Mulligan Manual Therapy and Trunk Stabilization Exercises Versus Isometric Knee Strengthening on Knee Osteoarthritis

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-09-20

Study Completion Date

2021-03-20

Brief Summary

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Knee joint arthritis posses a serious health problem and caring for an individual with knee osteoarthritis (KOA) produces a great burden on society. Knee joint pain is associated with physical activity while performing various activities of daily living (ADL) in patients with early and severe osteoarthritis (OA). In addition to knee pain, physical function or daily activity is strongly influenced by the severity of Osteoarthritis of the knee. Mulligan joint mobilization with movement provides evident effects on decreasing the pain and restoring the joint biomechanics. Trunk stabilization exercise will improve the stability of trunk which distributes the weight of body evenly on both feets. The aim of this study is to determine the effects of mulligan joint mobilization and trunk stabilization exercise on pain, disability and submaximal exercise performance in KOA.

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Detailed Description

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A randomized control trial will be conducted at IPM\&R on 60 subjects with knee osteoarthritis and age between 40-60 years. Initial screening of the subjects will be carried out by the referring consultant. Subjects who fulfilled the study criteria will be recruited using computer generated random sampling after explaining the study objective and taken written informed consent. All participants will be evaluated using visual analogue scale, Knee injury and Osteoarthritis Outcome Score and 6-minute walk test for pain severity, functional limitation and submaximal exercise capacity at 1st, 3rd and 6th week. The subjects will be allocated into three groups through computer generated random allocation. Group 1 will receive mulligan mobilization with kinesiotaping and knee strengthening. Group 2 will receive trunk stabilization exercise, knee strengthening and Kinesiotaping. Group 3 will receive knee strengthening along with kinesiotaping. A drop-out rate of 9 will be taken. Recorded data will be entered and analysed using SPSS version 21. Mean and SD will be calculated of quantitative variables like age, pain, knee related function, submaximal exercise capacity and stair climb by using repeated measure ANOVA. For pair wise comparison, post hoc tukey will be applied. Value of equal to or less than 0.05 will be considered significant.

Conditions

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Osteoarthritis, Knee

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

After confirming eligibility, the physiotherapist performing intervention obtained treatment assignment (S.S. Ali). The subject will not be aware of the group allocation and different time slot will be given for the intervention. Another physiotherapist who will not be aware of allocation concealment, record the reading of outcomes at the baseline, after three and six weeks

Study Groups

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Mulligan mobilization group

This study ARM will received Mulligan joint mobilization and concomitant therapies in this group.

The following are the brief detail of therapy

1. Mulligan joint mobilization in Non-weight bearing (NWB):
2. Knee strengthening
3. Kinesiotaping

Group Type EXPERIMENTAL

Mulligan Joint mobilization

Intervention Type OTHER

This study ARM will received Mulligan joint mobilization and concomitant therapies in this group.

The following are the brief detail of therapy

1. Mulligan joint mobilization in Non-weight bearing (NWB) to weight-bearing (WB) 6 -10 Reps and 3 sets/ session.

Procedural detail:

Joint mobilization will be performed in sagittal, frontal and transverse direction, following glide will be preferred will depend on patient adherence to the joint mobilization. Mobilization will be progress from NWB to WB according to patient compliance 27
2. Knee strengthening Type of exercise: Knee Isometric Strengthening exercises. Intensity: 10 reps Frequency: At 1st week one set of all knee exercise will be performed then it will be progressed to 2 sets at 3 weeks, and these exercises will be progressed to three sets until the 6 weeks
3. Kinesiotaping:

Trunk stabilization group

This study ARM will received Trunk stabilization exercises and concomitant therapies in this group.

The following are the brief detail of therapy:

1. Trunk stabilization i. modified supermen extension exercise ii. Back bridge: iii. Unilateral back bridge:

Iv. lateral step up:
2. Knee strengthening i. Isometric quadriceps exercise: ii. Straight leg raising (SLR) exercise:
3. Kinesiotaping:

Group Type EXPERIMENTAL

Trunk stabilization group

Intervention Type OTHER

This study ARM will received Trunk stabilization exercises and concomitant therapies in this group.

The following are the brief detail of therapy:

1. Trunk stabilization Area: Trunk Type of exercise: Stabilization exercise Intensity: 6-8 reps Frequency: 3 sets per session and 30 second duration break between sets

Procedural detail:

i. modified supermen extension exercise ii. Back bridge: iii. Unilateral back bridge:

Iv. lateral step up:
2. Knee strengthening Area: Knee Joint Type of exercise: Knee Isometric Strengthening exercises. Intensity: 10 reps Frequency: At 1st week one set of all knee exercise will be performed then it will be progressed to 2 sets at 3 weeks, and these exercises will be progressed to three sets until the 6 weeks

Procedural detail:

i. Isometric quadriceps exercise: ii. Straight leg raising (SLR) exercise:
3. Kinesiotaping:

Knee strengthening group

This study ARM will received Knee strengthening exercises and concomitant therapies in this group.

