Comparison of the Effectiveness of Single and Dual Task Training Applied to Individuals With Knee Meniscus Lesion: A Randomized Controlled, Single-Blind Study
Trial Snapshot
- Phase
- Not Applicable
- Status
- Not yet recruiting
- Sponsor
- Enrollment
- 32
- Locations
- 1
- Primary Endpoint
- Dynamic Balance
Study Overview
Brief Summary
The main function of the meniscus is to transfer and distribute femoral pressure to the tibia. Treatment of meniscus tears is divided into conservative and surgical treatment. The most preferred methods for patients with meniscus lesions include meniscectomy and exercise therapy. The anterior and posterior horns of the meniscus contain numerous mechanoreceptors, including Ruffini endings (slow adapting) and Pacinian corpuscles (fast adapting), which provide information about the position and movement of the joint. Reduced proprioception due to mechanoreceptor damage from meniscus tears may be associated with decreased postural stability, as sensory information associated with a patient's conscious perception of joint movement through mechanoreceptors in the meniscus may contribute to postural stability.
Dual task is based on the simultaneous maintenance of motor-motor or cognitive-motor performance. Dual tasking is used to evaluate the simultaneous performance of a postural task and a motor or cognitive task to examine the interaction or effect of the secondary task on primary task performance. In a purposeful movement, it is necessary to have the ability to adapt to overcome environmental loads and achieve the goal. This also involves performing a cognitive task simultaneously while performing a motor task. In knee meniscus lesions, knee joint position sense and sensory input decrease, walking speed decreases, and attention devoted to walking increases.
Detailed Description
Complex movement formation needs to be restructured as a result of sensory and motor disorders. With the loss of movement organization, postural control becomes vulnerable to cognitive attention elements and additional motor tasks. While physical disability creates a burden for the individual and society, it also has a negative impact on executive functions. Robust cognitive processes are essential when performing complex motor tasks and ensuring stable walking. Because the dependence on cognitive resources increases to compensate for the loss of control in postural stability and balance. Although walking and balance are considered to be automatic tasks, performance decreases when processing capacity is exceeded by a simultaneous task. In dual task studies, it has been reported that there is an increase in step time and a decrease in step length due to the increase in the single and double support phases of walking. This situation has been interpreted as a strategy developed to maintain balance in dual task conditions. With the dual task training to be applied to these individuals, it is aimed to ensure that motor control, balance, and the complex movements they encounter in daily life activities can be maintained in balance while walking.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Single (Outcomes Assessor)
Masking Description
The evaluation of the patients will be carried out by a blinded investigator.
Eligibility Criteria
- Ages
- 40 Years to 65 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •40 to 65 years old
- •According to magnetic resonance imaging (MRI) results, there is a maximum of Grade 2 degenerative bilateral meniscus tear
- •Having a Standardized Mini Mental Test score of 24 and above
- •Volunteering
- •Know how to read and write
- •Not having vision or hearing problems that cannot be corrected with a device
- •Being able to walk independently in society
Exclusion Criteria
- •Not meeting the inclusion criteria
- •Having compliance issues or emotional and cognitive problems that will prevent participation in the assessments and clinical practices to be used in the study
- •Having problems participating in exercises or follow-ups
- •Having had surgery related to the lower extremity
- •Having a neuromuscular disease
- •Having a history of systemic inflammatory joint disease
- •Having a rheumatic disease
- •Having an additional pathology in the knee
- •Receiving additional treatment
Arms & Interventions
Treatment group
Patients in this group are the group to which dual task training and conventional physiotherapy will be applied
Intervention: Dual task training (Other)
Treatment group
Patients in this group are the group to which dual task training and conventional physiotherapy will be applied
Intervention: Conventional physiotherapy (Other)
Control group
Patients in this group are the group to which single task training and conventional physiotherapy will be applied.
Intervention: Single task training (Other)
Control group
Patients in this group are the group to which single task training and conventional physiotherapy will be applied.
Intervention: Conventional physiotherapy (Other)
Outcomes
Primary Outcomes
Dynamic Balance
Time Frame: Change from baseline at 8 weeks treatment program and two months after.
The Modified Four Square Step Test will be used in the dynamic balance assessment.The test involves changing direction while taking steps forward, backward, and sideways. Individuals will be asked to stand in square number 1 and face square number 2. The movement will be started and they will be asked to step into squares number 2,3,4,1,4,3,2,1 in order. First, they will take a turn clockwise and then counterclockwise. Two measurements will be made and the average value will be recorded in seconds. The test will be repeated with single task, cognitive dual task and motor dual task.
Static Balance
Time Frame: Change from baseline at 8 weeks treatment program and two months after.
Static balance will be assessed with a one-leg standing test.The test starts when one foot leaves the ground and ends when it touches the ground again, in case of excessive oscillation or jumping with the foot on the ground. The person is asked to stand on one leg for as long as possible. The test is terminated when 30 seconds are reached. The test will be applied to bilateral lower extremities with single task, cognitive dual task, and motor dual task.
Gait Evaluation
Time Frame: Change from baseline at 8 weeks treatment program and two months after.
A 10-meter walking test will be used to evaluate individuals' walking. Two measurements will be made and the average value will be recorded in seconds. The test will be repeated with single task, cognitive dual task and motor dual task.
Assessment of Functional Mobility
Time Frame: Change from baseline at 8 weeks treatment program and two months after.
The Timed Up and Go Test will be used to assess functional mobility. In this test, the individual is asked to stand up while sitting in a chair with armrests and no wheels with the command 'Start', walk at his/her normal pace on a flat surface to a colored tape that was previously attached 3 meters away, then turn around and walk back to the chair and sit down again. The test will be repeated twice and the average time will be recorded in seconds. The test will be repeated with a single task, a cognitive dual task and a motor dual task.
Joint Position Sense
Time Frame: Change from baseline at 8 weeks treatment program and two months after.
Joint position sense is evaluated by the angular difference between a repeatedly determined target position and the estimated position, and this is called absolute angular error. 30° and 60° knee flexion will be determined as target angles. A smartphone measurement application will be used for measurement. For the test position, individuals will be seated with their hips and knees at 90° flexion and their feet off the ground, and while the knee is slowly brought from 90° flexion to passive extension, individuals will be asked to perceive and learn this position by first stopping at 60° flexion angle for 5 seconds. Then, the individual will be asked to bring their knee to this target angle and the measurement will be made. The difference will be recorded as absolute angular error. The same process will be done for 30° flexion angle. Three repetitions will be requested for both positions and the averages will be calculated and recorded.
Secondary Outcomes
- Pain level(Change from baseline at 8 weeks treatment program and two months after.)
- Functional Capacity Assessment(Change from baseline at 8 weeks treatment program and two months after.)
- Evaluation of the Functional Level of the Knee(Change from baseline at 8 weeks treatment program and two months after.)
- Dual Task Assessment(Change from baseline at 8 weeks treatment program and two months after.)
- Muscle Strength Measurement(Change from baseline at 8 weeks treatment program and two months after.)