Hip Joint Mobilizations and Strength Training in Patients With Knee OA Osteoarthritis

NCT04769531 | Completed

• 1 other identifier: 00001
• Study Type: interventional
• Target: 66
• Locations: 1 country
• Sites: 1

Brief Summary

Knee osteoarthritis has been ranked 11th highest contributor to non-fatal burdens in the world. Many research studies have discussed the relationship of hip muscle with knee joint stating that impaired hip strength can be a reason for knee pain. Furthermore, mobilization has been shown to be helpful in reducing pain, increasing range of motion and physical function in Osteoarthritis. Despite the evidence, there are very few studies that actually conducted clinical trials to test the effectiveness of mobilizations and strengthening of hip muscles in knee Osteoarthritis. Therefore our aim is to evaluate the effectiveness of hip joint mobilizations and strength training in knee osteoarthritis. OBJECTIVE: To determine the effects of hip joint mobilizations and strengthening exercises, on pain, physical function and dynamic balance in patients with knee osteoarthritis (OA) using Visual analog scale, Knee injury and Osteoarthritis Outcome Score and four square step test. METHODOLOGY: A randomized control trial will be conducted on 66 subjects with knee osteoarthritis and age 50 years will be enrolled in this study after screening by referring consultants. This study will be carried out at Physiotherapy OPD of DUHS, Civil hospital Karachi and Rabia Moon Memorial Institute of Neurosciences Trust. Subjects will be assessed at baseline and after 18 sessions using Visual analog scale, Knee injury and Osteoarthritis Outcome Score and square step test for pain, physical functioning and dynamic balance respectively. The subjects will be allocated into three groups through simple random sampling. Group A (joint mobilization group) will receive hip mobilization techniques, hip strengthening exercises along with the best available knee exercises while group B (hip muscles strengthening group) will receive hip-strengthening exercises with the best available knee exercises. Group C (knee strengthening group) will be receiving the best available knee treatment including exercises only. Patients will receive a total of 18 sessions, 5 treatment sessions per week for four successive weeks. The data will be entered and analyzed using SPPS version 21. Repeated mean one way ANOVA will be applied to measure VAS and KOOS scores within the group, for pairwise comparison between groups, Tukey's test will be applied. Chi-square will be applied for FSST scoring. A P-Value less than 0.5 will be considered significant.

Conditions

Osteoarthritis, Knee

Keywords

Knee Osteo-arthritis; Musculoskeletal; lower extremity manual therapy; clinical trial Manual therapy; Resistance training; posture

Outcome Measures

Primary Outcomes (3)

• Visual analog scale

  Visual analog scale (VAS) is a tool evaluating subjective attitudes that cannot be directly measurable, it has a good Test-retest reliability. This scoring range from 0 to 10 cm, Where 0 stands for no pain and 10 indicates worse possible pain.

  up to 6 weeks

• Four step square test

  Four square step tests is a tool for assessing the dynamic balance and mobility while standing. It also assess the fall risk.

  up to 6 weeks

• Koos

  The Knee Injury and Osteoarthritis Outcome Score is a PROM having five sub scales used for knee osteoarthritis (OA), it monitors the course of disease and final outcomes following interventions. Each subscale is scored from 0 (extreme problems) to 100 (no problems). It has high test-retest reliability.

  up to 6 weeks

Study Arms (3)

Hip Joint Mobilizations

EXPERIMENTAL

Hip joint mobilizations Hip strength training Knee exercises

Other: Hip Joint Mobilizations; Other: Hip joint Muscle strength training; Other: knee strengthening and flexibility exercises

Hip & Knee Muscles strength training

EXPERIMENTAL

Hip strength training Knee exercises

Other: Hip joint Muscle strength training; Other: knee strengthening and flexibility exercises

Knee Muscles strength training

ACTIVE COMPARATOR

Knee exercises

Other: knee strengthening and flexibility exercises

Interventions

Hip Joint Mobilizations OTHER

i. Anterior-posterior glide ii. Posterior-anterior glide iii. Caudal glide iv. Posterior-anterior glide with Abduction, flexion, and lateral rotation

Hip Joint Mobilizations

Hip joint Muscle strength training OTHER

i. Hip abduction in side-lying ii. Hip extension in the prone position iii. Sideways walk iv. Hip abduction in stand up position v. Hip hitching

Hip & Knee Muscles strength training; Hip Joint Mobilizations

knee strengthening and flexibility exercises OTHER

i. STRENGTHENING EXERCISES: Knee extension static quads set, terminal knee extension while standing up, sitting leg press, partial squat, step-ups. ii. STRETCHING EXERCISES:: stretching of the calf, hamstring, and quadriceps-femoris. iii. RANGE OF MOTION EXERCISES: Knee in mid-flexion to full-extension, Knee in mid-flexion to full-flexion:

