Mulligan Manual Therapy and Trunk Stabilization Exercises Versus Isometric Knee Strengthening on Knee Osteoarthritis

NCT04099017 | Completed DMC

• 1 other identifier: IPM&R/DUHS-19/
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Knee joint arthritis posses a serious health problem and caring for an individual with knee osteoarthritis (KOA) produces a great burden on society. Knee joint pain is associated with physical activity while performing various activities of daily living (ADL) in patients with early and severe osteoarthritis (OA). In addition to knee pain, physical function or daily activity is strongly influenced by the severity of Osteoarthritis of the knee. Mulligan joint mobilization with movement provides evident effects on decreasing the pain and restoring the joint biomechanics. Trunk stabilization exercise will improve the stability of trunk which distributes the weight of body evenly on both feets. The aim of this study is to determine the effects of mulligan joint mobilization and trunk stabilization exercise on pain, disability and submaximal exercise performance in KOA.

Conditions

Osteoarthritis, Knee

Keywords

manual therapy; kinesiotape; Excercise therapies; isometric contraction; muscle strength

Outcome Measures

Primary Outcomes (1)

• Change from baseline Knee injury and Osteoarthritis Outcome Score (KOOS) at 6 weeks

  The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self reported specific joint measure developed to assess a broad spectrum of patients with knee injuries and OA, for pain and other symptoms, function in daily life, function in sports and recreation, and quality of knee-related life, being easy to use, evaluating the short- and long-term health problems related to the knee joint. The KOOS contains 42 items covering five subscales: pain, other symptoms, activities of daily living, sport and leisure activities and quality of life. A score of 0 (extreme problems) 100 (smoothly) can be obtained separately for each sub-range.

  baseline and post intervention (week 6 - the analysis will be conducted on the first week immediately after the end of the training

Secondary Outcomes (4)

• Visual Analogue Scale

  baseline, 3 weeks and 6 weeks

• Knee injury and Osteoarthritis Outcome Score (KOOS)

  baseline, 3 weeks and 6 weeks

• 6 Minute Walk Test

  baseline, 3 weeks and 6 weeks

• Stairs Climb Test

  baseline, 3 weeks and 6 weeks

Study Arms (3)

Mulligan mobilization group

EXPERIMENTAL

This study ARM will received Mulligan joint mobilization and concomitant therapies in this group. The following are the brief detail of therapy 1. Mulligan joint mobilization in Non-weight bearing (NWB): 2. Knee strengthening 3. Kinesiotaping

Other: Mulligan Joint mobilization

Trunk stabilization group

EXPERIMENTAL

This study ARM will received Trunk stabilization exercises and concomitant therapies in this group. The following are the brief detail of therapy: 1. Trunk stabilization i. modified supermen extension exercise ii. Back bridge: iii. Unilateral back bridge: Iv. lateral step up: 2. Knee strengthening i. Isometric quadriceps exercise: ii. Straight leg raising (SLR) exercise: 3. Kinesiotaping:

Other: Trunk stabilization group

Knee strengthening group

OTHER

This study ARM will received Knee strengthening exercises and concomitant therapies in this group. The following are the brief detail of therapy: 1. Knee strengthening i. Isometric quadriceps exercise ii. Straight leg raising (SLR) exercise: 2. Kinesio-taping:

Other: Knee strengthening group

Interventions

Mulligan Joint mobilization OTHER

This study ARM will received Mulligan joint mobilization and concomitant therapies in this group. The following are the brief detail of therapy 1. Mulligan joint mobilization in Non-weight bearing (NWB) to weight-bearing (WB) 6 -10 Reps and 3 sets/ session. Procedural detail: Joint mobilization will be performed in sagittal, frontal and transverse direction, following glide will be preferred will depend on patient adherence to the joint mobilization. Mobilization will be progress from NWB to WB according to patient compliance 27 2. Knee strengthening Type of exercise: Knee Isometric Strengthening exercises. Intensity: 10 reps Frequency: At 1st week one set of all knee exercise will be performed then it will be progressed to 2 sets at 3 weeks, and these exercises will be progressed to three sets until the 6 weeks 3. Kinesiotaping:

