OBJECTIVE: To investigate the effect of a 12-week exercise-based physical therapy on movement-evoked pain (MEP) in knee osteoarthritis (OA) and assess the relations between baseline psychological factors and treatment responses based on MEP. BACKGROUND: Pain during movement (i.e., MEP) is one of the most common complaints amongst people with knee OA, which induces greater functional challenges during daily activities. Although the worsening of pain during exercise appears to hinder activity-based treatment adherence, the assessments of MEP tend to be overlooked in the pain management in knee OA. METHODS: The data analyzed in this study was from the parent study, Wearable Sensors in Knee Osteoarthritis (WESENS-OA) study, a longitudinal, single-arm clinical trial of a 12-week exercise intervention in people with symptomatic knee OA. In the WESENS-OA (n = 60), participants self-reported pain intensity during the nominated activity as well as psychological symptoms (Center for Epidemiologic Studies Depression Scale), cognitive pattern (Pain Catastrophizing Scale), and central sensitization (Central Sensitization Inventory). Pain intensity during functional tasks and strength testing were collected during the laboratory visits. Three characteristics of MEP outcomes were assessed: (1) pain during the nominated activity, (2) functional MEP, and (3) exercise MEP. The participants reported the pain intensity during the nominated activity that is most troublesome due to their knee pain weekly using the 11-point numerical rating scale (NRS, range: 0-10). Pain intensity during or immediately after functional tasks (i.e., 6-minute walking, chair stand, climbing the staircase, range: 0-10) and strength testing (i.e., maximal voluntary isometric contractions of knee extensors and flexors, isokinetic knee flexion-extension at 60°/s and 120°/s each, range: 0-10) were evaluated to measure functional MEP or exercise MEP, respectively. MEP index score (i.e., maximum pain corrected for baseline pain) was reported as the outcome. Mixed model repeated measures (MMRM) analysis was utilized to evaluate the effect of an exercise intervention on the change in movement-evoked pain from baseline to 12 weeks, and least square means with the standard error were reported simultaneously. Each participant’s treatment response was determined by comparing the change in MEP from baseline to Week 12. A participant with a difference of ≥ 2 points in NRS for pain-nominated activity was classified as a responder, and for functional MEP and exercise MEP, treatment responder classification was done based on the hierarchical agglomerative clustering analysis. After dichotomizing participants, using binomial regression, the relative risk (RR) was reported to explore the predictive ability of CSI, CES-D, and PCS on treatment response based on MEP. RESULTS: For pain during nominated activity, the mean difference (MD) from baseline to Week 6 was -1.72 with 95% CI (-2.35 to -1.08; P <0.0001), and the difference at Week 12 was -2.41 with 95% CI (-2.92 to -1.89; P <0.0001). For functional MEP, MD with 95% CI at Week 6 was -0.34 (-0.52 to -0.16; P = 0.0003), and at Week 12 was -0.44 (-0.58 to -0.31; P<0.0001). Unlike the other MEP measures, for exercise MEP, MD was measured at one timepoint, at Week 12, which was -0.58 with 95% CI (-0.88 to -0.27; P = 0.003). Our secondary analysis did not provide evidence that baseline measures of CSI, CES-D, and PCS were associated with the treatment response based on the change in MEP measures after the exercise intervention. CONCLUSION: In conclusion, our study strongly supports the effect of exercise on reduction in three measures of MEP—pain during nominated activity, functional MEP, and exercise MEP. Our hypothesis to confirm the predictive ability of psychological factors on treatment response based on MEP was not reached, with insufficient evidence to substantiate such a notion. However, our findings hold strength to pioneer discovering the underlying mechanism of understudied MEP in knee OA. / 2026-02-28T00:00:00Z

