Determination of the Effectiveness of Certain Physical Methods in the Treatment of Knee Osteoarthritis

NCT ID: NCT04197284

Last Updated: 2021-04-28

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

93 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-08-28

Study Completion Date

2022-06-30

Brief Summary

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Osteoarthritis (OA) is a chronic joint disease that involves the entire joint, causing cartilage damage, bone remodeling, osteophyte formation and loss of normal joint function. Knee OA is one of the leading causes of disability in the world and thus represents a major public health problem. Knee OA treatment can be operative and non-operative. Non-operative treatment includes pharmacological treatment, changing life style and physical therapy. The goal of physical therapy in knee OA is to reduce pain and improve knee function through therapeutic exercise, especially by strengthening the quadriceps muscle. In addition to therapeutic exercise, muscle electrical stimulation is often used, and in the literature there is evidence of biofeedback therapy efficacy.

Goal of the study is to investigate whether there is a difference in pain reduction, increase in quadriceps muscle strength, and improvement in knee function in patients who had only kinesitherapy, from those who underwent kinesitherapy and biofeedback, and in patients who received electrical stimulation of quadriceps muscle with kinesitherapy. 93 patients with knee OA according to ACR criteria and Kellgren and Lawrence radiological classification grades 1 and 2 will be included in study. Subjects will complete: Visually Analogous Pain Scale (VAS), Western Ontario Universities Osteoarthritis Index (WOMAC), 36 Item Short Form Health Survey (SF 36), International Classification of Functioning, Disability and Health (ICF) osteoarthritis core set, and quadriceps muscle strength will be measured by EMG biofeedback device.

Detailed Description

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The research will be conducted in the Department of Orthopedic surgery of the Clinical Hospital Center Zagreb. The research will be prospective, randomized, single blinded. Randomization of patients will be performed before physical therapy using web site www.randomization.com, and the results of the randomization will be known to the physician who will not be directly involved in the treatment or examination of patients.

All patients will sign informed consent before the study begins. Research has been approved by the Ethics Committee of Clinical Hospital Center Zagreb and Ethics committee of the School of Medicine, University of Zagreb.

Inclusion criteria are: patients age 55 years and older who have knee OA according to the American College of Rheumatology criteria (ACR) and knee OA according to Kellgren and Lawrence Radiology Classification Grade 1 and 2, and who report knee pain for at least 3 months. Exclusion criteria are: patients who had surgery on that knee, patients with a pacemaker, and metallic foreign body in the area of muscle stimulation, patients with thrombophlebitis and deep vein thrombosis, patients with skin infection, malignancy, bleeding disorders, patients with neurological disease, patients with inflammatory rheumatological disease, with congenital and acquired knee deformities, with contractures of the hips and ankles, with grade 3 and 4 osteoarthritis according to Kellgren and Lawrence classification, patients who received intraarticular knee injection in the last 3 months and patients with post-traumatic knee osteoarthritis and osteonecrosis.

The investigators will record: age, sex, height, weight, body mass index, leg length and use of orthopedics aids. Clinical examination will be performed on the first day, day 21, after 90 and after 180 days.

At each examination patients will complete following questionnaires: Visually Analog Scale for pain (VAS), Western Ontario Universities Osteoarthritis Index (WOMAC), 36 Item Short Form Health Survey (SF 36) and International Classification of Functioning, Disability and Health (ICF) osteoarthritis core set.

Quadriceps muscle strength will be measured with a Biofeedback therapy device (EMG Biofeedback, Myomed 632, United Kingdom, 2017) .

Patients will be randomisen in three groups. Patients in the first group will be treated with individual kinesitherapy. Patients in the second group will be treated with individual kinesitherapy and biofeedback therapy for strengthening of the quadriceps muscle using EMG Biofeedback device, Myomed 632, United Kingdom, 2017.

Patients in the third group will be treated with individual kinesitherapy together with electrical stimulation of the quadriceps muscle using electrostimulation device (BTL- 4000 Smart, United Kingdom, 2017).

The required sample size was calculated based on pain values data reported in the study by Choi et al. Pain was measured using VAS scale, and sample size was calculated using G Power software package (v3.1.9.4). With the parameter of statistical significance level (alpha) of 0.05 and a test power (1 - beta) of 0.90, based on the data from the Choi et al work, the required final sample size is a total of 93 subjects and 31 subjects for each of the three groups.

The investigators expect to find that kinesitherapy and biofeedback therapy are more efficient compared to kinesitherapy alone or and kinesitherapy and electrical stimulation in reducing pain, improving knee function and strengthening of the quadriceps muscle.

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

Investigators Outcome Assessors
The research will be single-blind. Randomization of patients will be performed immediately prior to physical therapy using web page www.randomization.com, and the results of the randomization will be known to the physician who will not be directly involved in the treatment or examination of patients.

