Comparative effects of virtual reality training and sensory motor training on bone morphogenic proteins and inflammatory biomarkers in post-traumatic osteoarthritis

Gopal Nambi, Walid Kamal Abdelbasset, Shereen H Elsayed, Mona A Khalil, Saud M Alrawaili, Saud F Alsubaie, Gopal Nambi, Walid Kamal Abdelbasset, Shereen H Elsayed, Mona A Khalil, Saud M Alrawaili, Saud F Alsubaie

Abstract

The objective of this study is to compare the effects of virtual reality training (VRT) and sensory-motor training (SMT) in bone morphogenetic proteins (BMP) and inflammatory biomarkers expression in post-traumatic osteoarthritis (PTOA) after the anterior cruciate ligament injury. Through a simple random sampling method, 60 eligible participants were allocated into VRT (n = 20), SMT (n = 20), and control groups (n = 20). They underwent training programs for 4 weeks. Clinical (pain intensity and functional disability) and biochemical (bone morphogenic proteins and inflammatory biomarkers) values were measured at baseline, after 4 weeks, 8 weeks and 3 months follow up. Four weeks following training, the VRT group shows more significant changes in pain intensity and functional disability than SMT and control groups (P < 0.001). Bone morphogenic protein (BMP) measures such as BMP 2, 4, 6, and 7 don't show any significant changes between the groups. But at the same time, the VRT group shows positive improvement in inflammatory biomarkers (CRP, TNF-α, IL-2, IL-4, IL-6) analysis than the other two groups (P < 0.001). Our study suggests that including virtual reality training in PTOA shows beneficial changes in pain, functional disability, and modification of inflammatory biomarkers than sensory-motor training, but at the same time it shows a negligible effect on bone morphogenic proteins.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flow chart showing the study details.
Figure 2
Figure 2
Mean values of VAS and WOMAC scores in VRT, SMT and control group.
Figure 3
Figure 3
Mean values of BMP-2, BMP-4, BMP-6 and BMP-7 levels in VRT, SMT and control groups.
Figure 4
Figure 4
Mean values of CRP, TNF-α, IL-2, IL-4 and IL-6 levels in VRT, SMT and control group.

