Comparison of Progressive Motor Imagery and Sensorimotor Exercises in Knee Osteoarthritis

NCT ID: NCT05850793

Last Updated: 2023-06-13

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

54 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-05-15

Study Completion Date

2024-12-30

Brief Summary

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Osteoarthritis is the most common type of arthritis, which can affect all joints in the body and includes synovial inflammation, cartilage degeneration, osteophyte formation and bone remodeling in its pathophysiology. Many approaches are used in its treatment, and the effectiveness of exercise in conservative treatment has been proven. Many exercise methods such as strengthening, balance, aquatherapy are applied, but there is no definite consensus on exercise prescribing.Programs that focus on restoring balance and proprioception are called "sensorimotor or neuromuscular trainings". Previous studies have shown that neuromuscular exercises reduce pain, improve function, improve balance, and cause positive biomechanical changes in knee osteoarthritis and meniscus injuries. Progressive Motor Imagery (AMI) is an approach in rehabilitation where the focus is on progressive brain exercise. It is an education that approaches patients with pain, activity limitation and functional loss with a holistic view within the framework of the biopsychosocial model.

The aim of this study; to examine the effects of two current treatment programs (AMI, SM training) on symptoms, functionality, balance and proprioception parameters in osteoarthritis rehabilitation.

Detailed Description

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Osteoarthritis (OA) is the most common arthritis, affecting more than 300 million adults worldwide. The pathophysiology of OA, which can affect all joints in the body, includes synovial inflammation, cartilage degeneration, osteophyte formation, and bone remodeling. These changes in OA, a chronic and degenerative joint disease, impair joint stability and function, causing pain. With the deterioration of the dynamic balance between production and destruction in the articular cartilage and subchondral bone, the joint becomes unable to meet the load . The knee joint is the most commonly affected joint in the body by OA; it also ranks eleventh among the leading causes of global disability. Typically, patients with knee OA experience pain, swelling, decreased muscle strength (especially the quadriceps femoris), joint stiffness, and loss of function

Therapeutic exercise, weight control in obese patients, self-efficacy and self-management programs, use of orthoses, topical and oral nonsteroidal anti-inflammatory drugs, intra-articular injections, radiofrequency and surgical methods are used in the management of knee OA. The primary treatment in the treatment of OA is to prefer conservative practices such as exercise and education .

Progressive Motor Imagery (AMI) is an approach in rehabilitation where the focus is on progressive brain exercise. It is an education that approaches patients with pain, activity limitation and functional loss with a holistic view within the framework of the biopsychosocial model. It consists of three components in turn: Laterality training (left-right discrimination training), motor imagery (imagining movements), and the third step mirror therapy (providing visual feedback through the mirror). Laterality (closed imagery) is the process of determining whether a limb is a left or right limb, or that the patient is turning right or left for the spine. Motor imagery (open imagery) is the patient's internal, external and kinesthetic imagining of their movements and postures. Mirror therapy (visual feedback) refers to the use of a mirror to present an inverted image of a limb, thereby tricking the brain. By following these three steps, it is aimed to sequentially activate cortical motor networks and improve cortical organization.

* The aim of our study; to examine the effects of two current treatment programs (AMI, SM training) on symptoms, functionality, balance and proprioception parameters in osteoarthritis rehabilitation.
* The study is a prospective, three arm ,randomized controlled trial. A total participant number was calculated with Gpower as 54 patients with %90 power.
* There will be 3 groups and participants will perform the exercises which included their group 2 times a week for 6 weeks, accompanied by a physiotherapist.Each group includes 18 patients.
* Evaluations will be made at the start of treatment, at 6th weeks and 12th weeks after treatment.

Conditions

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Osteoarthritis, Knee

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

A randomized controlled trial
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors
participants and the researcher who evaluated the analysis are blind to the study

Study Groups

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Sensorimotor Exercise Training

Sensorimotor exercise content has been prepared based on previous sensorimotor, balance and proprioceptive studies in the literature. It is organized as a structured traditional exercise program + SM training content.

