Effect of eccentric isokinetic strengthening in the rehabilitation of patients with knee osteoarthritis: Isogo, a randomized trial

Anne-Gaëlle Jegu, Bruno Pereira, Nicolas Andant, Emmanuel Coudeyre, Anne-Gaëlle Jegu, Bruno Pereira, Nicolas Andant, Emmanuel Coudeyre

Abstract

Background: Femorotibial knee osteoarthritis is associated with muscle weakness in the lower limbs, particularly in the quadriceps, which results in disease progression. The interest of having muscular strengthening as part of the therapeutic arsenal for the medical treatment of knee osteoarthritis is now well established.The functional disability induced by knee osteoarthritis manifests itself principally when walking, notably downhill, during which the muscles are called upon to contract eccentrically.We can therefore think that eccentric muscular strengthening could bring a functional benefit that is superior to concentric muscular strengthening.

Methods/design: This is a prospective, randomized, bicenter, parallel-group, international study. Eighty patients aged from 40 to 75 years old, suffering from medical-stage knee osteoarthritis, will undertake 6 weeks of isokinetic muscular strengthening. Randomization determines the mode of muscular strengthening: either exclusively eccentric or exclusively concentric.The principal objective is to demonstrate the superiority of the improvement in the quadriceps isokinetic torque after isokinetic muscular strengthening by the eccentric mode compared to the concentric mode.The following parameters are also evaluated: the variations in the level of pain, the parameters of walking (maximum speed over 10 and 200 meters, analysis on a computerized Gaitrite™ treadmill), static equilibrium (on a FUSYO™ force platform), and the functional status of the patient using the Western Ontario and MacMaster Universities osteoarthritis index (WOMAC) questionnaire after the strengthening period and at 6 months.

Discussion: A better knowledge of the most effective mode of muscular strengthening is needed to optimize the functional benefits to the patients. In case of superiority in terms of efficacy of the eccentric mode, the latter could be given priority in the rehabilitation treatment of knee osteoarthritis patients.

Trial registration: Clinical trials.gov number: NCT01586130.

Figures

Figure 1
Figure 1
Study design: This flow-chart (to be read from left to right) displays the different phases of the protocol and explorations being conducted.