Mulligan mobilization group

Trunk stabilization group OTHER

This study ARM will received Trunk stabilization exercises and concomitant therapies in this group. The following are the brief detail of therapy: 1. Trunk stabilization Area: Trunk Type of exercise: Stabilization exercise Intensity: 6-8 reps Frequency: 3 sets per session and 30 second duration break between sets Procedural detail: i. modified supermen extension exercise ii. Back bridge: iii. Unilateral back bridge: Iv. lateral step up: 2. Knee strengthening Area: Knee Joint Type of exercise: Knee Isometric Strengthening exercises. Intensity: 10 reps Frequency: At 1st week one set of all knee exercise will be performed then it will be progressed to 2 sets at 3 weeks, and these exercises will be progressed to three sets until the 6 weeks Procedural detail: i. Isometric quadriceps exercise: ii. Straight leg raising (SLR) exercise: 3. Kinesiotaping:

Trunk stabilization group

Knee strengthening group OTHER

This study ARM will received Knee strengthening exercises and concomitant therapies in this group. The following are the brief detail of therapy: 1. Knee strengthening Area: Knee Joint Type of exercise: Knee Isometric Strengthening exercises. Intensity: 10 reps Frequency: At 1st week one set of all knee exercise will be performed then it will be progressed to 2 sets at 3 weeks, and these exercises will be progressed to three sets until the 6 weeks Procedural detail: i. Isometric quadriceps exercise ii. Straight leg raising (SLR) exercise: 2. Kinesio-taping: Muscle stretch method will be applied which involves one Y and two I straps: The Y-shaped tape base will be affixed over the top of patella then pulls up his/her knee to its maximum bending capacity then both end of Y strip is placed around the patella ending on the tibial tuberosity. Then reinforcing I-tape will be affixed at the origin and insertion of MCL and LCL. Tape will be change in every session.

Knee strengthening group

Eligibility Criteria

• Age: 40 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• \- Both gender (female and male) patients
• Age between 40 - 60
• Knee osteoarthritis Grade I \& II on Kellgren and Lawrence (K/L) criteria
• Prediagnosed case of knee OA as per the American College of Rheumatology (ACR).

You may not qualify if:

• Known skin allergies
• Sensory-motor dysfunction of lower extremity
• Severe joint deformity of lower extremity
• Post Traumatic Arthritis
• Constitutional Symptoms (Fever, Malaise, Weight Loss and high blood pressure)
• Knee Intraarticular injection in past 3 months
• Acute low back pain
• History of spinal surgery
• Subject using assistive devices for ambulation i.e. cane, walkers, sticks
• Refused to give consent
• Body Mass Index \> 30 kg/m2
• Received physiotherapy treatment in the past 3 months
• Visual Analogue Scale \<4
• Patellofemoral joint arthritis will be excluded

Sponsors & Collaborators

• Dow University of Health Sciences: lead

Study Sites (1)

Dow University of Health Sciences & Institute of Physical Medicine and Rehabilitation

Karachi, Sindh, 74200, Pakistan

Location

Related Publications (2)

• Nam CW, Park SI, Yong MS, Kim YM. Effects of the MWM Technique Accompanied by Trunk Stabilization Exercises on Pain and Physical Dysfunctions Caused by Degenerative Osteoarthritis. J Phys Ther Sci. 2013 Sep;25(9):1137-40. doi: 10.1589/jpts.25.1137. Epub 2013 Oct 20.

  PMID: 24259931 BACKGROUND

• Nazir SNB, Rathore FA. Efficacy of Mulligan joint mobilizations and trunk stabilization exercises versus isometric knee strengthening in the management of knee osteoarthritis: a randomized controlled trial. BMC Sports Sci Med Rehabil. 2024 May 7;16(1):105. doi: 10.1186/s13102-024-00893-7.

  PMID: 38715135 DERIVED

MeSH Terms

Conditions

Osteoarthritis, Knee

Condition Hierarchy (Ancestors)

Osteoarthritis; Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases

Study Officials

• SHAIKH NABI B NAZIR, MSAPT

  Dow University of Health Sciences

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: After confirming eligibility, the physiotherapist performing intervention obtained treatment assignment (S.S. Ali). The subject will not be aware of the group allocation and different time slot will be given for the intervention. Another physiotherapist who will not be aware of allocation concealment, record the reading of outcomes at the baseline, after three and six weeks
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: September 18, 2019
• First Posted: September 23, 2019
• Study Start: September 20, 2020
• Primary Completion: February 24, 2021
• Study Completion: March 20, 2021
• Last Updated: May 10, 2022

Record last verified: 2022-05

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR, ANALYTIC CODE
• Time Frame: Beginning 3 months and ending 3 years following article publication.
• Access Criteria: Researchers who provide a methodologically sound proposal.

Locations

PA (1)