0 valutazioniIl 0% ha trovato utile questo documento (0 voti)
271 visualizzazioni9 pagine
This study assessed the effects of retro-walking combined with conventional treatment on pain and disability in patients with chronic knee osteoarthritis. Twelve patients received deep heating, exercises, and two daily 10-minute sessions of retro-walking for 3 weeks. Pain, stiffness, physical function, knee range of motion, and hip/quadriceps strength were measured before, during, and after the intervention. The results showed highly significant reductions in pain and disability scores and significant improvements in secondary outcomes over the 3-week period. The study concluded that retro-walking is an effective adjunct to conventional treatment for decreasing pain and disability in knee osteoarthritis.
Descrizione originale:
Titolo originale
Efficacy of Retrowalking in Patients With Chronic Knee Osteoarthritis a Single Group Experimental Pilot Study. Gauri Arun Gondhalekar, Medha Vasant Deo Srji Vol 3 Issue 2 Year 2014
This study assessed the effects of retro-walking combined with conventional treatment on pain and disability in patients with chronic knee osteoarthritis. Twelve patients received deep heating, exercises, and two daily 10-minute sessions of retro-walking for 3 weeks. Pain, stiffness, physical function, knee range of motion, and hip/quadriceps strength were measured before, during, and after the intervention. The results showed highly significant reductions in pain and disability scores and significant improvements in secondary outcomes over the 3-week period. The study concluded that retro-walking is an effective adjunct to conventional treatment for decreasing pain and disability in knee osteoarthritis.
This study assessed the effects of retro-walking combined with conventional treatment on pain and disability in patients with chronic knee osteoarthritis. Twelve patients received deep heating, exercises, and two daily 10-minute sessions of retro-walking for 3 weeks. Pain, stiffness, physical function, knee range of motion, and hip/quadriceps strength were measured before, during, and after the intervention. The results showed highly significant reductions in pain and disability scores and significant improvements in secondary outcomes over the 3-week period. The study concluded that retro-walking is an effective adjunct to conventional treatment for decreasing pain and disability in knee osteoarthritis.
EFFICACY OF RETROWALKING IN PATIENTS WITH CHRONIC KNEE
OSTEOARTHRITIS: A SINGLE GROUP EXPERIMENTAL PILOT STUDY
Gauri Arun Gondhalekar*, Medha Vasant Deo**
ABSTRACT Background: Increased external knee adduction moment during ambulation is a strong predictor of the severity of symptoms in patients with chronic knee osteoarthritis. Objectives: To assess the effects of Retro-walking along with conventional treatment on pain and disability in patients with acute exacerbation of chronic knee osteoarthritis. Methods: Twelve patients (6 men, 6 women) with chronic knee osteoarthritis fulfilling the inclusion criteria received conventional treatment and Retro-walking. Pain and disability were the primary outcomes and knee range of motion (ROM), hip abductor and extensor strength were the secondary outcomes; measured pre-intervention, after 1 week and after 3 weeks of intervention. Results: One way analysis of variance was used for all the primary and secondary outcomes. At the end of 3 weeks; the primary outcomes showed highly significant difference (P < 0.0001), secondary outcomes showed significant difference ( P < 0.05). Conclusion: Retrowalking is an effective adjunct to conventional treatment in decreasing pain and disability in patients with knee osteoarthritis. Keywords: Retrowalking, Backward-walking, Knee osteoarthritis, external knee adductor moment
INTRODUCTION Osteoarthritis (OA) is a chronic degenerative disorder of multifactorial etiology characterized ISSN: 2277-1700 Website: http://srji.drkrishna.co.in URL Forwarded to: http://sites.google.com/site/scientificrji 8 by loss of articular cartilage, hypertrophy of bone at the margins, subchondral sclerosis and range of biochemical and morphological alterations of the synovial membrane and joint capsule. 1-5
Osteoarthritis is the most common form of arthritis. 6,7 It is the most frequent joint disease with a prevalence of 22-39% in India; 6,8 and one of the leading causes of pain and disability worldwide. 9-12 Knee is the most common site for OA 13 with characteristic signs like pain during weight bearing, limitation of knee range of motion (ROM), crepitus, joint effusion, and local inflammation. 11,14-16