The following are the brief detail of therapy:

1. Knee strengthening i. Isometric quadriceps exercise ii. Straight leg raising (SLR) exercise:
2. Kinesio-taping:

Group Type OTHER

Knee strengthening group

Intervention Type OTHER

This study ARM will received Knee strengthening exercises and concomitant therapies in this group.

The following are the brief detail of therapy:

1. Knee strengthening Area: Knee Joint Type of exercise: Knee Isometric Strengthening exercises. Intensity: 10 reps Frequency: At 1st week one set of all knee exercise will be performed then it will be progressed to 2 sets at 3 weeks, and these exercises will be progressed to three sets until the 6 weeks

Procedural detail:

i. Isometric quadriceps exercise ii. Straight leg raising (SLR) exercise:
2. Kinesio-taping:

Muscle stretch method will be applied which involves one Y and two I straps: The Y-shaped tape base will be affixed over the top of patella then pulls up his/her knee to its maximum bending capacity then both end of Y strip is placed around the patella ending on the tibial tuberosity. Then reinforcing I-tape will be affixed at the origin and insertion of MCL and LCL. Tape will be change in every session.

Interventions

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Mulligan Joint mobilization

This study ARM will received Mulligan joint mobilization and concomitant therapies in this group.

The following are the brief detail of therapy

1. Mulligan joint mobilization in Non-weight bearing (NWB) to weight-bearing (WB) 6 -10 Reps and 3 sets/ session.

Procedural detail:

Joint mobilization will be performed in sagittal, frontal and transverse direction, following glide will be preferred will depend on patient adherence to the joint mobilization. Mobilization will be progress from NWB to WB according to patient compliance 27
2. Knee strengthening Type of exercise: Knee Isometric Strengthening exercises. Intensity: 10 reps Frequency: At 1st week one set of all knee exercise will be performed then it will be progressed to 2 sets at 3 weeks, and these exercises will be progressed to three sets until the 6 weeks
3. Kinesiotaping:

Intervention Type OTHER

Trunk stabilization group

This study ARM will received Trunk stabilization exercises and concomitant therapies in this group.

The following are the brief detail of therapy:

1. Trunk stabilization Area: Trunk Type of exercise: Stabilization exercise Intensity: 6-8 reps Frequency: 3 sets per session and 30 second duration break between sets

Procedural detail:

i. modified supermen extension exercise ii. Back bridge: iii. Unilateral back bridge:

Iv. lateral step up:
2. Knee strengthening Area: Knee Joint Type of exercise: Knee Isometric Strengthening exercises. Intensity: 10 reps Frequency: At 1st week one set of all knee exercise will be performed then it will be progressed to 2 sets at 3 weeks, and these exercises will be progressed to three sets until the 6 weeks

Procedural detail:

i. Isometric quadriceps exercise: ii. Straight leg raising (SLR) exercise:
3. Kinesiotaping:

Intervention Type OTHER

Knee strengthening group

This study ARM will received Knee strengthening exercises and concomitant therapies in this group.

The following are the brief detail of therapy:

1. Knee strengthening Area: Knee Joint Type of exercise: Knee Isometric Strengthening exercises. Intensity: 10 reps Frequency: At 1st week one set of all knee exercise will be performed then it will be progressed to 2 sets at 3 weeks, and these exercises will be progressed to three sets until the 6 weeks

Procedural detail:

i. Isometric quadriceps exercise ii. Straight leg raising (SLR) exercise:
2. Kinesio-taping:

Muscle stretch method will be applied which involves one Y and two I straps: The Y-shaped tape base will be affixed over the top of patella then pulls up his/her knee to its maximum bending capacity then both end of Y strip is placed around the patella ending on the tibial tuberosity. Then reinforcing I-tape will be affixed at the origin and insertion of MCL and LCL. Tape will be change in every session.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* \- Both gender (female and male) patients
* Age between 40 - 60
* Knee osteoarthritis Grade I \& II on Kellgren and Lawrence (K/L) criteria
* Prediagnosed case of knee OA as per the American College of Rheumatology (ACR).

Exclusion Criteria

* Known skin allergies
* Sensory-motor dysfunction of lower extremity
* Severe joint deformity of lower extremity
* Post Traumatic Arthritis
* Constitutional Symptoms (Fever, Malaise, Weight Loss and high blood pressure)
* Knee Intraarticular injection in past 3 months
* Acute low back pain
* History of spinal surgery
* Subject using assistive devices for ambulation i.e. cane, walkers, sticks
* Refused to give consent
* Body Mass Index \> 30 kg/m2
* Received physiotherapy treatment in the past 3 months
* Visual Analogue Scale \<4
* Patellofemoral joint arthritis will be excluded

Minimum Eligible Age

40 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No