The Effect of Dry Needling in Patients With Knee Osteoarthritis

Not Applicable

Completed

• Conditions: Osteoarthritis, Knee
• Interventions: Other: Dry Needling; Other: Sham Needling

• Registration Number: NCT04717167
• Lead Sponsor: Universiteit Antwerpen

Brief Summary

Research suggests that myofascial trigger points (MTrP) play an important role in explaining pain in patients with musculoskeletal knee disorders. Trigger points are usually defined as hypersensitive tender spots within taut bands of skeletal muscles that are painful on muscle stimulation and that usually elicit referred pain. Treatment of these trigger points could possibly alleviate symptoms in patients with knee pain. However, literature on the effect of trigger point therapy, dry needling in particular, in patients with musculoskeletal knee disorders is scarce. The purpose of this study is to examine the effect of trigger point therapy (dry needling (DN)) on pain, presence of altered central pain processing, muscle features and gait pattern in patients with knee osteoarthritis (KOA). 60 patients with symptomatic KOA will participate in this study. They will randomly be allocated in either an experimental group (EG) (dry needling technique) or a placebo group (PG) (sham needling technique). Pain (Visual analogue scale (VAS) \& KOA outcome score (KOOS), muscle features during gait and gait pattern (3D gait analysis and surface electroMyoGraphy (EMG)) and presence of altered central pain processing (Central Sensitization Inventory (CSI), Quantitative Sensory testing (QST)) will be measured at baseline and 15 minutes after the intervention. Additionally, pain will be measured 3 days after the intervention. The investigators hypothesize that the effect on the outcome measures will be significantly larger in the EG compared to the PG.

Detailed Description

Not available

Study Timeline

• Study Start: 2016-12-01
• Primary Completion: 2019-04-01
• Study Completion: 2019-04-01
• Status Verified: 2021-01
• Study First Submitted: 2021-01-13
• Study First Submitted QC: 2021-01-18
• Last Update Submitted: 2021-01-18
• Study First Posted: 2021-01-20
• Last Update Posted: 2021-01-20

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 61

Inclusion Criteria

• A minimum age of fifty years old;

• Diagnosed with KOA based on the American College of Rheumatology (ACR) clinical classification criteria(48), including:

  • A Kellgren-Lawrence grade of minimum two on radiography;
  • At least three months of chronical knee pain.

Exclusion Criteria

• Patients suffering from autoimmune and/or neurological disorders
• Patients who had a major trauma/fracture of the lower limb in the past six months -
• Patients who experienced other musculoskeletal problems than OA

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: FACTORIAL

Arm && Interventions

Group	Intervention	Description
DN group	Dry Needling	All identified MTrPs were inserted with a sterile filiform needle (0,30mm x 40mm or 0,30mm x 75mm, depending on the muscle) that moved up- and downwards until a local twitch response was elicited. When the repeated local twitch response fade away or the subject reported too much pain, the needle was removed. After the treatment, a 15 minutes break(51) was set up and the subjects were not permitted to use a hot pack or to stretch the muscle.
Sham needling (SN) group	Sham Needling	The SN technique was similar to DN, except for penetrating the muscle. In this technique, the needle only penetrated the skin and was therefore impossible to provoke a local twitch response.

Primary Outcome Measures

Name	Time	Method
Pain pressure thresholds	Change from baseline central pain processing at 15minutes postintervention	Measured with an digital algometer (kilogram force/ square cm)
Conditioned pain modulation	Change from baseline central pain processing at 15minutes postintervention	Measured with an digital algometer (test stimulus) and an inflatable cuff (conditioning stimulus). (kilogram force/ square cm)
Pain sensation	Change from 15minutes postintervention pain sensation at 3days postintervention	Measured with the Knee Osteoarthritis Outcome Score- subscale pain, scored on a scale from 0 to 36, transferred from 0 to 100. Higher scores indicate a higher pain sensation.
Temporal summation	Change from baseline central pain processing at 15minutes postintervention	Measured with an digital algometer (kilogram force/ square cm)

Secondary Outcome Measures

Name	Time	Method
Muscle coactivation of musculus Vastus medialis and musculus Biceps femoris	Change from baseline muscle coactivation at 15minutes postintervention	Measured with wireless surface electromyography. Muscle activation patterns will be gathered through surface electrodes. Hereafter, the co-contraction index was calculated. Higher percentages indicate higher coactivation.
Muscle coactivation of musculus Tibialis anterior and musculus Gastrocnemius medialis	Change from baseline muscle coactivation at 15minutes postintervention	Measured with wireless surface electromyography. Muscle activation patterns will be gathered through surface electrodes. Hereafter, the co-contraction index was calculated. Higher percentages indicate higher coactivation.
Step time (meters/second)	Change from baseline muscle coactivation at 15minutes postintervention	measured with force plates and markers to measure toe off and heel strike during a 3D motion analysis.
Muscle coactivation of musculus Vastus medialis and musculus Semitendinosus	Change from baseline muscle coactivation at 15minutes postintervention	Measured with wireless surface electromyography. Muscle activation patterns will be gathered through surface electrodes. Hereafter, the co-contraction index was calculated. Higher percentages indicate higher coactivation.
Step width (meters)	Change from baseline muscle coactivation at 15minutes postintervention	measured with force plates and markers to measure toe off and heel strike during a 3D motion analysis.
Muscle coactivation of musculus Vastus lateralis and musculus Semitendinosus	Change from baseline muscle coactivation at 15minutes postintervention	Measured with wireless surface electromyography. Muscle activation patterns will be gathered through surface electrodes. Hereafter, the co-contraction index was calculated. Higher percentages indicate higher coactivation.
Muscle coactivation of musculus Vastus lateralis and musculus Biceps femoris	Change from baseline muscle coactivation at 15minutes postintervention	Measured with wireless surface electromyography. Muscle activation patterns will be gathered through surface electrodes. Hereafter, the co-contraction index was calculated. Higher percentages indicate higher coactivation.
Muscle coactivation of musculus Tibialis anterior and musculus Gastrocnemius lateralis	Change from baseline muscle coactivation at 15minutes postintervention	Measured with wireless surface electromyography. Muscle activation patterns will be gathered through surface electrodes. Hereafter, the co-contraction index was calculated. Higher percentages indicate higher coactivation.
Stride time (seconds)	Change from baseline muscle coactivation at 15minutes postintervention	measured with force plates and markers to measure toe off and heel strike during a 3D motion analysis.
Stride length (meters)	Change from baseline muscle coactivation at 15minutes postintervention	measured with force plates and markers to measure toe off and heel strike during a 3D motion analysis.
Step length (meters)	Change from baseline muscle coactivation at 15minutes postintervention	measured with force plates and markers to measure toe off and heel strike during a 3D motion analysis.
Stance phase (%)	Change from baseline muscle coactivation at 15minutes postintervention	measured with force plates and markers to measure toe off and heel strike during a 3D motion analysis.