Background: Osteoarthritis (OA) is a common degenerative disease in elderly people, OA of the knee (KOA) makes up for a big part of all OA cases. Common KOA inconveniences are joint stiffness, pain and loss of muscle strength, which can have a negative impact on the quality of life. The OA process affects the kinematics of the knee joint and increases joint laxity, an impairment which can create more damage to the knee joint. Conservative treatment including exercise is the first option of choice in rehabilitation. Manual joint mobilization is another common treatment method which has effect on function and pain in patients with KOA. One muscle located in the hollow of the knee is the popliteal muscle and its function is to internally rotate the tibia, flex the knee joint and reduce ventral translation of the tibia; popliteal activity aims to maintain proper knee kinematics. Purpose: To investigate what effect myofascial release and exercise for the popliteus muscle have regarding pain, function and health related quality of life in people suffering from KOA. Method: A single subject experimental design study consisting of three participants with KOA was performed. The study started with a baseline phase measurement where the participants answered questionnaires about their pain, function and quality of life, followed by the intervention phase consisting of myofascial release (MFR) and exercise for the popliteal muscle. Result: There was not any concordant results for any of the outcome measurements even though each participant had positive changes in one or more of the different measurements mainly regarding pain, function in daily living or quality of life (QoL). Conclusion: MFR and exercise for the popliteus muscle might be effective as a treatment for people with KOA related inconveniences regarding mainly pain, function in daily living and QoL. Key words: Knee osteoarthritis, myofascial release, exercise, popliteus muscle.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第25001号 / 医博第5035号 / 新制||医||1070(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 近藤 尚己, 教授 古川 壽亮, 教授 森田 智視 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Yes / When lying supine, due to the reaction force from the mattress acting mostly through the heel, an external knee-extension joint-torque is induced that keeps the knee fully extended. This torque becomes zero if the feet are hung over the end of the support. This study investigated, in patients with knee-osteoarthritis (knee-OA) who routinely sleep supine, whether a change to such a sleeping position would ameliorate the knee pain and associated physical problems they suffer. Patients were recruited (General-Practitioners Centre, UK) over a 9-month period; those eligible (51/70) were randomly allocated to an intervention (65% female; age 71.5 [11.3] yrs; BMI, 29.20 [5.54] kg/m2; knee-OA severity, 20 mild–mod/3 severe) or control group (63% female; age, 68.3 [9.7] yrs; BMI, 28.69 [5.51] kg/m2; knee-OA severity, 17 mild–mod/2 severe). The primary outcome was improvements (0 [worst] to 100 [best]) in knee pain at 3 months and was rated in the Knee-Injury-and-Osteoarthritis-Outcome-Score questionnaire (KOOS). Secondary outcomes were improvements (0–100) in the other four KOOS-subscales. There were no differences between groups in KOOS outcomes at baseline, and there were no changes in KOOS outcomes in the control group at 3 months. Relative to the baseline KOOS values in Knee-Pain (50.1), Symptoms (52.5), Activities-of-Daily-Living (53.8) and Quality-of-Life (31.5), were all seen to improve at 3 months in the intervention group (by between 11.9 and 12.9); however, when comparing to controls, only the improvements in the subscale Activities-of-Daily-Living (which improved by 12.2) were statistically significant. Findings indicate that for those with knee-OA who routinely sleep supine, sleeping with the feet over the end of the mattress (to prevent the knee being pushed into/held in full extension) can help ameliorate the physical problems they suffer.

