Background & Aims
Therapeutic exercises have gained great prominence, due to the benefits shown in the treatment of knee OA. Studies demonstrate positive results in reducing pain and improving function using strength exercise, in addition to positive effects on knee functionality of balance training with visual feedback or gait training. However, to date, there is no evidence on the effects of an exercise program combined with strength training, static and dynamic balance training, and gait training with visual feedback, as a conservative treatment in older women with and without knee OA. Therefore, the objective of this randomized clinical trial (RCT), is to evaluate the therapeutic effect of a program of muscular resistance training in the lower limbs, balance, and gait associated with visual feedback on the chronic pain, functional, and biomechanical aspects of older women with and without knee OA.
Methods
Controlled, parallel clinical trial, with random allocation and blinding of evaluators, in which 40 older women were recruited; 20 older women with grade 2 or 3 knee OA randomized and allocated to the intervention group (OAG, n=20), and 20 older women without the disease to the control group (CG, n=20). The intervention included a muscular resistance training program in the lower limbs, and reactive and proactive balance and gait training associated with visual feedback. The primary outcomes were: pain intensity using the Visual Analogue Scale, and pain and functionality domains using the questionnaires: WOMAC (Western Ontario and McMaster Universities Osteoarthritis) and Lequesne Algofunctional Index. The secondary outcomes were: the six-minute walk test, the Falls Risk Awareness Questionnaire-FRAQ-Brazil, physical performance using the Timed Up & Go Test (TUG), plantar load distribution during gait, and patients’ acceptability of the intervention protocol.
Results
The intervention was effective in improving chronic pain and edema, as well as increasing functionality in older women with knee OA pre- and post-intervention and in relation to the control, with a moderate to high effect size. In relation to body balance (TUG), an increase with a larger effect size was observed in older women with OA, and the perception of risk of falls (FRAQ) and the 6-minute walk test (6MWT) increased pre- and post-intervention for both groups of older women (OAG and CG) with a high effect size in the perception of the risk of falls. Furthermore, there was a reduction in plantar load on the midfoot and medial and lateral hindfoot areas pre and post-intervention for the older women in the knee OAG, but still maintaining an increased contact area in the midfoot when compared to the post-intervention in the CG. Both groups (OAG and CG) showed excellent acceptability, suitability, and feasibility of the intervention program.
Conclusions
The protocol of muscular resistance training, reactive and proactive balance training, and gait with visual feedback was effective, over a period of 2 consecutive months, to reduce pain and edema in older women with knee OA. Furthermore, the intervention increased knee functionality, balance, walking distance, and perception of falls in older women with and without knee OA. During gait with visual feedback, the intervention protocol promoted a better adjustment of the distribution of plantar load over the midfoot and medial and lateral hindfoot regions of older women with knee OA. Older women with and without knee OA showed excellent acceptability and feasibility of the intervention.
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Presenting Author
Tatiane Silva de Souza
Poster Authors
Ana Paula Ribeiro
PhD.
Universidade de São Paulo
Lead Author
Tatiane Silva de Souza and Msc.
University Santo Amaro, Health Science Post-Graduate Department
Lead Author
Daniel Borges Pereira and Msc.
University Santo Amaro, Medicine School, Health Science Post-Graduate Department
Lead Author
Rodrigo Jugue Hagihara and Dr.
University Santo Amaro, Medicine School, Biomechanics and Musculoskeletal Rehabilitation Lab.
Lead Author
Carolina Tayama Fuzinato and Dr.
University Santo Amaro, Medicine School, Biomechanics and Musculoskeletal Rehabilitation Lab.
Lead Author
Brenda Luciano de Souza and Msc.
University Santo Amaro, Health Science Post-Graduate Department
Lead Author
Ana Paula Ribeiro and PhD.
Physical Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil
Lead Author
Topics
- Pain in Special Populations: Elderly