A comparison of strength training, self‐management, and the combination for early osteoarthritis of the knee

McKnight, Patrick E.; Kasle, Shelley; Going, Scott B.; Villanueva, Isidro; Cornett, Michelle; Farr, Josh; Wright, Jill; Streeter, Clara; Zautra, Alex

doi:10.1002/acr.20013

Cited by 81 publications

(97 citation statements)

References 28 publications

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“…The participants started with 2 sets of 6 repetitions and increased to 2 sets of 10 repetitions using the same resistance. 51 Jan et al 40 compared the effects of high-and low-resistance exercises in elderly people with mild to moderate knee OA. The lowresistance group performed 10 sets of 15 repetitions using 10% of the 1RM.…”

Section: Discussionmentioning

confidence: 99%

“…22,28,40,51 However, to our knowledge, no studies have yet evaluated the effect of active rehabilitation programs in patients with articular cartilage lesions or compared the effect of rehabilitation alone to that of surgical interventions followed by postoperative rehabilitation. It has been stated that nonsurgical treatment for patients with articular cartilage lesions scheduled for cartilage repair is considered inappropriate, because most symptomatic patients are likely to be nonresponders to nonsurgical management.…”

Section: T T Conclusionmentioning

confidence: 99%

See 1 more Smart Citation

The Feasibility of a 3-Month Active Rehabilitation Program for Patients With Knee Full-Thickness Articular Cartilage Lesions: The Oslo Cartilage Active Rehabilitation and Education Study

Wondrasch¹,

Årøen²,

Røtterud³

et al. 2013

Journal of Orthopaedic & Sports Physical Therapy

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Study Design Case series. Objectives To evaluate the feasibility of an active rehabilitation program for patients with knee full-thickness articular cartilage lesions. Background No studies have yet evaluated the effect of active rehabilitation in patients with knee full-thickness articular cartilage lesions or compared the effects of active rehabilitation to those of surgical interventions. As an initial step, the feasibility of such a program needs to be described. Methods Forty-eight patients with a knee full-thickness articular cartilage lesion and a Lysholm score below 75 participated in a 3-month active rehabilitation program consisting of cardiovascular training, knee and hip progressive resistance training, and neuromuscular training. Feasibility was determined by monitoring adherence to the program, clinical changes in knee function, load progression, and adverse events. Patients were tested before and after completing the rehabilitation program by using patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score, International Knee Documentation Committee Subjective Knee Evaluation Form 2000) and isokinetic muscle strength and hop tests. To monitor adherence, load progression, and adverse events, patients responded to an online survey and kept training diaries. Results The average adherence rate to the rehabilitation program was 83%. Four patients (9%) showed adverse events, as they could not perform the exercises due to pain and effusion. Significant and clinically meaningful improvement was found, based on changes on the International Knee Documentation Committee Subjective Knee Evaluation Form 2000, the Knee injury and Osteoarthritis Outcome Score quality of life subscale, isokinetic muscle strength, and hop performance (P<.05), with small to large effect sizes (standardized response mean, 0.3–1.22). Conclusion The combination of a high adherence rate, clinically meaningful changes, and positive load progression and the occurrence of only a few adverse events support the potential usefulness of this program for patients with knee full-thickness cartilage lesions. This study was registered with the public trial registry Clinical Trials.gov (NCT00885729). Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2013;43(5):310–324. Epub 13 March 2013. doi:10.2519/jospt.2013.4354

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Section: Discussionmentioning

confidence: 99%

Section: T T Conclusionmentioning

confidence: 99%

The Feasibility of a 3-Month Active Rehabilitation Program for Patients With Knee Full-Thickness Articular Cartilage Lesions: The Oslo Cartilage Active Rehabilitation and Education Study

Wondrasch¹,

Årøen²,

Røtterud³

et al. 2013

Journal of Orthopaedic & Sports Physical Therapy

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“…Anwer and collaborator, instead, evaluated the effect of gender on strength gains after a five-week training program that consisted of isometric exercise coupled with electromyographic biofeedback to the quadriceps muscle, concluding that gender did not affect gains in muscle strength; in fact, the 23 female patients with knee OA involved in this clinical trial reported gains in muscle strength with no significant differences compared to male participants [45]. Other authors, such as McKnight et al [46], considered the relative effectiveness of combining self-management and strength training for improving functional outcomes in patients with early knee OA. In their clinical trial, middle-aged adults aged 35 to 64 years with knee OA, pain and self-reported physical disability completed a strength training program, a self-management program or a combined program.…”

Section: Anaerobic Trainingmentioning

confidence: 92%

“…Outcomes included both physical function tests (leg press, range of motion, work capacity, balance and stair climbing) and self-reported measures of pain and disability. These authors highlighted benefits from strength training, self-management and the combination program, suggesting that both strength training and self-management are suitable treatments for the early onset of knee OA, even if self-management alone may offer the least burdensome treatment for early OA [46]. Instead, Knoop and collaborators investigated whether strength training, initially focusing on knee stabilization and subsequently on muscle strength and the performance of daily activities, was more effective than an exercise program focusing on muscle strength and performance of daily activities only, in reducing activity limitations in patients with knee OA and instability of the knee joint.…”

Section: Anaerobic Trainingmentioning

confidence: 99%

Which is the Best Physical Treatment for Osteoarthritis?