In knee joint, OA affects the medial compartment more frequently than the lateral. This is attributed to higher transfer of loads through the medial compartment than through the lateral, resulting in higher external knee adduction moment. 14
The external knee adduction moment (EKAM) is the product of ground reaction force (GRF) and the moment arm with respect to knee joint center. 17-21 It leads to adduction at the tibiofemoral joint causing compressive load at the medial compartment of the knee joint. This increase in joint forces results in a deleterious effect on knee cartilage and leads to development and progression of knee OA. 21-29 Various studies have stated that, the first peak knee adduction moment during walking is a strong predictor of the severity and rate of progression of medial compartment of knee OA. 14
Management of knee OA aims to control pain and reduce disability. 30-32 A multidisciplinary approach Is required with physiotherapy as the main choice of conservative management; which includes various strategies such as exercises, patellar taping, manual therapy and various electrical and thermal modalities for pain relief. 6,31,32
Recently, weight bearing exercises have drawn much attention in the management of knee OA. 33-34 Studies suggest that these exercises are more effective and functional than the traditionally employed non weight bearing exercises. 32 Weight bearing exercises for knee joint can be incorporated in many ways; one of them is Retro-walking. 30 Retro-walking is walking backwards. 6 Since there is backward propulsion, it leads to reversal of leg movement in Retro-walking. This requires different muscle activation patterns than in forward walking. 33 Various studies have stated the effects of backward walking and backward running in strength gains and joint stress reduction and facilitating rehabilitation. 6 Along with a unique muscle activation pattern; Retro- walking is leads to increased cadence, decreased stride length and different joint kinematics as compared to forward walking; offering some benefits over forward walking alone. 30,32
A growing body of evidence suggests the importance of exercises in improvement of symptoms and joint function in knee OA. Precise guidelines as regards their type and dosage have not been established. Hence, Scientific Research Journal of India Volume: 3, Issue: 2, Year: 2014 9 Retro-walking may offer additional benefits in this population. The current study aimed at finding out the efficacy of Retro-walking as an adjunct to conventional treatments on pain and disability in patients with chronic knee OA.
MATERIALS AND METHODS: Written informed consent was obtained from all participants prior to screening and participation in the study. The study was conducted at the Department of Physiotherapy in Terna Hospital and Research Center, Navi-Mumbai, India. Out-patients with diagnosis of knee OA referred by a physician or an orthopedic surgeon were screened for inclusion criteria.
Participant selection Patients having knee pain for more than 6 weeks and fulfilling three out of the six clinical criteria listed by The American College of Rheumatology were included in the study. 34-35 The inclusion criteria are: Age >50 years, Morning stiffness lasting <30 min, Crepitus with active motion, Bony tenderness, Bony enlargement, and No warmth to touch. Exclusion criteria: Patients with bilateral involvement, a history of any lower extremity injury or underlying pathology and a history of any inflammatory joint disease and balance problems, neurological problems and using an assistive device for ambulation were excluded. Testing instruments For primary outcomes: (1) A 10 cm visual analogue scale (VAS) for rating the intensity of perceived pain. The scale had 0 (no pain at all) and 10 (maximum pain felt at this moment) at either ends. The patient was asked to mark his/her pain where he felt it would take its position in the scale. (2) Western Ontario and McMaster Universities Arthritis Index (WOMAC) of OA, a patient reported scale, was used to assess pain, stiffness and physical function levels in the subjects. It measures five items for pain, two for stiffness, and 17 for functional limitation. Physical functioning questions cover activities of daily living. Good test-retest reliability in pain and physical function domain has been established for WOMAC. 36
For secondary outcomes: Medical Research Council grading was used to assess concentric strength of hip abductors and hip extensors and quadriceps muscles. (2) Universal Goniometer was used to assess knee joint ROM in prone position.