Group Type EXPERIMENTAL

Sensorimotor Exercise

Intervention Type BEHAVIORAL

Balance, perturbation , aging and strengthing exercise will be performed for knee

Conventional Exercise

Intervention Type BEHAVIORAL

Range of motion, strengthing and stretching exercise will be performed for knee

Progressive Motor Imagery Training

In order to sequentially activate the cortical motor networks and improve cortical organization, a literature-supported program including the components of AMI training (first stage laterality training, second stage motor imagery and third stage mirror therapy) was prepared and a six-week structured exercise program suitable for knee joint treatment + AMI training was prepared.

Group Type EXPERIMENTAL

Conventional Exercise

Intervention Type BEHAVIORAL

Range of motion, strengthing and stretching exercise will be performed for knee

Progressive Motor Imagery Exercise

Intervention Type BEHAVIORAL

Different types of exercises will be applied targeting muscle strength, proprioceptive sense or brain neurons for knee

Conventional Exercise Training

A 6-week program was prepared from traditional treatment exercises based on previous studies in knee osteoarthritis. It consists of progressive muscle strengthening of Quadriceps, Hamstrings and gluteals and also stretching exercises.

Group Type ACTIVE_COMPARATOR

Sensorimotor Exercise

Intervention Type BEHAVIORAL

Balance, perturbation , aging and strengthing exercise will be performed for knee

Conventional Exercise

Intervention Type BEHAVIORAL

Range of motion, strengthing and stretching exercise will be performed for knee

Progressive Motor Imagery Exercise

Intervention Type BEHAVIORAL

Different types of exercises will be applied targeting muscle strength, proprioceptive sense or brain neurons for knee

Interventions

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Sensorimotor Exercise

Balance, perturbation , aging and strengthing exercise will be performed for knee

Intervention Type BEHAVIORAL

Conventional Exercise

Range of motion, strengthing and stretching exercise will be performed for knee

Intervention Type BEHAVIORAL

Progressive Motor Imagery Exercise

Different types of exercises will be applied targeting muscle strength, proprioceptive sense or brain neurons for knee

Intervention Type BEHAVIORAL

Other Intervention Names

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traditional exercise for osteoarthritis

Eligibility Criteria

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Inclusion Criteria

* Diagnosed with knee OA according to the criteria of the American Society of Rheumatology (ACR),
* Stage 2 or 3 according to Kellgren Lawrence radiological staging criteria,
* Between the ages of 50 and 65,
* Body mass index below 35 kg/m²,
* Pain intensity defined by the patient in the last 3 months is at least 3 out of 10 according to NPRS,
* There are no obstacles to being included in the exercise program,
* Patients with a score of at least 24 on the Standardized Mini Mental Test will be included.

Exclusion Criteria

* Receiving any physiotherapy program or injection treatment in the last 3 months,
* Having a diagnosis of additional pathology other than OA in the knee, having a history of knee injury / surgery in the past
* Having uncontrollable hypertension, cardiovascular and neurological diseases that will prevent exercise,
* The patient has any vision, hearing or cognitive problems that will prevent him from complying with the treatment,
* Providing ambulation with an assistive device
Minimum Eligible Age

50 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Istanbul Medipol University Hospital

OTHER

Sponsor Role lead

Responsible Party

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ebru gulek karaduz

Physiotherapist (MSc ) / PhD (continous) / Lecturer Ebru Gülek Karadüz

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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EBRU KARADÜZ, PhD(c)

Role: PRINCIPAL_INVESTIGATOR

İstanbul Medipol University

Sena TOLU, Asist Prof

Role: STUDY_CHAIR

Medipol Mega Hospital

Candan Algun, Prof

Role: STUDY_CHAIR

İstanbul Medipol University

Locations

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Ebru Karadüz

Fatih, Istanbul, Turkey (Türkiye)

Site Status RECRUITING

Countries

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Turkey (Türkiye)

Central Contacts

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EBRU KARADÜZ, MSc

Role: CONTACT

+905346434872

Sena TOLU, Assist Prof

Role: CONTACT

05054424722

Facility Contacts

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EBRU KARADÜZ, MSc

Role: primary

05346434872

Sena Tolu, Asist Prof

Role: backup

05054424722

References

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Busija L, Bridgett L, Williams SR, Osborne RH, Buchbinder R, March L, Fransen M. Osteoarthritis. Best Pract Res Clin Rheumatol. 2010 Dec;24(6):757-68. doi: 10.1016/j.berh.2010.11.001.