Study Groups

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Control group

In control group subjects will undergo individual kinesitherapy- isometric exercise for strengthening of the quadriceps muscle.

Group Type ACTIVE_COMPARATOR

kinesitherapy

Intervention Type OTHER

isometric exercise of the quadriceps muscle

Biofeedback group

Biofeedback group will perform physical therapy using biofeedback device for better activation control of the quadriceps muscle with audio and visual signal. They will also perform isometric exercise.

Group Type ACTIVE_COMPARATOR

Biofeedback, Myomed 632

Intervention Type DEVICE

Biofeedback is a mind-body technique that involves using visual or auditory feedback to gain control over involuntary bodily functions.

Electrical stimulation is a technique used to elicit a muscle contraction using electrical impulses.

kinesitherapy

Intervention Type OTHER

isometric exercise of the quadriceps muscle

Electrical stimulation

Electrical stimulation group will receive electrical stimulation of the quadriceps muscle and they will also perform isometric exercise.

Group Type ACTIVE_COMPARATOR

device for electrical stimulation, BTL 4000 Smart

Intervention Type DEVICE

Electrical stimulation is a technique used to elicit a muscle contraction using electrical impulses. Electrodes, controlled by a unit, are placed on the skin over a predetermined area. Electrical current is then sent from the unit to the electrodes and delivered into the muscle causing a contraction.

kinesitherapy

Intervention Type OTHER

isometric exercise of the quadriceps muscle

Interventions

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Biofeedback, Myomed 632

Biofeedback is a mind-body technique that involves using visual or auditory feedback to gain control over involuntary bodily functions.

Electrical stimulation is a technique used to elicit a muscle contraction using electrical impulses.

Intervention Type DEVICE

device for electrical stimulation, BTL 4000 Smart

Electrical stimulation is a technique used to elicit a muscle contraction using electrical impulses. Electrodes, controlled by a unit, are placed on the skin over a predetermined area. Electrical current is then sent from the unit to the electrodes and delivered into the muscle causing a contraction.

Intervention Type DEVICE

kinesitherapy

isometric exercise of the quadriceps muscle

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* radiological evidence of primary OA with Grade 1 and 2 on the Kellgren-Lawrence Scale
* knee pain for 3 months
* knee osteoarthritis defined by American College of Rheumatology Criteria

Exclusion Criteria

* surgery on that knee
* pacemaker
* metallic foreign body in the area of stimulation
* thrombophlebitis and thrombosis
* skin infection
* malignancy,
* bleeding disorders
* neurological disease
* inflammatory rheumatology disease
* congenital and acquired knee deformities
* contracture of the hips and ankles
* grade 3 and 4 osteoarthritis om the Kellgren and Lawrence classification
* intraarticular injection in the last 3 months
* post-traumatic knee osteoarthritis and osteonecrosis
Minimum Eligible Age

55 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Clinical Hospital Centre Zagreb

OTHER

Sponsor Role lead

Responsible Party

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Silvija Mahnik

MD, Physical medicine and rehabilitation specialist

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ivan Bojanić, Prof Phd

Role: STUDY_CHAIR

Universty of Zagreb, School of medicine

Locations

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University Hospital Centre Zagreb, Department of Orthopaedic Surgery

Zagreb, , Croatia

Site Status RECRUITING

Countries

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Croatia

Central Contacts

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Silvija Mahnik, MD

Role: CONTACT

+385 (0)1 2368 911

Ana Aljinovic, MD, Phd

Role: CONTACT

+385 (0)1 2368 911

Facility Contacts

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Silvija Mahnik, MD

Role: primary

+385 (0)1 2368 911

Ana Aljinović, Phd

Role: backup

+385 (0)1 2368 911

References

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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 Jan;27(1):149-53. doi: 10.1589/jpts.27.149. Epub 2015 Jan 9.

Reference Type BACKGROUND
PMID: 25642061 (View on PubMed)

Lucca JA, Recchiuti SJ. Effect of electromyographic biofeedback on an isometric strengthening program. Phys Ther. 1983 Feb;63(2):200-3. doi: 10.1093/ptj/63.2.200.

Reference Type BACKGROUND
PMID: 6823470 (View on PubMed)

Yilmaz OO, Senocak O, Sahin E, Baydar M, Gulbahar S, Bircan C, Alper S. Efficacy of EMG-biofeedback in knee osteoarthritis. Rheumatol Int. 2010 May;30(7):887-92. doi: 10.1007/s00296-009-1070-9. Epub 2009 Aug 20.

Reference Type BACKGROUND
PMID: 19693508 (View on PubMed)

Akkaya N, Ardic F, Ozgen M, Akkaya S, Sahin F, Kilic A. Efficacy of electromyographic biofeedback and electrical stimulation following arthroscopic partial meniscectomy: a randomized controlled trial. Clin Rehabil. 2012 Mar;26(3):224-36. doi: 10.1177/0269215511419382. Epub 2011 Oct 4.