Hip & Knee Muscles strength training; Hip Joint Mobilizations; Knee Muscles strength training

Eligibility Criteria

• Age: 50 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients with unilateral or bilateral knee OA.
• Subjects of 50 years or above
• palpable bony enlargement
• Crepitus on knee motion
• morning stiffness for less than 30 minutes
• Kellgren and Lawrence scale: Grade 1-3

You may not qualify if:

• Patients with spinal surgery
• lower extremity arthroplasty
• Severe joint contractures and bony deformities of lower extremity
• Amputation of lower extremity
• Recent trauma to lower extremity
• A cortisone injection to the hip/ knee within previous 30 days
• Patient having mechanical back pain .i.e. lumbosacral radiculopathy and sciatica
• Patient with lower extremity bony deformities either acquired or congenital
• Patient with advanced hip OA.
• Systemic arthritis or rheumatoid arthritis

Sponsors & Collaborators

• Dow University of Health Sciences: lead

Study Sites (1)

Dow University of Health Sciences

Karachi, Sindh, 75400, Pakistan

Location

Related Publications (22)

• Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian J Intern Med. 2011 Spring;2(2):205-12.

  PMID: 24024017 BACKGROUND

• Mora JC, Przkora R, Cruz-Almeida Y. Knee osteoarthritis: pathophysiology and current treatment modalities. J Pain Res. 2018 Oct 5;11:2189-2196. doi: 10.2147/JPR.S154002. eCollection 2018.

  PMID: 30323653 BACKGROUND

• Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, Bridgett L, Williams S, Guillemin F, Hill CL, Laslett LL, Jones G, Cicuttini F, Osborne R, Vos T, Buchbinder R, Woolf A, March L. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014 Jul;73(7):1323-30. doi: 10.1136/annrheumdis-2013-204763. Epub 2014 Feb 19.

  PMID: 24553908 BACKGROUND

• Wallace IJ, Worthington S, Felson DT, Jurmain RD, Wren KT, Maijanen H, Woods RJ, Lieberman DE. Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proc Natl Acad Sci U S A. 2017 Aug 29;114(35):9332-9336. doi: 10.1073/pnas.1703856114. Epub 2017 Aug 14.

  PMID: 28808025 BACKGROUND

• Iqbal MN, Haidri FR, Motiani B, Mannan A. Frequency of factors associated with knee osteoarthritis. J Pak Med Assoc. 2011 Aug;61(8):786-9.

  PMID: 22356003 BACKGROUND

• Ro DH, Lee J, Lee J, Park JY, Han HS, Lee MC. Effects of Knee Osteoarthritis on Hip and Ankle Gait Mechanics. Adv Orthop. 2019 Mar 24;2019:9757369. doi: 10.1155/2019/9757369. eCollection 2019.

  PMID: 31019809 BACKGROUND

• A. Tanvi, R. Amrita, R. Deepak, P. Kopa. Comparison of effect of hip joint mobilization and hip joint muscle strengthening exercises with knee osteoarthritis. Scientific Research Journal of India. 2014;3

  BACKGROUND

• Currier LL, Froehlich PJ, Carow SD, McAndrew RK, Cliborne AV, Boyles RE, Mansfield LT, Wainner RS. 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 Sep;87(9):1106-19. doi: 10.2522/ptj.20060066. Epub 2007 Jul 3.

  PMID: 17609333 BACKGROUND

• Cliborne AV, Wainner RS, Rhon DI, Judd CD, Fee TT, Matekel RL, Whitman JM. Clinical hip tests and a functional squat test in patients with knee osteoarthritis: reliability, prevalence of positive test findings, and short-term response to hip mobilization. J Orthop Sports Phys Ther. 2004 Nov;34(11):676-85. doi: 10.2519/jospt.2004.34.11.676.

  PMID: 15609488 BACKGROUND

• Ahmad A, Daud M. A COMPARATIVE STUDY BETWEEN JOINT MOBILIZATION AND CONVENTIONAL PHYSIOTHERAPY IN KNEE OSTEOARTHRITIS. Int J Physio [Internet]. 2016Apr.8 [cited 2021Feb.2];3(2):159-62. Available from: https://www.ijphy.org/index.php/journal/article/view/207

  BACKGROUND

• A. Tanvi, R. Amrita, R. Deepak, P. Kopa.Comparison of effect of hip joint mobilization and hip joint muscle strengthening exercises with knee osteoarthritis. Scientific Research J of Ind 2014;3(1)

  BACKGROUND

• Santos TR, Oliveira BA, Ocarino JM, Holt KG, Fonseca ST. Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: a systematic review. Braz J Phys Ther. 2015 May-Jun;19(3):167-76. doi: 10.1590/bjpt-rbf.2014.0089. Epub 2015 May 29.

