Proprioceptive neuromuscular facilitation improves pain and descending mechanics among elderly with knee osteoarthritis

Abstract

Purpose Knee osteoarthritis (KOA) is a common disease that causes pain and limits functionality in the elderly during daily activities, especially during stair descent. Proprioceptive neuromuscular facilitation (PNF) practices promote multiple‐plane joint movements, which relieve pain and increase joint range of motion (ROM). This study aims to examine the effects of a 12‐week PNF intervention on pain relief, passive and active joint ROM, external knee adduction moment (KAM), and hip adduction moment (HAM) in the elderly with KOA during stair descent. Materials and Methods Seventy‐six elderly who were diagnosed with KOA were assessed for eligibility and, 36 of them met the inclusive criteria, were randomly divided into two groups: the twelve‐week PNF intervention group and the control group. Pain score was measured by the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Passive joint ROM was measured using a goniometer. Active joint ROM, KAM, and HAM during stair descent were measured using a motion analysis system with a force platform. All the data were recorded at weeks 0, 6, and 12. Results Compared to the control group, the PNF group showed a decreased pain score; increased passive hip, knee, and ankle ROM; a decreased minimum knee flexion angle, and increased HAM during stair descent. Perspective Proprioceptive neuromuscular facilitation intervention is a successful method to relieve symptoms of KOA. It relieves pain without increasing KAM, enhances passive ROM, increases active knee flexion ROM, and increases HAM during stair descent in the elderly with KOA.

Proprioceptive Training for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…However, except for two (29,38), the remaining studies did not account for "the blinding of the subjects and therapists, " 12 (39, 41, 44, 52, 53, 55, 57-59, 64, 66, 67) of the studies employed assessor blinding. In addition, six of the studies (40,41,43,45,53,61) lost more than 15% participants during follow-up and the inconsistent use of "intention-to-treat" analyses were found to be consistent trial limitations in most of the studies.…”

“…Twenty-four studies involving a total of 1,275 participants with KOA were included. The studies were from Brazil (52), Turkey (60,64,66,69), Australia (58), Canada (59), Thailand (62), Egypt (55,65), Iran (44), Malaysia (63), the United States (40,41,61), India (39,43,54,68), and China (45,53,56,57,67). The publication intervals of 24 included articles were from 2005 to 2020, and the sample size ranging from 15 to 183 participants.…”

“…Nine studies (40,44,45,53,57,58,61,66,69) used the WOMAC pain subscale to assess pain. Subgroup analysis showed significant improvement in pain for proprioceptive training compared to no intervention (SMD = −1.07, 95%CI: [−1.46, −0.68], I 2 = 0%, P < 0.00001).…”

“…Only eight studies (41,45,52,56,58,59,64,66) reported safety-related data, however some trials stated that no adverse events were reported (41,64,66), no serious adverse events during the intervention occurred (58). In addition, from another four studies (45,52,56,58) that provided data (n = 210), 12 participants (5.7%) reported adverse events, including postexercise soreness, back pain, hip soreness, foot pain, and ankle injury.…”

“…Besides, these two reviews did not assess the safety of proprioceptive training and investigate the effects of combinations of proprioceptive training with other interventions in KOA. Our interest in updating the current evidence has increased as the numerous renewals of high-quality studies on proprioceptive training in treating KOA (43)(44)(45). Therefore, we conducted this study to summarize all current high-quality evidence on the clinical efficacy and safety of proprioceptive training for KOA, and to provide a quantitative assessment.…”