Reference Type BACKGROUND
PMID: 21971752 (View on PubMed)

Raeissadat SA, Rayegani SM, Sedighipour L, Bossaghzade Z, Abdollahzadeh MH, Nikray R, Mollayi F. 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. J Pain Res. 2018 Nov 8;11:2781-2789. doi: 10.2147/JPR.S169613. eCollection 2018.

Reference Type BACKGROUND
PMID: 30519081 (View on PubMed)

Cherian JJ, McElroy MJ, Kapadia BH, Bhave A, Mont MA. Prospective Case Series of NMES for Quadriceps Weakness and Decrease Function in Patients with Osteoarthritis of the Knee. J Long Term Eff Med Implants. 2015;25(4):301-6. doi: 10.1615/jlongtermeffmedimplants.2015012620.

Reference Type BACKGROUND
PMID: 26852638 (View on PubMed)

Giggins O, Fullen B, Coughlan G. Neuromuscular electrical stimulation in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Clin Rehabil. 2012 Oct;26(10):867-81. doi: 10.1177/0269215511431902. Epub 2012 Feb 9.

Reference Type BACKGROUND
PMID: 22324059 (View on PubMed)

Durmus D, Alayli G, Canturk F. Effects of quadriceps electrical stimulation program on clinical parameters in the patients with knee osteoarthritis. Clin Rheumatol. 2007 May;26(5):674-8. doi: 10.1007/s10067-006-0358-3. Epub 2006 Aug 1.

Reference Type BACKGROUND
PMID: 16897119 (View on PubMed)

de Oliveira Melo M, Aragao FA, Vaz MA. Neuromuscular electrical stimulation for muscle strengthening in elderly with knee osteoarthritis - a systematic review. Complement Ther Clin Pract. 2013 Feb;19(1):27-31. doi: 10.1016/j.ctcp.2012.09.002. Epub 2012 Oct 18.

Reference Type BACKGROUND
PMID: 23337561 (View on PubMed)

de Oliveira Melo M, Pompeo KD, Baroni BM, Vaz MA. Effects of neuromuscular electrical stimulation and low-level laser therapy on neuromuscular parameters and health status in elderly women with knee osteoarthritis: A randomized trial. J Rehabil Med. 2016 Mar;48(3):293-9. doi: 10.2340/16501977-2062.

Reference Type BACKGROUND
PMID: 26871692 (View on PubMed)

Zeng C, Li H, Yang T, Deng ZH, Yang Y, Zhang Y, Lei GH. Electrical stimulation for pain relief in knee osteoarthritis: systematic review and network meta-analysis. Osteoarthritis Cartilage. 2015 Feb;23(2):189-202. doi: 10.1016/j.joca.2014.11.014. Epub 2014 Nov 26.

Reference Type BACKGROUND
PMID: 25497083 (View on PubMed)

Lepley AS, Gribble PA, Pietrosimone BG. Effects of electromyographic biofeedback on quadriceps strength: a systematic review. J Strength Cond Res. 2012 Mar;26(3):873-82. doi: 10.1519/JSC.0b013e318225ff75.

Reference Type BACKGROUND
PMID: 22289696 (View on PubMed)

Eid MA, Aly SM, El-Shamy SM. Effect of Electromyographic Biofeedback Training on Pain, Quadriceps Muscle Strength, and Functional Ability in Juvenile Rheumatoid Arthritis. Am J Phys Med Rehabil. 2016 Dec;95(12):921-930. doi: 10.1097/PHM.0000000000000524.

Reference Type BACKGROUND
PMID: 27149595 (View on PubMed)

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 Dec;15(12):1833-40.

Reference Type BACKGROUND
PMID: 3068365 (View on PubMed)

Grazio S. [International Classification of Functioning, Disability and Health (ICF) in the most important diseases and conditions of rheumatology practice]. Reumatizam. 2011;58(1):27-43. Croatian.

Reference Type BACKGROUND
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Maslic Sersic D, Vuletic G. Psychometric evaluation and establishing norms of Croatian SF-36 health survey: framework for subjective health research. Croat Med J. 2006 Feb;47(1):95-102.

Reference Type BACKGROUND
PMID: 16489702 (View on PubMed)

Hurley MV, Scott DL. Improvements in quadriceps sensorimotor function and disability of patients with knee osteoarthritis following a clinically practicable exercise regime. Br J Rheumatol. 1998 Nov;37(11):1181-7. doi: 10.1093/rheumatology/37.11.1181.

Reference Type BACKGROUND
PMID: 9851266 (View on PubMed)

Other Identifiers

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1505984

Identifier Type: -

Identifier Source: org_study_id

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