The efficacy of electromyographic biofeedback on pain, function, and maximal thickness of vastus medialis oblique muscle in patients with knee osteoarthritis: a randomized clinical trial

Seyed Ahmad Raeissadat, Seyed Mansoor Rayegani, Leyla Sedighipour, Zeynab Bossaghzade, Mohamad Hesam Abdollahzadeh, Rojin Nikray, Fazeleh Mollayi, Seyed Ahmad Raeissadat, Seyed Mansoor Rayegani, Leyla Sedighipour, Zeynab Bossaghzade, Mohamad Hesam Abdollahzadeh, Rojin Nikray, Fazeleh Mollayi

Abstract

Introduction: The aim of this survey was to examine the effect of adding electromyographic biofeedback (EMGBF) to isometric exercise, on pain, function, thickness, and maximal electrical activity in isometric contraction of the vastus medialis oblique (VMO) muscle in patients with knee osteoarthritis (OA).

Methods: In this clinical trial, 46 patients with a diagnosis of knee OA were recruited and assigned to two groups. The case group consisted of 23 patients with EMGBF-associated exercise, and the control group was made up of 23 patients with only isometric exercise. Data were gathered via visual analog scale (VAS) score, the Persian version of the Western Ontario and McMaster Universities Osteoarthritis Index and Lequesne questionnaires, ultrasonography of the VMO, and surface electromyography of this muscle at baseline and at the end of the study. Variables were compared before and after the exercise program in each group and between the two groups.

Results: At the end of the study, there were no significant differences between the two groups regarding measured variables. Only the VAS score was significantly less in the case group. Although all assessed parameters, except for VMO muscle thickness, were found to be improved significantly in each group, the degree of change was not significantly different between the two groups, except for VAS score. VMO muscle thickness did not change significantly after exercise therapy in either of the groups.

Conclusion: Isometric exercises accompanied by EMGBF and the same exercises without biofeedback for 2 months both led to significant improvements in pain and function of patients with knee OA. Real EMGBF was not superior to exercise without biofeedback in any of the measured variables, except for VAS score.

Keywords: EMG biofeedback; isometric quadriceps exercise; knee osteoarthritis.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of the study.
Figure 2
Figure 2
Comparison of patient satisfaction between the two groups.