Methods Twelve patients (6 men, 6 women) with chronic knee osteoarthritis fulfilling the inclusion criteria received conventional treatment and Retro-walking. Conventional treatment was in the form of deep heating modality (Short Wave Diathermy) (Electro Medical Control, Electrotherm 250 W) ISSN: 2277-1700 Website: http://srji.drkrishna.co.in URL Forwarded to: http://sites.google.com/site/scientificrji 10 for 20 minutes and exercises (static and dynamic quadriceps, knee bending exercise in prone lying, hip flexion exercise in supine, hip abduction in side lying and hip extension in prone lying position). All exercises were done in sets of 10 repetitions; twice a day for 3 weeks. Subjects also underwent two sessions of Retro- walking per day (10 mins. per session) for 3 weeks on a flat surface at their maximum pace.
Data collection: Pain and disability were the primary outcomes and knee range of motion (ROM), hip abductor and extensor, and quadriceps strength were the secondary outcomes; measured pre- intervention, after 1 week and after 3 weeks of intervention
Statistical-analysis: The outcomes were analyzed using one way analysis of variance with level of significance set at P < 0.05; using SPSS version 17.0 for Windows.
RESULTS Fifteen patients fulfilling the inclusion criteria were screened and included in study after obtaining their consent. Three patients were lost to follow-up. The study population thus had 12 adults (6 men, 6 women) of mean age 64.23 3.01 years [Table 1]. Scores were analyzed pre intervention, at the end of 1 week and at the end of 3 weeks [Table 2]. VAS and WOMAC showed highly significant difference over a period of time [Table 3]. Knee joint ROM, Strength of hip abductor muscles and hip extensor muscles, and quadriceps muscles showed significant improvement [Table 3].
Table 1: Demographic characteristics of participants Characteristics N 12 Age 64.23 3.01 Female % 50 % N: Number of subjects
Table 2: Baseline parameters Scientific Research Journal of India Volume: 3, Issue: 2, Year: 2014 11 PARAMETER PRE POST 1 WEEK POST 3 WEEKS VAS 7.79 + 1.09 6.04 + 1.03 3.75 + 1.32 WOMAC 64.72 + 15.48 52.08 + 11.34 37.16 + 14.14 Knee ROM 72.11 + 11.09 88.78 + 14.99 90.32 + 13.22 Quadriceps Strength 3.55 + 0.32 4.2 + 0.88 4.43 + 0.11 Hip Extensors Strength 3.22 + 0.78 3.59 + 0.32 4.11 + 0.2 Hip Abductor Strength 3.8 + 0.43 4.17 + 0.71 4.63 + 0.19 VAS: Visual Analogue Scale, WOMAC: Western Ontario and McMaster Universities Arthritis Index , ROM: Range of Motion Table 3: One way analysis of variance Parameter F value df P value Significance VAS 37.022 2 <0.0001 HS WOMAC 12.059 2 <0.0001 HS Knee ROM 7.027 2 0.001 Sig Quadriceps Strength 8.436 2 0.001 Sig Hip Extensors Strength 9.585 2 0.001 Sig Hip Abductor Strength 8.584 2 0.001 Sig F value: Observed F value; df: Degrees of freedom; P value: Significance level, HS: Highly significant; Sig: Significant
12 DISCUSSION Current pilot study examines the efficacy of Retro-walking as an adjunct to conventional treatment in reducing pain and disability in patients with chronic knee OA. Pain relief could be attributed to reduced compressive forces on medial compartment of knee joint by reduction of excess adductor moment due to Retro-walking. Along with thermal effects causing local hypoalgesia 29 and muscle relaxation, improvement in strength of musculature around knee and hip providing steadiness in the knee and giving additional joint protection from shock and stress as a result of conventional treatment. Improvement in function may be attributed to the pain relief, improved ROM, improved muscle activation pattern and reduction in abnormal joint kinetics and kinematics during functional movement. Several studies have stated that compared to forward walking; backward walking creates more muscle activity in proportion to efforts. 37-43 It has also shown to reduce external adductor moment at knee during stance phase of gait. Due to a specific kinematics Retro-walking leads to augmented stretch of hamstring muscle groups during the stride. Other advantage of Retro-walking includes improvement in muscle activation pattern; all of these serve in reducing disability thus leading to improved function. Since it is a weight bearing exercise, it could have led to proprioceptive and balance training, adding to its benefits. Retro-walking also has effect on preventing abnormal loading at knee joint by improving strength of hip extensors leading to reduced hip flexion moment during stance phase and thus and, in turn, the disability. As a result of exercises and Retro- walking there was improvement in the strength of muscles at knee and hip which may have helped in improving functional ability.