  PMID: 26039034 BACKGROUND

• Bennell KL, Hunt MA, Wrigley TV, Hunter DJ, McManus FJ, Hodges PW, Li L, Hinman RS. Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial. Osteoarthritis Cartilage. 2010 May;18(5):621-8. doi: 10.1016/j.joca.2010.01.010. Epub 2010 Feb 6.

  PMID: 20175973 BACKGROUND

• Schache MB, McClelland JA, Webster KE. Does the addition of hip strengthening exercises improve outcomes following total knee arthroplasty? A study protocol for a randomized trial. BMC Musculoskelet Disord. 2016 Jun 13;17:259. doi: 10.1186/s12891-016-1104-x.

  PMID: 27295978 BACKGROUND

• Moore M, Barker K. The validity and reliability of the four square step test in different adult populations: a systematic review. Syst Rev. 2017 Sep 11;6(1):187. doi: 10.1186/s13643-017-0577-5.

  PMID: 28893312 BACKGROUND

• Collins NJ, Prinsen CA, Christensen R, Bartels EM, Terwee CB, Roos EM. Knee Injury and Osteoarthritis Outcome Score (KOOS): systematic review and meta-analysis of measurement properties. Osteoarthritis Cartilage. 2016 Aug;24(8):1317-29. doi: 10.1016/j.joca.2016.03.010. Epub 2016 Mar 21.

  PMID: 27012756 BACKGROUND

• Alviar MJ, Olver J, Brand C, Hale T, Khan F. Do patient-reported outcome measures used in assessing outcomes in rehabilitation after hip and knee arthroplasty capture issues relevant to patients? Results of a systematic review and ICF linking process. J Rehabil Med. 2011 Apr;43(5):374-81. doi: 10.2340/16501977-0801.

  PMID: 21448553 BACKGROUND

• Gould D, Kelly D, Goldstone L, Gammon J. Examining the validity of pressure ulcer risk assessment scales: developing and using illustrated patient simulations to collect the data. J Clin Nurs. 2001 Sep;10(5):697-706. doi: 10.1046/j.1365-2702.2001.00525.x.

  PMID: 11822520 BACKGROUND

• Hanrahan S, Van Lunen BL, Tamburello M, Walker ML. The Short-Term Effects of Joint Mobilizations on Acute Mechanical Low Back Dysfunction in Collegiate Athletes. J Athl Train. 2005 Jun;40(2):88-93.

  PMID: 15970954 BACKGROUND

• Philadelphia Panel. Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for knee pain. Phys Ther. 2001 Oct;81(10):1675-700.

  PMID: 11589643 BACKGROUND

• Hengeveld E, Banks K.(ed) Maitland's Peripheral Manipulation. 4th ed. Elsevier: London.(2005)

  BACKGROUND

• Mehwish B, Ali SS, Mirza Baig AA. Effect of hip joint mobilisations and strength training on pain, physical function and dynamic balance in patients with Knee Osteoarthritis: A randomized controlled trial. J Pak Med Assoc. 2023 Apr;73(4):749-754. doi: 10.47391/JPMA.6223.

  PMID: 37051976 DERIVED

MeSH Terms

Conditions

Osteoarthritis, Knee

Condition Hierarchy (Ancestors)

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

Study Officials

• Bushra Mehwish, MSAPT

  Dow University of Health Sciences

  PRINCIPAL INVESTIGATOR

• Shahzad Ali Syed, MSPT

  Dow University of Health Sciences

  STUDY DIRECTOR

• Aftab Ahmed Mirza Baig, MSAPT

  Dow University of Health Sciences

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: After enrolling the patient, informed consent will be taken from each taken. All patients will be blinded to the type of information to avoid biasness.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: It is a randomized control trial. Total 66 patients will be carry out, 22 in each of the three groups that include 2 patients as a drop out per group. There will be two interventional groups and one control group. Treatment will be allocated normally using random number sheet generated by statistician.

Study Record Dates

• First Submitted: February 21, 2021
• First Posted: February 24, 2021
• Study Start: January 15, 2019
• Primary Completion: August 30, 2021
• Study Completion: December 30, 2021
• Last Updated: January 28, 2022

Record last verified: 2022-01

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)