Castrogiovanni

Musumeci

2016

JFMK

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Osteoarthritis (OA) is a degenerative disease of the articular cartilage, and it represents one of the most common causes of disability in the world. It leads to social, psychological and economic costs with financial consequences. Different OA treatments are usually considered in relation to the stage of the disease, such as surgical management, pharmacologic and non-pharmacologic treatments. In relation to mild OA, non-pharmacologic and behavioral treatments are recommended because they are less invasive and better tolerated by patients. All of these treatments used to manage OA are problematic, but solutions to these problems are on the horizon. For this reason, we decided to realize this report because until today, there has been very little information regarding the physical treatment of this important disease to help medical doctors and patients in the choice of the best adapted training to manage pain and disability limitations in patients with OA. The aim of this review is to find some answer in the management of OA through physical therapy treatment. In the present review, we analyze data from the most recent literature in relation to the effects of physical exercise on mild OA. All data suggest that training exercise is considered an effective instruments for the treatment of mild OA. The literature search was conducted on PubMed, using appropriate keywords in relation to exercise and osteoarthritis.

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“…4,5 Given that exercise and self-management programs address different aspects of knee oa, it might be supposed that a combined treatment program would be more effective than either alone. surprisingly, however, this hypothesis was not supported by the results of a study by mcKnight et al, 6 in which 273 sedentary individuals aged 35-64 years with early knee oa were enrolled in a strength-training program, a self-management program or a combined program. nonetheless, the study contributes specific new knowledge owing to its focus on younger individuals with early oa, its evaluation of a multimodal treatment program, and its use of a 2-year intervention to determine adherence and long-term outcomes.…”

mentioning

confidence: 92%

Strength training, self-management or both for early knee OA

Bennell

Messier

2010

Nat Rev Rheumatol

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Physical and behavioral interventions have been shown to improve symptoms of advanced knee osteoarthritis, but do middle-aged, sedentary individuals with early-stage disease also benefit from these approaches, either alone or in combination?Knee osteoarthritis (oa) is a common chronic joint disease and a major contributor to long-term disability for which nonpharmacological conservative therapy is the cornerstone of management. exercise improves pain and function, 1 and is recommended by clinical guidelines. 2 there is also increasing emphasis on the use of self-management strategies to improve self-efficacy and empower individuals to become active participants in the management of their condition, 3 although effect sizes for this approach reported in the literature tend to be small. 4,5 Given that exercise and self-management programs address different aspects of knee oa, it might be supposed that a combined treatment program would be more effective than either alone. surprisingly, however, this hypothesis was not supported by the results of a study by mcKnight et al., 6 in which 273 sedentary individuals aged 35-64 years with early knee oa were enrolled in a strength-training program, a self-management program or a combined program. nonetheless, the study contributes specific new knowledge owing to its focus on younger individuals with early oa, its evaluation of a multimodal treatment program, and its use of a 2-year intervention to determine adherence and long-term outcomes.oa research has generally focused on older individuals with advanced disease and greater symptomatic and functional deficits. By contrast, the group included in this study had early knee oa with mild symptoms. interventions that target early-stage disease could be particularly important to limit the progression of symptoms and structural deterioration. However, in this study, neither radiography nor mri were used to determine the effects of the interventions on knee joint structure.all three treatment programs involved an initial 9-month phase of intensive contact followed by a second, 15-month phase during which contact was tapered. the low-to-moderate intensity exercise program targeted muscle strength, balance, range of motion and flexibility, consistent with common clinical practice, with supervised sessions in the first phase and self-directed exercise in the second phase. Given that the participants were healthy, relatively young and had mild symptoms, it is likely that they were capable of undertaking a more-intense program. although the type of exercise does not seem to influence clinical outcome, 1 the effects of exercise intensity have not been well-studied. 7 the self-management program comprised weekly 90-min classroom sessions for 12 weeks, then weekly telephone calls for the duration of the first phase; in the second phase, the phone calls reduced in frequency. the program components included education regarding coping and self-efficacy skills, and general exercise advice. these treatment programs were relatively time-intensi...

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A comparison of strength training, self‐management, and the combination for early osteoarthritis of the knee

Cited by 81 publications

References 28 publications

The Feasibility of a 3-Month Active Rehabilitation Program for Patients With Knee Full-Thickness Articular Cartilage Lesions: The Oslo Cartilage Active Rehabilitation and Education Study

The Feasibility of a 3-Month Active Rehabilitation Program for Patients With Knee Full-Thickness Articular Cartilage Lesions: The Oslo Cartilage Active Rehabilitation and Education Study

Which is the Best Physical Treatment for Osteoarthritis?

Strength training, self-management or both for early knee OA

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