There were certain limitations in the current study. Effects of BMI, severity of knee deformities (for eg. genu valgum/varum), lower limb mal-alignments (for eg. flat foot), footwear used, activities of daily living and recreational activities of patients were not taken into account. The compliance of patients with the home exercise program was not monitored.
CONCLUSION Retrowalking is an effective adjunct to conventional treatment in decreasing pain and disability in patients with chronic knee osteoarthritis.
ACKNOWLEDGMENT The author would like to acknowledge Dr. Senthil P Kumar and Dr. Sujata S. Wagle for their valuable guidance in preparation of this manuscript.
Scientific Research Journal of India Volume: 3, Issue: 2, Year: 2014 13 REFERENCES 1. Kugler LM. Amstrong CW. Moleski B. Comparative Analysis Of The Kinematics And Kinetics Of Forward And Backward Human Locomotion. ISBS 1988:451-464. 2. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Therapeutic Exercises and Manual Therapy in the Management of Osteoarthritis.Phys Ther. 2005;85:90771. 3. Silva LE, Valim V, Pessanha APC, Oliveira LM, Myamoto S, Jones A et al. Hydrotherapy versus con-ventional land-based exercise for the management of patients with osteoarthritis of the knee: a ran-domized clinical trial.Phys Ther. 2008;88:1221. 4. Rutjes AWS, Nesch E, Sterchi R, Jni P. Therapeutic ultrasound for osteoarthritis of the knee or hip. THE COCHRANE REVIEW. 5. Rutjes AWS, Nesch E, Sterchi R, Kalichman L, Hendriks E, Osiri M etal. Transcutaneous electrostimulation for osteoarthritis of the knee (Review) cochrane 6. NOR AMN. LYN KS. Effects of Passive Joint Mobilization on Patients with Knee Osteoarthritis. Sains Malaysiana 2011;40:1461-1465. 7. McKnight PE, Kasle S,Going S, Villaneuva I, Cornett M, Farr J, Wright J etal. A comparison of strength-training, self-management and the combination for early osteoarthritis of the knee. Arthritis Care Res (Hoboken). 2010 January 15; 62(1): 4553. 8. Mahajan A. Verma S. Tandon V. Osteoarthritis. JAPI 2005;53:634-641. 9. French HP, Brennan A, White B, Cusack T. Manual therapy for osteoarthritis of the hip or kneeeA systematic review. Man Ther 16 (2011) 109-17. 10. Bar-Ziv Y, Beer Y, Ran Y, Benedict S, Halperin N. A treatment applying a biomechanical device to the feet of patients with knee osteoarthritis results in reduced pain and improved function: a prospective controlled study. BMC Musculoskeletal Disorders2010,11:179. 11. ALTMAN R, ASCH E, BLOCH D, BOLE G, BORENSTEIN D, BRANDT K etal. Development Of Criteria For The Classification And Reporting Of Osteoarthritis-Classification of Osteoarthritis of the Knee. Arthritis and Rheumatism, Vol. 29, No. 8 (August 1986) p 1039-49. 12. Fary RE, Carroll GJ, Briffa TG, Gupta R, Briffa NK. The effectiveness of pulsed electrical stimulation (E-PES) in the management of osteoarthritis of the knee: a protocol for a randomised controlled trial. Study protocol. BMC Musculoskeletal Disorders2008, 9:18. 13. Currier LL, Froehlich PJ, Carow SD, McAndrew RK, Cliborne AV, Boyles et al. Development of a clinical prediction rule to identify patients with knee pain and clinical evidence of knee osteoarthritis who demonstrate a favorable short-term response to hip mobilization. Phys Ther. 2007;87: 11061119. 