Reference Type BACKGROUND
PMID: 21665124 (View on PubMed)

Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br J Sports Med. 2015 Dec;49(24):1554-7. doi: 10.1136/bjsports-2015-095424. Epub 2015 Sep 24.

Reference Type BACKGROUND
PMID: 26405113 (View on PubMed)

Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, Bridgett L, Williams S, Guillemin F, Hill CL, Laslett LL, Jones G, Cicuttini F, Osborne R, Vos T, Buchbinder R, Woolf A, March L. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014 Jul;73(7):1323-30. doi: 10.1136/annrheumdis-2013-204763. Epub 2014 Feb 19.

Reference Type BACKGROUND
PMID: 24553908 (View on PubMed)

Sharma L. Osteoarthritis of the Knee. N Engl J Med. 2021 Jan 7;384(1):51-59. doi: 10.1056/NEJMcp1903768. No abstract available.

Reference Type BACKGROUND
PMID: 33406330 (View on PubMed)

Zhang W, Doherty M, Peat G, Bierma-Zeinstra MA, Arden NK, Bresnihan B, Herrero-Beaumont G, Kirschner S, Leeb BF, Lohmander LS, Mazieres B, Pavelka K, Punzi L, So AK, Tuncer T, Watt I, Bijlsma JW. EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis. Ann Rheum Dis. 2010 Mar;69(3):483-9. doi: 10.1136/ard.2009.113100. Epub 2009 Sep 17.

Reference Type BACKGROUND
PMID: 19762361 (View on PubMed)

Dominguez-Navarro F, Igual-Camacho C, Silvestre-Munoz A, Roig-Casasus S, Blasco JM. Effects of balance and proprioceptive training on total hip and knee replacement rehabilitation: A systematic review and meta-analysis. Gait Posture. 2018 May;62:68-74. doi: 10.1016/j.gaitpost.2018.03.003. Epub 2018 Mar 5.

Reference Type BACKGROUND
PMID: 29525292 (View on PubMed)

Moseley GL. Graded motor imagery for pathologic pain: a randomized controlled trial. Neurology. 2006 Dec 26;67(12):2129-34. doi: 10.1212/01.wnl.0000249112.56935.32. Epub 2006 Nov 2.

Reference Type BACKGROUND
PMID: 17082465 (View on PubMed)

Baird CL, Sands L. A pilot study of the effectiveness of guided imagery with progressive muscle relaxation to reduce chronic pain and mobility difficulties of osteoarthritis. Pain Manag Nurs. 2004 Sep;5(3):97-104. doi: 10.1016/j.pmn.2004.01.003.

Reference Type BACKGROUND
PMID: 15359221 (View on PubMed)

Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, Callahan L, Copenhaver C, Dodge C, Felson D, Gellar K, Harvey WF, Hawker G, Herzig E, Kwoh CK, Nelson AE, Samuels J, Scanzello C, White D, Wise B, Altman RD, DiRenzo D, Fontanarosa J, Giradi G, Ishimori M, Misra D, Shah AA, Shmagel AK, Thoma LM, Turgunbaev M, Turner AS, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken). 2020 Feb;72(2):149-162. doi: 10.1002/acr.24131. Epub 2020 Jan 6.

Reference Type RESULT
PMID: 31908149 (View on PubMed)

Other Identifiers

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ebrugk

Identifier Type: -

Identifier Source: org_study_id

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