacity	at the end of the 3-week rehabilitation
Timed Up and Go test	Timed Up and Go test measuring functional capacity	at the end of the 3-week rehabilitation

Collaborators and Investigators

• Sponsor: University of Pecs

Publications and helpful links

General Publications

• Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P; American College of Rheumatology. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012 Apr;64(4):465-74. doi: 10.1002/acr.21596.
• McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, Hawker GA, Henrotin Y, Hunter DJ, Kawaguchi H, Kwoh K, Lohmander S, Rannou F, Roos EM, Underwood M. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014 Mar;22(3):363-88. doi: 10.1016/j.joca.2014.01.003. Epub 2014 Jan 24.
• Maricar N, Shacklady C, McLoughlin L. Effect of Maitland mobilization and exercises for the treatment of shoulder adhesive capsulitis: a single-case design. Physiother Theory Pract. 2009 Apr;25(3):203-17. doi: 10.1080/09593980902776654.

Study record dates

Study Major Dates

• Study Start (ACTUAL): February 12, 2020
• Primary Completion (ACTUAL): February 12, 2020
• Study Completion (ACTUAL): May 12, 2020

Study Registration Dates

• First Submitted: February 12, 2020
• First Submitted That Met QC Criteria: February 12, 2020
• First Posted (ACTUAL): February 17, 2020

Study Record Updates

• Last Update Posted (ACTUAL): November 3, 2020
• Last Update Submitted That Met QC Criteria: October 31, 2020
• Last Verified: October 1, 2020

More Information

Terms related to this study

• Keywords: Conservative Treatment; Osteoarthritis, Knee; Musculoskeletal Manipulations
• Additional Relevant MeSH Terms: Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Arthritis; Osteoarthritis; Osteoarthritis, Knee
• Other Study ID Numbers: PozsgaiMMaitlandKnee

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No