14. Mundermann A. Dyrby CO. Andriacchi TP. Secondary Gait Changes in Patients with Medial Compartment Knee Osteoarthritis Increased Load at the Ankle, Knee, and Hip During Walking. Arthritis & Rheumatism 2005;52:2835-2844. 15. JAN MH, TANG PF, LIN JJ, TSENG SC, LIN YF, LIN DH. Efficacy of a Target-Matching Foot-Stepping Exercise on Proprioception and Function in Patients With Knee Osteoarthritis. J Orthop Sports Phys Ther 2008;38(1):19- 25. 16. Hinman RS, Bowles KA, Bennell KL. Laterally wedged insoles in knee osteoarthritis: do biomechanical effects decline after one month of wear? BMC Musculoskeletal Disorders2009, 10:146. 17. Zhao D, Banks SA, Mitchell KH, D'Lima DD, Colwell CW Jr, Fregly BJ: Correlation between the knee adduction torque and medical contact force for a variety of gait patterns. J Orthop Res 2007, 25:789-797. ISSN: 2277-1700 Website: http://srji.drkrishna.co.in URL Forwarded to: http://sites.google.com/site/scientificrji 14 18. Shelburne KB, Torry MR, Steadman JR, Pandy MG: Effects of foot orthoses and valgus bracing on the knee adduction moment and medial joint load during gait. Clin Biomech 2008, 23:814-821. 19. Schipplein OD, Andriacchi TP: Interaction between active and passive knee stabilizers during level walking. J Orthop Res 1991, 9:113-119. 20. Hurwitz DE, Sumner DR, Andriacchi TP, Sugar DA: Dynamic knee loads during gait predict proximal tibial bone distribution. J Biomech 1998, 31:423-430. 21. Teoh et al.: Investigation of the biomechanical effect of variable stiffness shoe on external knee adduction moment in various dynamic exercises. Journal of Foot and Ankle Research 2013 6:39. 22. Setton LA, Mow VC, Muller FJ, Pita JC, Howell DS:Altered structure-function relationships for articular cartilage in human osteoarthritis and an experimental canine model.Agents Actions1993,39:2748. 23. Teohet al. Journal of Foot and Ankle Research2013,6:39 Page 7 of 9 http://www.jfootankleres.com/content/6/1/39 24. Radin EL, Burr DB, Caterson B, Fyhrie D, Brown TD, Boyd RD:Mechanical determinants of osteoarthrosis.Semin Arthritis Rheum1991,21:1221. 25. Frost HM, Jee WSS:Perspectives: Applications of a biomechanical model of the endochondral ossification mechanism.Anat Rec1994,240:447455. 26. Hovis KK, Stehling C, Souza RB, Haughom BD, Baum T, Nevitt M, McCulloch C, Lynch JA, Link TM:Physical activity is associated with magnetic resonance imaging-based knee cartilage T2 measurements in asymptomatic subjects with and those without osteoarthritis risk factors. Arthritis Rheum2011,63:22482256. 27. Imeokparia RL, Barrett JP, Arrieta MI, Leaverton PE, Wilson AA, Hall BJ, Marlowe SM:Physical activity as a risk factor for osteoarthritis of the knee.Ann Epidemiol1994,4:221230. 28. Yoshimura N, Kinoshita H, Hori N, Nishioka T, Ryujin M, Mantani Y, Miyake M, Takeshita TT, Ichinose M, Yoshiida M,et al: Risk factors for knee osteoarthritis in Japanese men: A casecontrol study.Mod Rheumatol 2006,16:2429. 