© [2015] American Physical Therapy Association. / 京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第19641号 / 人健博第33号 / 新制||人健||3(附属図書館) / 32677 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 市橋 則明, 教授 山田 重人, 教授 妻木 範行 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Objetivo: verificar os efeitos de intervenções fisioterapêuticas, laser de baixa potência (LBP) e exercícios físicos (EF), de forma associada ou isolada, na osteoartrite de joelhos (OAJ). Método: Ensaio clínico randomizado, controlado, cego. Participaram da pesquisa 60 indivíduos de ambos os sexos, idade entre 45 e 75 anos, com diagnóstico radiográfico de OAJ graus 1 a 3, os quais foram randomizados em quatro grupos: 1) Grupo controle (GC, n=15): pacientes com OAJ e sem tratamento; 2) Grupo laser (GL, n=15): pacientes com OAJ e tratados com LBP (808nm, 5,6J); 3) Grupo exercício (GE, n=15): pacientes com OAJ e tratados com EF; 4) Grupo laser e exercício (GLE, n=15): pacientes com OAJ e tratados com LBP e EF. As avaliações foram realizadas no Laboratório de Avaliação e Reabilitação do Equilíbrio, no início e após dois meses, incluindo o questionário WOMAC (dor, rigidez e função física); avaliação das variáveis espaço-temporais da marcha pelo equipamento GAITRite; avaliação do torque dos músculos extensores de joelho pelo dinamômetro isocinético Biodex e a funcionalidade (teste de transpor degrau e teste de levantar-se de uma cadeira) pelo equipamento Balance Master. O tratamento foi realizado durante dois meses, 2x por semana. Na análise estatística foi utilizado o teste de Wilcoxon (dados não paramétricos) e o teste Anova Two Way seguido do teste post hoc de Tukey (dados paramétricos), com nível de significância de 5%, usando o software SPSS. Resultados: no questionário WOMAC, houve diferença apenas na comparação pré e após 2 meses (intragrupo) para o GE nas variáveis: dor (p=0,006), função (p=0,01) e na pontuação total do WOMAC (p=0,01). Na marcha, na análise intragrupo, os grupos que receberam intervenção (GL, GE e GLE) apresentaram redução significativa apenas na duração da fase de apoio direito (p=0,014; p=0,011; p=0,035, respectivamente). Na avaliação intergrupo, ocorreu um aumento significativo na velocidade da marcha dos grupos que receberam intervenção (GL, GE e GLE) comparado ao GC (p=0,03; p=0,04 e p=0,005 respectivamente), na cadência ocorreu aumento apenas no GLE em comparação ao GC (0,009). Ainda na avaliação intergrupo, na duração da fase de apoio direito, os grupos GE (p=0,035) e GLE (p=0,003) apresentaram diminuição significativa em relação ao GC e na duração da fase de apoio único direito, apenas o GLE apresentou aumento significativo (p=0,04) em relação ao GC. Na análise isocinética do torque dos extensores de joelho, apenas na avaliação intergrupo após 2 meses, o membro inferior esquerdo apresentou aumento significativo nos grupos GE (p=0,03) e GLE (p=0,04) em relação ao GC. Na avaliação intragrupo da funcionalidade, apresentaram diminuição significativa (p=0,04) apenas o GLE no teste de transpor degrau (variável: tempo de movimento do membro direito) e apenas o GE (p=0,04) no teste de levantar-se da posição sentada (variável: tempo de transferência do movimento). Conclusão: de uma maneira geral, os grupos: GE e GLE apresentaram mais benefícios quando comparados aos grupos GC e GL, o que sugere que o EF deve ser incluído no tratamento da OAJ, podendo ser acrescido do LBP. / Objective: To verify the effects of physical therapy interventions, low level laser therapy (LLLT) and physical exercises (PE), in an associated or isolated way, on knee osteoarthritis (KOA). Method: Randomized, controlled and blind clinical trial. Sixty individuals, both sexes, aged 45 to 75 years, with radiographic diagnosis of KOA, grades 1 to 3, were randomly assigned into four groups: 1) Control group (CG, n=15): patients with KOA, without treatment; 2) Laser group (LG, n=15): patients with KOA, treated with LLLT (808nm, 5.6J); 3) Exercise group (EG, n=15): patients with KOA, treated with PE; 4) Laser and Exercise group (LEG, n=15): patients with KOA, treated with LLLT and PE. The evaluations were performed at Laboratory of Assessment and Rehabilitation of Equilibrium, in the beginning and after 2 months, including the WOMAC questionnaire (pain, stiffness and physical function); evaluation of spatiotemporal gait variables was performed on GAITRite equipment; evaluation of knee extensor muscle torque using the Biodex isokinetic dynamometer and the functionality (step up/over and sit-to-stand test) through the Balance Master equipment. The treatment was performed for 2 months, twice