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

Abstract

Background: There is increased interest in proprioceptive training for knee osteoarthritis (KOA). However, little consensus supports the effectiveness of this intervention.Objective: This meta-analysis aimed to assess the effects of proprioceptive training on symptoms, function, and proprioception in people with KOA.Methods: The PubMed, Cochrane Library, Web of Science, and EMBASE databases were systematically searched from the inception dates to April 16, 2021 for relevant randomized controlled trials (RCTs). Data were pooled by calculating the standardized mean differences (SMDs) and 95% confidence intervals (CIs). A random-effects model was used for the analyses.Results: A total of 24 RCTs involving 1,275 participants were included in our analysis. This study indicated that compared to no intervention, proprioceptive training significantly improved pain, stiffness, physical function, joint position sense (JPS), muscle strength, mobility, and knee ROM (P < 0.05) in people with KOA. When compared to other non-proprioceptive training, proprioceptive training provided better results in terms of JPS (SMD = −1.28, 95%CI: [−1.64, −0.92], I2 = 0%, P < 0.00001) and mobility (timed walk over spongy surface) (SMD = −0.76, 95%CI: [−1.33, −0.18], I2 = 64%, P = 0.01), and other results are similar. When proprioceptive training plus other non-proprioceptive training compared to other non-proprioceptive training, the two groups showed similar outcomes, but there was a greater improvement for JPS (SMD = −1.54, 95%CI: [−2.74, −0.34], I2 = 79%, P = 0.01), physical function (SMD = −0.34, 95%CI: [−0.56, −0.12], I2 = 0%, P = 0.003), and knee ROM (P < 0.05) in the proprioceptive training plus other non-proprioceptive training group. When proprioceptive training plus conventional physiotherapy compared against conventional physiotherapy, the two groups demonstrated similar outcomes, but there was a significant improvement for JPS (SMD = −0.95, 95%CI: [−1.73, −0.18], I2 = 78%, P = 0.02) in the proprioceptive training plus conventional physiotherapy group.Conclusions: Proprioceptive training is safe and effective in treating KOA. There is some evidence that proprioceptive training combined with general non-proprioceptive training or conventional physiotherapy appears to be more effective and should be considered as part of the rehabilitation program. However, given that the majority of current studies investigated the short-term effect of these proprioceptive training programs, more large-scale and well-designed studies with long-term follow up are needed to determine the long-term effects of these proprioceptive training regimes in KOA.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/#recordDetails, PROSPERO, identifier: CRD42021240587.

EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update

“…For knee OA, four SRs and five additional RCTs were identified on the exercise26–28 modalities Tai Chi, yoga, stationary cycling, proprioceptive training, weight-bearing and non-weight bearing exercise, and neuromuscular exercise combined with strength training 29–33. Overall, the results showed small to moderate positive effects on pain and function for all these exercise modalities compared with no-exercise control (no intervention, waiting list or non-exercise interventions).…”

Sensorimotor versus core stabilization home exercise programs following total knee arthroplasty: a randomized controlled trial

“…Another study comparing sensorimotor and functional training after TKA found greater improvements in JPS in the sensorimotor group at bilateral extremities [22]. Therefore, these authors recommend SMT incorporating rehabilitation as being clinically effective [7,22,46].…”

“…A recent meta-analysis showed that proprioceptive training is more effective than nonproprioceptive training in improving pain, stiffness, function, muscle strength, and JPS in patients with OA [46]. In addition, sensorimotor home-based exercises have been proven to restore neuromuscular activation and muscle strength [46,47].…”

Pain, quality of life, proprioception and physical function in patient with knee osteoarthritis: Comparison of different grades

“…In contrast, there is evidence to suggest that abnormal foot posture, combined with the onset of KOA, can affect force distribution across the entire lower limb and potentially affect the alignment of the knee joint [39,40]. Therefore, comprehensive foot posture assessment is important to understand the development of KOA and to contribute to the selection of the appropriate intervention method [9]. Several studies have reported a more pronated foot posture in patients with KOA [41,42].…”

“…In people with KOA, activities such as climbing stairs, walking, climbing become difficult over time with poor balance, restriction in range of motion, deformities, damage to joint mechanoreceptors and increased pain [8]. Since proprioception originates from proprioceptors in skeletal muscles, tendons, ligaments and joint capsule, a decrease in proprioceptive sensation can be seen with the progression of KOA, and a decrease in proprioception may be a cause of increased knee pain or activity limitation [9][10][11][12]. There are studies showing significantly higher pain scores, lower quality of life scores, and decreased knee proprioception in KOA compared to healthy individuals [13,14].…”