The effects of neuromuscular exercise programme on pain and physical function in patients with knee osteoarthritis_West China Medical Journal

Authors：

LIANG Qiu , HE Chengqi , JIANG Junliang , YANG Haolun ,  YANG Lin

Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

YANG Lin, Email: 5648197@qq.com

Keywords：

Neuromuscular exercise; Knee osteoarthritis; Function

DOI：

10.7507/1002-0179.201805116

Video：

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Objective To observe and study the effect of neuromuscular exercise (NEMEX) on pain and physical function in patients with knee osteoarthritis (KOA). Methods From December 2016 to December 2017, a total of 70 participants with degenerative KOA were randomly divided into the control group and the observation group, with 35 participants in each group. The participants in the observation group received 8-weeks NEMEX, and the ones in the control group received 8-week quadriceps strengthening. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and the WOMAC physical functional subscale were used to measure pain and physical function before treatment and after 1 week, 2 weeks, 4 weeks, and 8 weeks of treatment. Results The WOMAC pain scores of participants before treatment and after 1 week, 2 weeks, 4 weeks, and 8 weeks of treatment were 24.2±10.0, 23.4±9.1, 18.9±8.2, 15.0±6.3, 15.0±7.0, respectively in the observation group, and 25.6±9.8, 24.1±9.2, 20.2±8.8, 15.2±6.0, 11.4±5.3, respectively in the control group. After 1 week of treatment, neither group showed a significant change in pain than pretreatment (P>0.05), but after 2, 4, 8 weeks of treatment, both groups showed significant improvements in pain (P<0.05). There was no significant between-group difference in pain before treatment or after 1 week, 2 weeks, and 4 weeks of treatment (P>0.05), but after 8 weeks of treatment, statistically significant difference in WOMAC pain score was found between the two groups (t=2.439, P<0.05). The WOMAC physical function scores of participants before treatment and after 1 week, 2 weeks, 4 weeks, and 8 weeks of treatment were 94.3±31.0, 81.8±28.3, 68.9±22.1, 34.0±15.1, 22.0±8.0, respectively in the observation group, and 92.7±31.8, 82.6±29.3, 75.2±22.9, 52.2±20.0, 43.4±18.2 respectively in the control group. After 1 week, 2 weeks, 4 weeks and 8 weeks of treatment, both groups showed significant changes in WOMAC physical function scores than pretreatment (P<0.05). There was no statistically significant between-group difference before treatment or after 1, 2 weeks of treatment in physical function (P>0.05). The functional improvements in the observation group were significantly better than those in the control group after 4 and 8 weeks of treatment, and the differences were statistically significant (t=–4.287, –6.355; P<0.05). Conclusion NEMEX and quadriceps strengthening have similar effects in relieve pain in patients with KOA. And both exercises can effectively improve the physical function, and NEMEX is better than quadriceps strengthening on physical function improvement in patients with KOA.

Citation： LIANG Qiu, HE Chengqi, JIANG Junliang, YANG Haolun, YANG Lin. The effects of neuromuscular exercise programme on pain and physical function in patients with knee osteoarthritis. West China Medical Journal, 2018, 33(10): 1247-1251. doi: 10.7507/1002-0179.201805116 Copy

1.	Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the management of hip and knee osteoarthritis, partⅠ: critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis Cartilage, 2007, 15(9): 981-1000.
2.	Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the management of hip and knee osteoarthritis, PartⅡ: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage, 2008, 16(2): 137-162.
3.	邱貴興. 骨關節炎診治指南//2011 全國骨關節創傷學術研討會論文集. 漳州: 中國骨與關節損傷雜志社, 2011: 1-2.
4.	張聽雨, 白玉龍. 膝骨關節炎及其康復治療. 上海醫藥, 2017, 38(1): 19-24.
5.	Bennell KL, Hunt MA, Wrigley TV, et al. Role of muscle in the genesis and management of knee osteoarthritis. Rheum Dis Clin North Am, 2008, 34(3): 731-754.
6.	Fitzgerald GK, Piva SR, Irrgang JJ. Reports of joint instability in knee osteoarthritis: its prevalence and relationship to physical function. Arthritis Rheum, 2004, 51(6): 941-946.
7.	Ageberg E, Roos EM. Neuromuscular exercise as treatment of degenerative knee disease. Exerc Sport Sci Rev, 2015, 43(1): 14-22.
8.	Williams GN, Chmielewski T, Rudolph K, et al. Dynamic knee stability: current theory and implications for clinicians and scientists. J Orthop Sports Phys Ther, 2001, 31(10): 546-566.
9.	中華醫學會風濕病學分會. 骨關節炎診斷及治療指南. 中華風濕病學雜志, 2010, 14(6): 416-419.
10.	Lim BW, Hinman RS, Wrigley TV, et al. Does knee malalignment mediate the effects of quadriceps strengthening on knee adduction moment, pain, and function in medial knee osteoarthritis? A randomized controlled trial. Arthritis Rheum, 2008, 59(7): 943-951.
11.	Thomeé R. A comprehensive treatment approach for patellofemoral pain syndrome in young women. Phys Ther, 1997, 77(12): 1690-1703.
12.	Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol, 1988, 15(12): 1833-1840.
13.	Hauk L. Treatment of knee osteoarthritis: a clinical practice guideline from the AAOS. Am Fam Physician, 2014, 89(11): 918-920.
14.	Peter WF, Jansen MJ, Hurkmans EJ, et al. Physiotherapy in hip and knee osteoarthritis: development of a practice guideline concerning initial assessment, treatment and evaluation. Acta Reumatol Port, 2011, 36(3): 268-281.
15.	Richmond J, Hunter D, Irrgang J, et al. American academy of orthopaedic surgeons clinical practice guideline on the treatment of osteoarthritis (OA) of the knee. J Bone Joint Surg Am, 2010, 92(4): 990-993.
16.	Juhl C, Christensen R, Roos EM, et al. Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta-regression analysis of randomized controlled trials. Arthritis Rheumatol, 2014, 66(3): 622-636.
17.	Ageberg E, Link A, Roos EM. Feasibility of neuromuscular training in patients with severe hip or knee OA: the individualized goal-based NEMEX-TJR training program. BMC Musculoskelet Disord, 2010, 11(1): 126.
18.	Roos EM, Dahlberg L. Positive effects of moderate exercise on glycosaminoglycan content in knee cartilage: a four-month, randomized, controlled trial in patients at risk of osteoarthritis. Arthritis Rheum, 2005, 52(11): 3507-3514.
19.	Zech A, Hübscher M, Vogt L, et al. Neuromuscular training for rehabilitation of sports injuries: a systematic review. Med Sci Sports Exerc, 2009, 41(10): 1831-1841.
20.	夏傳濤, 余方方, 方華, 等. 西安大略和麥克馬斯特大學骨關節炎指數量表應用于大骨節病的信度和效度評價. 中華地方病學雜志, 2015, 34(4): 274-277.

1. Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the management of hip and knee osteoarthritis, partⅠ: critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis Cartilage, 2007, 15(9): 981-1000.
2. Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the management of hip and knee osteoarthritis, PartⅡ: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage, 2008, 16(2): 137-162.
3. 邱貴興. 骨關節炎診治指南//2011 全國骨關節創傷學術研討會論文集. 漳州: 中國骨與關節損傷雜志社, 2011: 1-2.
4. 張聽雨, 白玉龍. 膝骨關節炎及其康復治療. 上海醫藥, 2017, 38(1): 19-24.
5. Bennell KL, Hunt MA, Wrigley TV, et al. Role of muscle in the genesis and management of knee osteoarthritis. Rheum Dis Clin North Am, 2008, 34(3): 731-754.
6. Fitzgerald GK, Piva SR, Irrgang JJ. Reports of joint instability in knee osteoarthritis: its prevalence and relationship to physical function. Arthritis Rheum, 2004, 51(6): 941-946.
7. Ageberg E, Roos EM. Neuromuscular exercise as treatment of degenerative knee disease. Exerc Sport Sci Rev, 2015, 43(1): 14-22.
8. Williams GN, Chmielewski T, Rudolph K, et al. Dynamic knee stability: current theory and implications for clinicians and scientists. J Orthop Sports Phys Ther, 2001, 31(10): 546-566.
9. 中華醫學會風濕病學分會. 骨關節炎診斷及治療指南. 中華風濕病學雜志, 2010, 14(6): 416-419.
10. Lim BW, Hinman RS, Wrigley TV, et al. Does knee malalignment mediate the effects of quadriceps strengthening on knee adduction moment, pain, and function in medial knee osteoarthritis? A randomized controlled trial. Arthritis Rheum, 2008, 59(7): 943-951.
11. Thomeé R. A comprehensive treatment approach for patellofemoral pain syndrome in young women. Phys Ther, 1997, 77(12): 1690-1703.
12. Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol, 1988, 15(12): 1833-1840.
13. Hauk L. Treatment of knee osteoarthritis: a clinical practice guideline from the AAOS. Am Fam Physician, 2014, 89(11): 918-920.
14. Peter WF, Jansen MJ, Hurkmans EJ, et al. Physiotherapy in hip and knee osteoarthritis: development of a practice guideline concerning initial assessment, treatment and evaluation. Acta Reumatol Port, 2011, 36(3): 268-281.
15. Richmond J, Hunter D, Irrgang J, et al. American academy of orthopaedic surgeons clinical practice guideline on the treatment of osteoarthritis (OA) of the knee. J Bone Joint Surg Am, 2010, 92(4): 990-993.
16. Juhl C, Christensen R, Roos EM, et al. Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta-regression analysis of randomized controlled trials. Arthritis Rheumatol, 2014, 66(3): 622-636.
17. Ageberg E, Link A, Roos EM. Feasibility of neuromuscular training in patients with severe hip or knee OA: the individualized goal-based NEMEX-TJR training program. BMC Musculoskelet Disord, 2010, 11(1): 126.
18. Roos EM, Dahlberg L. Positive effects of moderate exercise on glycosaminoglycan content in knee cartilage: a four-month, randomized, controlled trial in patients at risk of osteoarthritis. Arthritis Rheum, 2005, 52(11): 3507-3514.
19. Zech A, Hübscher M, Vogt L, et al. Neuromuscular training for rehabilitation of sports injuries: a systematic review. Med Sci Sports Exerc, 2009, 41(10): 1831-1841.
20. 夏傳濤, 余方方, 方華, 等. 西安大略和麥克馬斯特大學骨關節炎指數量表應用于大骨節病的信度和效度評價. 中華地方病學雜志, 2015, 34(4): 274-277.

West China Medical Journal

The effects of neuromuscular exercise programme on pain and physical function in patients with knee osteoarthritis

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