References

    1. Guccione AA, Felson DT, Anderson JJ, et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Public Health. 1994;84(3):351–358.
    1. Cross M, Smith E, Hoy D, et al. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014;73(7):1323–1330.
    1. Raeissadat SA, Tabibian E, Rayegani SM, Rahimi-Dehgolan S, Babaei-Ghazani A. An inestigation into the efficacy of intra-articular ozone (O2-O3) injection in patients with knee osteoarthritis: a systematic review and meta-analysis. J Pain Res. 2018
    1. Raeissadat SA, Rayegani SM, Forogh B, Hassan Abadi P, Moridnia M, Rahimi Dehgolan S. Intra-articular ozone or hyaluronic acid injection: which one is superior in patients with knee osteoarthritis? A 6-month randomized clinical trial. J Pain Res. 2018;11:111–117.
    1. Raeissadat SA, Babaee M, Rayegani SM, et al. An overview of platelet products (PRP, PRGF, PRF, etc.) in the Iranian studies. Future Sci OA. 2017;3(4):FSO231.
    1. Raeissadat SA, Rayegani SM, Ahangar AG, Abadi PH, Mojgani P, Ahangar OG. Efficacy of intra-articular Injection of a newly developed plasma rich in growth factor (PRGF) versus hyaluronic acid on pain and function of patients with knee osteoarthritis: a single-blinded randomized clinical trial. Clin Med Insights Arthritis Musculoskelet Disord. 2017;10:1179544117733452.
    1. Raeissadat SA, Rayegani SM, Hassanabadi H, et al. Knee osteoarthritis injection choices: platelet-rich plasma (PRP) versus hyaluronic acid (a one-year randomized clinical trial) Clin Med Insights Arthritis Musculoskelet Disord. 2015;8:CMAMD.S17894.
    1. Rayegani SM, Raeissadat SA, Heidari S, Moradi-Joo M. Safety and effectiveness of low-level laser therapy in patients with knee osteoarthritis: a systematic review and meta-analysis. J Lasers Med Sci. 2017;8(Suppl 1):S12–S19.
    1. Richards R, van den Noort JC, Dekker J, Harlaar J. Gait retraining with real-time biofeedback to reduce knee adduction moment: systematic review of effects and methods used. Arch Phys Med Rehabil. 2017;98(1):137–150.
    1. Demura T, Demura S, Uchiyama M, Sugiura H. Examination of factors affecting gait properties in healthy older adults: focusing on knee extension strength, visual acuity, and knee joint pain. J Geriatr Phys Ther. 2014;37(2):52–57.
    1. Sharma L, Dunlop DD, Cahue S, Song J, Hayes KW. Quadriceps strength and osteoarthritis progression in malaligned and lax knees. Ann Intern Med. 2003;138(8):613–619.
    1. Ettinger WH, Afable RF. Physical disability from knee osteoarthritis: the role of exercise as an intervention. Med Sci Sports Exerc. 1994;26(12):1435–1440.
    1. JOHANNES W. Pain and disability in patients with osteoarthritis of hip or knee: the relationship with articular, kinesiological, and psychological characteristics. Pain. 1998;25:125–133.
    1. Wang Y, Wluka AE, Berry PA, et al. Increase in vastus medialis cross-sectional area is associated with reduced pain, cartilage loss, and joint replacement risk in knee osteoarthritis. Arthritis Rheum. 2012;64(12):3917–3925.
    1. Meier WA, Marcus RL, Dibble LE, et al. The long-term contribution of muscle activation and muscle size to quadriceps weakness following total knee arthroplasty. J Geriatr Phys Ther. 2009;32(2):35–38.
    1. Eftekhar-Sadat B, Niknejad-Hosseyni SH, Babaei-Ghazani A, Toopchizadeh V, Sadeghi H. Reliability and validity of Persian version of Western Ontario and McMaster Universities Osteoarthritis index in knee osteoarthritis. J Anal Res Clin Med. 2015;3(3):170–177.
    1. Kim H, Song CH. Comparison of the VMO/VL EMG ratio and onset timing of VMO relative to VL in subjects with and without patellofemoral pain syndrome. J Phys Ther Sci. 2012;24(12):1315–1317.
    1. Anwer S, Alghadir A. Effect of isometric quadriceps exercise on muscle strength, pain, and function in patients with knee osteoarthritis: a randomized controlled study. J Phys Ther Sci. 2014;26(5):745–748.
    1. Levitt R, Deisinger JA, Remondet Wall J, Ford L, Cassisi JE, Wall JR, Ford LOR. I. EMG feedback-assisted postoperative rehabilitation of minor arthroscopic knee surgeries. J Sports Med Phys Fitness. 1995;35(3):218–223.
    1. Ahamed NU, Sundaraj K, Ahmad RB, Nadarajah S, Shi PT, Rahman SM. Recent survey of automated rehabilitation systems using EMG biosensors. J Phys Ther Sci. 2011;23(6):945–948.
    1. Mcconnell J. The physical therapist’s approach to patellofemoral disorders. Clin Sports Med. 2002;21(3):363–387.
    1. Kirnap M, Calis M, Turgut AO, Halici M, Tuncel M. The efficacy of EMG-biofeedback training on quadriceps muscle strength in patients after arthroscopic meniscectomy. N Z Med J. 2005;118(1224):U1704.
    1. Nitz JC, Luparia L. The use of EMG biofeedback in quadriceps strengthening exercise for rheumatoid arthritis patients: a clinical trial. Aust J Physiother. 1983;29(4):127–132.
    1. Moher D, Hopewell S, Schulz KF, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c869.
    1. Huang MH, Lin YS, Yang RC, Lee CL. A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis. Semin Arthritis Rheum. 2003;32(6):398–406.
    1. Cheing GL, Hui-Chan CW, Chan KM. Does four weeks of TENS and/or isometric exercise produce cumulative reduction of osteoarthritic knee pain? Clin Rehabil. 2002;16(7):749–760.
    1. Merletti R. Surface electromyography: The SENIAM project. Eur J Phys Rehab Med. 2000;36(4):167.
    1. Anwer S, Equebal A, Nezamuddin M, Kumar R, Lenka PK. Effect of gender on strength gains after isometric exercise coupled with electromyographic biofeedback in knee osteoarthritis: a preliminary study. Ann Phys Rehabil Med. 2013;56(6):434–442.
    1. Nadrian H, Moghimi N, Nadrian E, et al. Validity and reliability of the Persian versions of WOMAC Osteoarthritis Index and Lequesne Algofunctional Index. Clin Rheumatol. 2012;31(7):1097–1102.
    1. Giggins OM, Persson UM, Caulfield B. Biofeedback in rehabilitation. J Neuroeng Rehabil. 2013;10(1):60.
    1. Huang H, Wolf SL, He J. Recent developments in biofeedback for neuromotor rehabilitation. J Neuroeng Rehabil. 2006;3(1):11.
    1. Yılmaz OO, Senocak O, Sahin E, et al. Efficacy of EMG-biofeedback in knee osteoarthritis. Rheumatol Int. 2010;30(7):887–892.
    1. Choi YL, Kim BK, Hwang YP, Moon OK, Choi WS. Effects of isometric exercise using biofeedback on maximum voluntary isometric contraction, pain, and muscle thickness in patients with knee osteoarthritis. J Phys Ther Sci. 2015;27(1):149–153.
    1. Wasielewski NJ, Parker TM, Kotsko KM. Evaluation of electromyographic biofeedback for the quadriceps femoris: a systematic review. J Athl Train. 2011;46(5):543–554.
    1. Anwer S, Quddus N, Miraj M, Equebal A. Effectiveness of electromyographic biofeedback training on quadriceps muscle strength in osteoarthritis of knee. Hong Kong Physiother J. 2011;29(2):86–93.
    1. Lepley AS, Gribble PA, Pietrosimone BG. Effects of electromyographic biofeedback on quadriceps strength: a systematic review. J Strength Cond Res. 2012;26(3):873–882.
    1. Dursun N, Dursun E, Kiliç Z. Electromyographic biofeedback-controlled exercise versus conservative care for patellofemoral pain syndrome. Arch Phys Med Rehabil. 2001;82(12):1692–1695.
    1. Sedighipour L, Raeissadat SA, Rayegani SM, et al. AB0973 The efficacy of electromyographic biofeedback on pain, function and maximal thickness of vastus medialis oblique muscle in patients with knee oa; a randomised clinical trial. Annal Rheum Dis. 2018;77(Suppl 2):1610.

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