a week. In the statistical analysis, Wilcoxon test (non-parametric data), and Anova Two Way followed Tukey\'s post hoc test (parametric data) were used, with significance level of 5%, using SPSS software. Results: in the WOMAC questionnaire, mean difference only in the comparison intragroup for the EG in the variables: pain (p=0.006), physical function (p=0.01) and total WOMAC (p=0.01). Regarding gait variables, in the intragroup analysis, the only variable that presented a significant difference was the duration of the right support phase, and the LG, EG and LEG had a significant decrease in this variable (p=0.014, p=0.011, p=0.035, respectively) in relation to the pre-treatment period. In the intergroup evaluation, a significant increase in gait speed occurred in the groups: GL, GE and GLE compared to the CG (p=0.03, p=0.04 and p=0.005, respectively). In the cadence there was a significant increase only in the LEG compared to the CG (0.009). In the duration of the right support phase, the GE and GLE groups presented a significant decrease (p=0.035 and p=0.003, respectively) in relation to the CG. In the analysis of the duration of single right limb support, only the LEG presented a significant increase (p=0.04) in relation to the CG. In the isokinetic analysis of the torque of knee extensors, only in the intergroup evaluation after 2 months, the left lower limb presented significant increase in the EG (p=0.03) and LEG (p=0.04) groups in relation to the CG. In the step up/over test, in the intragroup evaluation, only the LEG showed a significant decrease (p=0.04) in the transfer time variable in the intragroup comparison. In the sit-to-stand test, in the variable of time of transfer, only the EG showed a significant decrease (p=0.04) in the intragroup comparison. Conclusion: in general, the groups: EG and LEG presented more benefits when compared to the GC and GL groups, this suggests that EF should be included in the treatment of KOA, and may be added to LLLT.

A dor crônica de joelho secundária a osteoartrite é uma patologia comum com a progressão da idade e que vem aumentando sua prevalência a medida que se elevam a expectativa de vida e os índices de obesidade e sobrepeso. A consequência desses sintomas se reflete de maneira direta sobre a capacidade de realização de atividades diárias, a qualidade do sono e a capacidade laboral do indivíduo. O impacto psicológico, social e econômico da dor crônica de joelho representam um desafio de saúde pública, demandando tratamento eficiente e custo-efetivo. As terapias farmacológicas com frequência apresentam benefício limitado associado a diversos efeitos colaterais. Os procedimentos invasivos não cirúrgicos, como a injeção intraarticular de ácido hialurônico, representam uma alternativa em casos refratários ao tratamento clínico, sendo utilizados como terapia complementar, entretanto apresentam benefício limitado e insuficiente para o controle da dor em casos severos. Os procedimentos cirúrgicos, como a artroplastia total do joelho, habitualmente apresentam resultados satisfatórios na doença avançada, contudo são limitadas pelo seu alto custo, risco cirúrgico inerente e pequena capacidade resolutiva diante da alta prevalência. O bloqueio dos nervos geniculados é uma técnica recentemente descrita, de fácil realização e com mínima invasão necessitando ser estudada para que possa ser aplicada no manejo clínico. Neste estudo foram selecionados pacientes com osteoartrite moderada e severa, que apresentavam dor refratária ao tratamento clínico otimizado. Foram selecionados 16 pacientes e um total de 22 joelhos foram avaliados. Inicialmente todos os pacientes foram submetidos a um pré-teste que avaliava: 1) a intensidade da dor; 2) a qualidade do sono; 3) a capacidade de realização de atividades diárias. Aleatoriamente 2 grupos foram formados, o primeiro submetido ao bloqueio intra-articular e o segundo ao bloqueio dos nervos geniculados. A solução formada por: lidocaína 1% sem vasoconstrictor - 9 mL - 90 mg adicionada de Dexametasona - 1mL - 10 mg era padrão e utilizada nos dois grupos de intervenção. Após um seguimento semanal por 12 semanas consecutivas, os paciente foram reconvocados e submetidos ao outro procedimento proposto, dessa forma todos os pacientes atuaram como o seu próprio controle (desenho de estudo \"crossover\"). Nos seguimentos semanais, assim como no pré-teste, eram avaliados a intensidade da dor, a qualidade do sono e a capacidade de realização de atividades diárias. Os resultados mostraram que o bloqueio intra-articular e o bloqueio dos nervos geniculados apresentam redução