29. Sharma L, Hurwitz DE, Thonar EJMA, Sum JA, Lenz ME, Dunlop DD, Schnitzer TJ, Kirwan-Mellis G, Andriacchi TP:Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis.Arthritis Rheum1998,41:12331240 30. Pollard H, Ward G, Hoskins W, Hardy K. The effect of a manual therapy knee protocol on osteoarthritic knee pain: a randomised controlled trial. J Can Chiropr Assoc 2008; 52(4). 229-42. 31. Jamtvedt G, Dahm KT, Christie A, Moe RH, Haavardsholm E, Holm I et al. Physical therapy interventions for patients with osteoarthritis of the knee: an overview of systematic reviews. Phys Ther. 2008;88:123136. 32. McCarthy CJ, Callaghan MJ, Oldham JA. Pulsed electromagnetic energy treatment offers no clinical benefit in reducing the pain of knee osteoarthritis: a systematic review. BMC Musculoskeletal Disorders2006, 7:51. 33. Hinman RS, Heywood SE, Day AR. Aquatic physical therapy for hip and knee osteoarthritis: results of a single- blind randomized controlled trial. Phys Ther. 2007; 87:32 43. 34. Ageberg E, LinkA, Roos EM. Feasibility of neuromuscular training in patients with severe hip or knee OA: The individualized goal-based NEMEX-TJR training program. BMC Musculoskeletal Disorders2010, 11:126. 35. Chen LY. Su FC. Chiang PY. Kinematic and EMG analysis of backward walking on treadmill. Engineering in Medicine and Biology Society 2000;2:825-827. 36. Tsauo JY, Cheng PF, Yang RS. The effects of sensorimotor training on knee proprioception and function for patients with knee osteoarthritis: a preliminary report. Clin Rehabil 2008; 22; 448-57. 37. Cipriani DJ. Armstrong CW. Gaul S. Backward Walking at Three Levels of Treadmill Inclination: An Electromyographic and Kinematic Analysis. JOSPT 1995;22:95-102. Scientific Research Journal of India Volume: 3, Issue: 2, Year: 2014 15 38. Kumar TRN. Ashraf M. The Effect Of Backward Walking Treadmill Training On Kinematics Of The Trunk And Lower Limbs. Serbian Journal of Sports Sciences 2009;3:121-127. 39. Brotzman BS. Manske RC. Clinical Orthopedic Rehabilitataion: An Evidenced Based Approach. 3 rd ed. Elsevier MOSBY; USA 2011:380-381. 40. Jan MH, Lin JJ, Liau JJ, Lin YF, Lin DH. Investigation of clinical effects of high- and low-resistance training for patients with knee osteo-arthritis: a randomized con-trolled trial. Phys Ther. 2008; 88:427 436. 41. McConnell S. Kolopack P. Davis AM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis & Rheumatism 2001;45:453461. 42. Brosseau L, Yonge KA, Welch V, Marchand S, Judd M, Wells GA etal. Thermotherapy for treatment of osteoarthritis (Review). Chocrane review. 2010, issue 7 43. Yang YR. Yen JG. Wang RY. Yen LL. Lieu FK. Gait outcomes after additional backward walking training in patients with stroke: a randomized controlled trial. Clinical Rehabilitation 2005;19:264-73.
Comparison of Effect of Hip Joint Mobilization and Hip Joint Muscle Strengthening Exercises With Knee Osteoarthritis A. Tanvi, R. Amrita, R. Deepak, P. Kopal Srji Vol 3-Issue 1 Year 2014
Comparison Between Outcomes of Dry Needling With Conventional Protocol and Rood's Approach With Conventional Protocol On Pain, Strength and Balance in Knee Osteoarthritis
Effectiveness of Neuromotor Task Training Combined With Kinaesthetic Training in Children With Developmental Co - Ordination Disorder - A Randomised Trial SRJI Vol-1 Issue-1 Year-2013