Randomized Controlled Trial of Dynamic Balance Training in People With Knee Osteoarthritis

Not Applicable

Completed

• Conditions: Knee Osteoarthritis
• Interventions: Other: Targeted dynamic balance training

• Registration Number: NCT02103907
• Lead Sponsor: University of British Columbia

Brief Summary

There is a high prevalence of falls in those with knee osteoarthritis (OA) compared to healthy older adults. Balance is a key element of function that allows individuals to maintain posture and respond to perturbations, and poor balance control, a risk factor for falls, has been noted in those with knee OA. There is a lack of research guiding treatment for balance deficits in knee OA, with interventions aimed at improving balance deficits in those with knee OA having mixed results. Targeted dynamic balance interventions in other patient populations have been shown to significantly improve dynamic balance control and physical function. If results similar to such populations can be achieved, such a program may produce a significant reduction in functional disability in the knee OA population and improve quality of life. The purpose of this study is to examine the effect of a 10-week targeted dynamic balance intervention on dynamic balance and physical function in people with knee OA. This will be a randomized controlled trial (RCT).

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2014-04-01
• Study First Submitted QC: 2014-04-01
• Study First Posted: 2014-04-04
• Study Start: 2014-06
• Primary Completion: 2015-12
• Study Completion: 2015-12
• Status Verified: 2016-06
• Last Update Submitted: 2016-06-05
• Last Update Posted: 2016-06-07

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 40

Inclusion Criteria

• age 50 - 80 years (to meet the American College of Rheumatology clinical definition of OA)
• radiographically confirmed knee OA in the medial compartment of the tibiofemoral joint
• predominance of pain/tenderness over the medial (inside) region of the knee

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Exclusion Criteria

• articular cartilage degradation in the lateral tibiofemoral compartment greater than the medial
• inflammatory arthritic condition
• history of knee or hip replacement surgery
• recent use of corticosteroids (oral or via injection, within last 6 months)
• pain originating predominantly from the patellofemoral joint
• inability to ambulate without a gait aid
• non-English speaking
• recent (within 6 months) arthroscopic knee surgery
• significant hip or back pain (limits the ability to perform the testing)
• Neurological, musculoskeletal or other condition that affects movement ability or balance (i.e. stroke, diabetes, Parkinson's, heart attack, multiple sclerosis, fibromyalgia)

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Treatment (balance training)	Targeted dynamic balance training	Targeted dynamic balance training. Dynamic balance training will consist of progressive exercise training over three phases, with exercises emphasising dynamic balance control, muscle strength and proprioception. Exercises will be performed four times per week for ten weeks. Exercises will be taught and supervised by a trained kinesiologist. Difficulty of exercises will be increased progressively over time by increasing resistance, time of timed exercises, and distance of walking exercises. Exercises will be progressed to different exercises in each new phase (total 3 phases). Participants will complete six treatment sessions at the university (during weeks 1, 2, 3, 5, 7, and 9) that will be included in the total number of sessions per week. All other sessions will be performed at home.

Primary Outcome Measures

Name	Time	Method
Change in dynamic balance and mobility from baseline	0, 10 weeks	The Community Balance and Mobility Scale (CB\&M) will be used to assess dynamic balance and mobility. The CB\&M is a scale designed to assess dynamic balance and mobility and is administered by a trained assessor. The scale consists of 13 items including bending, walking, turning, and stair descent, with a maximum possible score of 96 and minimum score of 0. The scale has been validated and deemed reliable for use in the knee osteoarthritis population.
Change in self-reported physical function from baseline	0, 10 weeks	The Western Ontario \& McMaster Universities Osteoarthritis Index (WOMAC) will be used to assess self-reported physical function. The WOMAC physical function subscale consists of 17 questions assessing physical function capabilities during activities of daily living.

Secondary Outcome Measures

Name	Time	Method
Change in knee pain from baseline	0, 10 weeks	Average pain over the previous week will be assessed using an 11-point numerical rating scale (0 = no pain; 10 = worst pain possible).
Change in fear of pain from baseline	0, 10 weeks	The Brief Fear of Movement Scale will be used to assess fear of pain. This scale is based on the widely used Tampa Scale of Kinesiophobia and contains 6 questions that evaluate fear of pain, movement and re-injury. The scale has been validated in individuals with OA.
Change in self-reported physical activity level from baseline	0, 10 weeks	The Physical Activity Scale for the Elderly score (PASE) will be used to measure self-reported physical activity level. This valid and reliable self-report instrument measures the type and level of recreational and occupational physical activity in the previous week.
Change in knee joint proprioception from baseline	0, 10 weeks	Knee joint proprioception will be measured using a knee joint repositioning task, previously used in those with OA to assess joint proprioception. Proprioception will be assessed in three randomly chosen target positions (15°, 30°, and 60° of knee flexion) while the participant is seated on an isokinetic dynamometer.
Change in muscle strength from baseline	0, 10 weeks	Maximal concentric and eccentric muscle strength of the plantarflexors, quadriceps, and hamstrings will be measured using the same isokinetic dynamometer as for the knee joint repositioning task.
Change in knee joint range of motion from baseline	0, 10 weeks	Range of motion will be measured using a goniometer, similar to other studies of knee OA. Participants will be asked to flex and extend their knee joint while supine.

Trial Locations

Locations (1)

Motion Analysis and Biofeedback Laboratory, The University of British Columbia; 🇨🇦 Vancouver, British Columbia, Canada