References

    1. Racine J, Aaron RK. Post-traumatic osteoarthritis after ACL injury. R. I. Med. J. 2014;97(11):25–28.
    1. Dare D, Rodeo S. Mechanisms of post-traumatic osteoarthritis after ACL injury. Curr. Rheumatol. Rep. 2014;16(10):448. doi: 10.1007/s11926-014-0448-1.
    1. Palmieri-Smith RM, Thomas AC. A neuromuscular mechanism of post-traumatic osteoarthritis associated with ACL injury. Exerc. Sport Sci. Rev. 2009;37:147–153. doi: 10.1097/JES.0b013e3181aa6669.
    1. Joy SM. Osteoarthritis after anterior cruciate ligament injury: The quadriceps question. Exerc. Sport Sci. Rev. 2009;37(3):112. doi: 10.1097/JES.0b013e3181aa6345.
    1. Amin S, Baker K, Niu J, et al. Quadriceps strength and the risk of cartilage loss and symptoms progression in knee osteoarthritis. Arthritis Rheum. 2009;60:189–198. doi: 10.1002/art.24182.
    1. Friel NA, Chu CR. The role of ACL injury in the development of posttraumatic knee osteoarthritis. Clin. Sports Med. 2013;32(1):1–12. doi: 10.1016/j.csm.2012.08.017.
    1. Myer GD, Ford KR, Barber Foss KD, Liu C, Nick TG, Hewett TE. The relationship of hamstrings and quadriceps strength to anterior cruciate ligament injury in female athletes. Clin. J. Sport Med. 2009;19:3–8. doi: 10.1097/JSM.0b013e318190bddb.
    1. Yoon YS, Chai M, Shin DW. Football injuries at Asian tournaments. Am. J. Sports Med. 2004;32:36–42. doi: 10.1177/0095399703258781.
    1. Alentorn-Geli E, Myer GD, Silvers HJ, et al. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee Surg. Sports Traumatol. Arthrosc. 2009;17:705–729. doi: 10.1007/s00167-009-0813-1.
    1. Badlani N, Oshima Y, Healey R, Richard Coutts BS, Amiel D. Use of bone morphogenic protein-7 as a treatment for osteoarthritis. Clin. Orthop. Relat. Res. 2009;467(12):3221–3229. doi: 10.1007/s11999-008-0569-9.
    1. Young WB, James R, Montgomery I. Is muscle power related to running speed with changes of direction? J. Sports Med. Phys. Fitness. 2002;42:282–288.
    1. Nambi G, Kamal W, George J, Manssor E. Radiological and biochemical effects (CTX-II, MMP-3, 8, and 13) of low-level laser therapy (LLLT) in chronic osteoarthritis in Al-Kharj, Saudi Arabia. Lasers Med. Sci. 2017;32(2):297–303. doi: 10.1007/s10103-016-2114-5.
    1. Wang L, Zeng N, Yan Z, et al. Post-traumatic osteoarthritis following ACL injury. Arthritis Res. Ther. 2020;22:57. doi: 10.1186/s13075-020-02156-5.
    1. Kizony R, Katz N, Weiss PL. Adapting an immersive virtual reality system for rehabilitation. J. Vis. Comput Animat. 2003;14:261–268. doi: 10.1002/vis.323.
    1. Jones T, Moore T, Choo J. The impact of virtual reality on chronic pain. PLoS ONE. 2016;11:e0167523. doi: 10.1371/journal.pone.0167523.
    1. Kim SS, Min WK, Kim JH, Lee BH. The effects of vr-based wii fit yoga on physical function in middle-aged female lbp patients. J. Phys. Ther. Sci. 2014;26:549. doi: 10.1589/jpts.26.549.
    1. Jack D, Boian R, Merians AS, et al. Virtual reality-enhanced stroke rehabilitation. IEEE Transl. Neural Syst. Rehabil. Eng. Publ. IEEE Eng. Med. Biol. Soc. 2001;9:308–318. doi: 10.1109/7333.948460.
    1. Thornton M, Marshall S, McComas J, Finestone H, McCormick A, Sveistrup H. Benefits of activity and virtual reality based balance exercise programmes for adults with traumatic brain injury: Perceptions of participants and their caregivers. Brain Inj. 2005;19:989–1000. doi: 10.1080/02699050500109944.
    1. Mongini F, Ibertis F, Barbalonga E, Raviola F. MMPI-2 profiles in chronic daily headache and their relationship to anxiety levels and accompanying symptoms. Headache. 2000;40:466–472. doi: 10.1046/j.1526-4610.2000.00070.x.
    1. Slesinger D, Archer RP, Duane W. MMPI-2 characteristics in a chronic pain population. Assessment. 2002;9:406–414. doi: 10.1177/1073191102238153.
    1. Sam-yeol W, Kang J. The effects of virtual reality interactive games on the balance ability of elderly women with knee osteoarthritis. J. Phys. 2012;7(3):387–393.
    1. Riemann BL, Lephart SM. The sensorimotor system. Part I: The physiologic basis of functional joint stability. J. Athlet. Train. 2002;37(1):71–79.
    1. Carvalho N, Bittar S, Pinto F, Ferreira M, Sitta R. Manual for guided home exercises for osteoarthritis of the knee. Clinics. 2010;65(8):775–780. doi: 10.1590/S1807-59322010000800006.
    1. Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P, Goldsmith CH. Reliability of pain scales in the assessment of literature and illiterate patients with rheumatoid arthritis. J. Rheumatol. 1990;17:1022–1024.
    1. Alghadir A, Anwer S, Iqbal ZA, Alsanawi HA. Cross-cultural adaptation, reliability and validity of the Arabic version of the reduced Western Ontario and McMaster Universities Osteoarthritis index in patients with knee osteoarthritis. Disabil. Rehabil. 2016;38(7):689–694. doi: 10.3109/09638288.2015.1055380.
    1. Mao Y, Chen P, Li L, et al. Virtual reality training improves balance function. Neural Regen. Res. 2014;9(17):1628–1634. doi: 10.4103/1673-5374.141795.
    1. McConville KMV, Virk S. Evaluation of an electronic video game for improvement of balance. Virtual Real. 2012;16(4):315–323. doi: 10.1007/s10055-012-0212-7.
    1. Paalanne N, Niinimaki J, Karppinen J, et al. Assessment of association between low back pain and para spinal muscle atrophy using opposed-phase magnetic resonance imaging: A population-based study among young adults. Spine. 2011;36:1961–1968. doi: 10.1097/BRS.0b013e3181fef890.
    1. D’hooge R, Cagnie B, Crombez G, et al. Increased intramuscular fatty infiltration without differences in lumbar muscle cross sectional area during remission of unilateral recurrent low back pain. Man Ther. 2012;12:584–588. doi: 10.1016/j.math.2012.06.007.
    1. Danneels LA, Vanderstraeten GG, Cambier DC, et al. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur. Spine J. 2000;9:266–272. doi: 10.1007/s005860000190.
    1. Chen CL, Chen CY, Liaw MY, Chung CY, Wang CJ, Hong WH. Efficacy of home-based virtual cycling training on bone mineral density in ambulatory children with cerebral palsy. Osteoporos Int. 2013;24(4):1399–1406. doi: 10.1007/s00198-012-2137-0.
    1. Elizabeth Y, Brian C, Bradley C, David E, Ruckle PT. Virtual reality neurorehabilitation for mobility in spinal cord injury: A structured review. Innov. Clin. Neurosci. 2019;16(1–2):13–20.
    1. Riemann BL, Lephart SM. The sensorimotor system. Part II: The role of proprioception in motor control and functional joint stability. J. Athlet. Train. 2002;37(1):80–84.
    1. Aguiar GC, Do Nascimento MR, De Miranda AS, Rocha NP, Teixeira AL, Scalzo PL. Effects of an exercise therapy protocol on inflammatory markers, perception of pain, and physical performance in individuals with knee osteoarthritis. Rheumatol. Int. 2015;35(3):525–531. doi: 10.1007/s00296-014-3148-2.
    1. Imamura M, et al. Impact of nervous system hyperalgesia on pain, disability, and quality of life in patients with knee osteoarthritis: A controlled analysis. Arthritis Care Res. 2008;59(10):1424–1431. doi: 10.1002/art.24120.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