importante da dor (p < 0,01), melhora na capacidade de realização de atividades diárias (p < 0,01) e melhora na qualidade do sono (p < 0,01), no entanto não houve diferença significativa no resultado entre os grupos estudados (p > 0,05). Conclui-se que o bloqueio dos nervos geniculados surge como uma alternativa segura, minimamente invasiva e de alta eficácia, apresentando resultados semelhantes ao bloqueio intra-articular. / Chronic pain of the knee secondary to osteoarthritis is a common pathology, progressive with age and which increases its prevalence as life expectancy is raised together with obesity and overweight. A consequence of these symptoms is reflected directly on the capacity of undertaking daily activities, the quality of sleep and the work capacity of each individual. The psychological, social and economic impact of chronic knee pain represents a challenge to public health, demanding efficient treatment at a worthwhile cost. Pharmaceutical therapies frequently present a limited benefit associated with various side effects. Non-surgical invasive procedures such as an injection intra-articular of hyaluronic acid, represents an alternative in refractory cases to clinical treatment, being used as a complementary therapy, however, presenting limited and insufficient benefit for the control of pain in severe cases. Surgical procedures such as complete arthroplasty of the knee, usually presents satisfactory results in patients with an advanced osteoarthritis, but are limited by their high cost, inherent surgical risk and small resolving capability facing a high prevalence. Blocking the genicular nerves is a recently described technique, easily applied by clinical management. Patients were selected in this study with moderate and severe osteoarthritis, with refractory pain in optimized clinical treatment. 16 patients were selected and a total of 22 knees were evaluated. Initially all the patients were submitted to a pre-test which evaluated: 1) the intensity of pain; 2) the quality of sleep; 3) the capacity to undertake daily activities. Two groups were formed randomly, the first submitted to intra-articular blocking and the second to blocking the genicular nerves. A solution of lidocaine 1% without a vasoconstrictor - 9 mL - 90 mg and Dexametasona - 1 mL - 10 mg was standard and used for intervention in both groups. After a weekly appraisal for 12 consecutive weeks, the patients were recalled and submitted to another proposed procedure and in this way all the patients acted as their own control (a \"crossover\" study design). In the following weeks, as also in the pretest, the intensity of pain, the quality of sleep and the capacity of undertaking daily activities were evaluated. The results showed that the intra-articular block and the blocking of the genicular nerves presented an important reduction of pain (p<0,01) but there was no significant difference in the result between the groups studied (p>0,05). It is therefore concluded that the blocking of the genicular nerves appears as a safe alternative, minimally invasive and highly efficient, presenting results similar to the intra-articular blocking.

Osteoarthritis (OA) of the knee is a disease that deteriorates the bones and surrounding soft tissue of the affected joint. Categorisation of the disease into grades of severity is subject to errors of measurement and poor observer agreement. There is an urgent need for automated methods to measure radiographic features and remove, as far as possible, the element of subjectivity in assessment. This project creates a fully automated system to analyse all aspects of the knee in radiographs. The methods evaluate explicit and implicit features of: overall shape, trabecular structure, osteophytes, tibial spines and intercondylar notch, and joint space shape. The project develops the first fully automated osteophyte detection algorithms, improved trabeculae features using raw pixel intensities, and a better analysis of joint space using shape models. This project is the first to combine explicit and implicit features across the whole of the knee, and applies these features to classify radiographs using four main outcomes: current OA, current pain, later onset OA, and later onset pain. The results find a strong current OA classification rate, with an Area Under the ROC Curve (AUC) of 0.904 and weighted kappa of 0.49 (0.48-0.51). The remaining later onset and pain experiments report weaker results; these results suggest that radiographic features in Posterior-Anterior (PA) view radiographs have a weak association with clinical and later onset OA.