References

    1. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81:646–656.
    1. Le Pen C, Reygrobellet C, Gérentes I. Financial cost of osteoarthritis in France. The “COART” France study. Joint Bone Spine. 2005;72:567–570. doi: 10.1016/j.jbspin.2005.01.011.
    1. Fernandes L, Hagen KB, Bijlsma JWJ, Andreassen O, Christensen P, Conaghan PG, Doherty M, Geenen R, Hammond A, Kjeken I, Lohmander LS, Lund H, Mallen CD, Nava T, Oliver S, Pavelka K, Pitsillidou I, da Silva JA, de la Torre J, Zanoli G, Vliet Vlieland TP. European League against Rheumatism (EULAR) EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis. 2013;72:1125–1135. doi: 10.1136/annrheumdis-2012-202745.
    1. Lankhorst GJ, Van de Stadt RJ, Van der Korst JK. The relationships of functional capacity, pain, and isometric and isokinetic torque in osteoarthrosis of the knee. Scand J Rehabil Med. 1985;17:167–172.
    1. Hurley MV, Newham DJ. The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early. Unilateral osteoarthritic knees. Rheumatology. 1993;32:127–131. doi: 10.1093/rheumatology/32.2.127.
    1. Slemenda C, Heilman DK, Brandt KD, Katz BP, Mazzuca SA, Braunstein EM, Byrd D. Reduced quadriceps strength relative to body weight: a risk factor for knee osteoarthritis in women? Arthritis Rheum. 1998;41:1951–1959. doi: 10.1002/1529-0131(199811)41:11<1951::AID-ART9>;2-9.
    1. O’Reilly SC, Jones A, Muir KR, Doherty M. Quadriceps weakness in knee osteoarthritis: the effect on pain and disability. Ann Rheum Dis. 1998;57:588–594. doi: 10.1136/ard.57.10.588.
    1. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16:137–162. doi: 10.1016/j.joca.2007.12.013.
    1. Huang M-H, Lin Y-S, Yang R-C, Lee C-L. A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis. Semin Arthritis Rheum. 2003;32:398–406. doi: 10.1053/sarh.2003.50021.
    1. Tüzun EH, Aytar A, Eker L, Daşkapan A. Effectiveness of two different physical therapy programmes in the treatment of knee osteoarthritis. Pain Clin. 2004;16:379–387. doi: 10.1163/1568569042664468.
    1. Elliott J. Assessing muscle strength isokinetically. JAMA. 1978;240:2408–2410. doi: 10.1001/jama.240.22.2408.
    1. LaStayo PC, Woolf JM, Lewek MD, Snyder-Mackler L, Reich T, Lindstedt SL. Eccentric muscle contractions: their contribution to injury, prevention, rehabilitation, and sport. J Orthop Sports Phys Ther. 2003;33:557–571.
    1. Gür H, Cakin N, Akova B, Okay E, Küçükoğlu S. Concentric versus combined concentric-eccentric isokinetic training: effects on functional capacity and symptoms in patients with osteoarthrosis of the knee. Arch Phys Med Rehabil. 2002;83:308–316. doi: 10.1053/apmr.2002.30620.
    1. Yu J, Park D, Lee G. Effect of eccentric strengthening on pain, muscle strength, endurance, and functional fitness factors in male patients with achilles tendinopathy. Am J Phys Med Rehabil. 2013;92:68–76. doi: 10.1097/PHM.0b013e31826eda63.
    1. Rochcongar P. Évaluation isocinétique des extenseurs et fléchisseurs du genou en médecine du sport: revue de la littérature. Ann Readapt Med Phys. 2004;47:274–281. doi: 10.1016/j.annrmp.2004.05.013.
    1. Sekiya N, Nagasaki H, Ito H, Furuna T. Optimal walking in terms of variability in step length. J Orthop Sports Phys Ther. 1997;26:266–272. doi: 10.2519/jospt.1997.26.5.266.
    1. AFP. Normes 85. 66, rue de Lisbonne 75008. Paris: Association Posture et Équilibre; 1985.
    1. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.
    1. Verbeke G, Molenberghs G. Linear Mixed Models for Longitudinal Data. New York: Springer; 2009.
    1. Verbeke G, Molenberghs G. Linear Mixed Models for Longitudinal Data. 2. Springer Series in Statistics; 2009.
    1. Beunckens C, Molenberghs G, Verbeke G, Mallinckrodt C. A latent-class mixture model for incomplete longitudinal Gaussian data. Biometrics. 2008;64:96–105. doi: 10.1111/j.1541-0420.2007.00837.x.
    1. Bennell KL, Hunt MA, Wrigley TV, Lim B-W, Hinman RS. Muscle and Exercise in the Prevention and Management of Knee Osteoarthritis: an Internal Medicine Specialist’s Guide. Med Clin North Am. 2009;93:161–177. doi: 10.1016/j.mcna.2008.08.006.
    1. Lange AK, Vanwanseele B, Fiatarone Singh MA. Strength training for treatment of osteoarthritis of the knee: a systematic review. Arthritis Rheum. 2008;59:1488–1494. doi: 10.1002/art.24118.
    1. Noorizadeh Dehkordi S, Talebian S, Olyaei G, Montazeri A. Reliability of isokinetic normalized peak torque assessments for knee muscles in post-stroke hemiparesis. Gait Posture. 2008;27:715–718. doi: 10.1016/j.gaitpost.2007.07.013.
    1. Pipes TV, Wilmore JH. Isokinetic vs isotonic strength training in adult men. Med Sci Sports. 1975;7:262–274.
    1. Isner-Horobeti M-E, Dufour SP, Vautravers P, Geny B, Coudeyre E, Richard R. Eccentric exercise training: modalities, applications and perspectives. Sports Med. 2013;43:483–512. doi: 10.1007/s40279-013-0052-y.

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