Tyrimo problema: sergant kelio sąnario osteoartritu atsiranda skausmas, apsunkinama kasdieninė veikla, trinka pusiausvyra, padidėja griuvimo rizika. Siekiant pagerinti pusiausvyrą ir sumažinti griuvimų riziką, analizavome kaip įvairios kineziterapijos programos veikia pagyvenusių žmonių, sergančių kelio sąnario osteoartritu, šlaunies raumenų jėgą, statinę ir dinaminę pusiausvyrą bei skausmą. Tyrimo objektas: pusiausvyros, raumenų jėgos ir skausmo pokyčiai taikant skirtingas kineziterapijos programas. Tyrimo tikslas: nustatyti skirtingų kineziterapijos programų poveikį ligoniams sergantiems kelio sąnario osteoartritu. Tyrimo uždaviniai: 1. Nustatyti pusiausvyros kaitą taikant sąnarių mobilizaciją, TENS ir fizinius pratimus. 2. Nustatyti šlaunies raumenų jėgos kaitą taikant sąnarių mobilizaciją, TENS ir fizinius pratimus. 3. Nustatyti pusiausvyros kaitą taikant tik TENS ir fizinius pratimus. 4. Nustatyti šlaunies raumenų jėgos kaitą taikant tik TENS ir fizinius pratimus. 5. Įvertinti skirtingų kineziterapijos programų efektyvumą. Tyrimo hipotezė: manome, kad didžiausią teigiamą poveikį pusiausvyros, šlaunies raumenų jėgos ir skausmo kaitai turi ankstyvas sąnarių mobilizacijos, TENS bei fizinių pratimų taikymas. Taikant minėtus metodus atskirai, poveikis pusiausvyrai, šlaunies raumenų jėgai ir skausmui turėtų būti mažesnis arba visai nepasireikšti. Tyrimo metodai ir organizavimas: tyrimas atliktas VšĮ Kauno slaugos ligoninėje 2005-2007 metais. Tyrime dalyvavo asmenys, sergantys... [toliau žr. visą tekstą] / Problem of study: osteoarthritis of knee joint causes pain, aggravates everyday activities, disconcerts balance, and increases the risk of fall. Aiming to improve balance and to decrease the risk of falls, we analyzed how various programs of physiotherapy influence the strength of thigh muscles, static and dynamic balance, and pain of elderly with knee osteoarthritis. Object of study: changes of balance, muscle strength and pain after application of various programs of physiotherapy. Aim of study: to determine the impact of various physiotherapy programs to the patients with knee osteoarthritis. Goals of study: 1. To determine the change in balance, when the joint mobilization, TENS and physical exercises are applied. 2. To determine the change in the thigh muscles strength, when the joint mobilization, TENS and physical exercises are applied. 3. To determine the change in balance, when TENS and physical exercises alone are applied. 4. To determine the range of thigh muscles strength, when TENS and physical exercises alone are applied. 5. To evaluate effectiveness of various physiotherapy programs Hypothesis of study: we believe that the biggest positive impact on the change of balance, strength of thigh muscles and pain has the combination of early joint mobilization, TENS and physical exercises. While applying all those methods separately, the impact on the change of balance, strength of thigh muscles and pain is lesser or even doesn’t emerge. Methods and organization of... [to full text]

Obesity is a highly cited risk factor for knee osteoarthritis (OA) associated with increased risk of development of OA and accelerated disease progression. Rates of obesity are increasing internationally, and while obesity is well established as a risk factor, the precise role of obesity in knee OA pathogenesis and progression is not as clearly understood. Mechanical loading has been implicated as an important factor in knee OA initiation and progression. The purpose of this thesis was to further examine the roles of moderate knee OA disease presence and obesity on knee joint mechanics during gait, and to characterize their mechanical interaction. Two methods have been applied. First, principal component analysis has been applied to resultant waveforms from gait analysis and second, a sagittal plane joint contact force model has been applied. Using both methods, statistical differences in biomechanical loading has been associated with obesity, moderate knee OA, and their interaction.