Single-centre, uncontrolled before-after study. As a secondary aim, this study will endeavour to determine to what degree any improvements in these factors may be reflected in corresponding improvements in self-reported knee pain, stiffness, and functional limitation. This is the first stage towards determining the effectiveness of such impairment-targeted treatment approaches. In this paper, we present the protocol for a proof-of-principle study (TargET-Knee-Pain) to explore whether, and to what degree, an impairment-targeted approach to home-based exercise prescription can improve quadriceps strength, range of movement at the knee, and balance in older adults with knee pain and OA. But although evidence-based recommendations on rehabilitation interventions recommend strengthening, stretching and functional exercises, such as standing balance, for knee OA, there are currently no published trials that have specifically used an impairment-targeted exercise approach with this population. One approach to doing this is to target exercises at specific and potentially-reversible physical impairments that are common in knee OA and are known to be associated with pain and disability. Instead, the MOVE Consensus has recommended that exercise therapy for OA of the hip or knee should be tailored to the individual patient. One potential reason for this may be that many of these clinical trials have tended to adopt a one-size-fits-all approach, whereby patients receive similar exercise interventions, regardless of the nature of their impairments. However, systematic reviews often show, at best, small to moderate beneficial effects of exercise. Likewise, clinical trials support exercise programmes supervised by physiotherapists, in terms of reduction in knee pain and improvement in function. Clinical guidelines support the overall effectiveness of exercise in knee and hip OA, but highlight the lack of evidence around the practical aspects of exercise delivery, including which exercises work best for whom.
Most patients are managed in primary care, where exercise is considered to be a core first-line treatment. Knee pain, associated with osteoarthritis (OA), is a common disabling problem.
#PHYSIOTOOLS KNEE EXERCISES TRIAL#
Trial registrationĬurrent Controlled Trials ISRCTN61638364. If warranted, future randomised clinical trials may compare this approach with more traditional one-size-fits-all exercise approaches. This study (TargET-Knee-Pain) is the first step towards exploring whether an impairment-targeted approach to exercise prescription for older adults with knee pain may have sufficient efficacy to warrant further testing. Outcome measures will be taken at three time-points (baseline, six weeks and twelve weeks) by a study nurse blinded to the exercise status of the participants. Key secondary outcome measures will be self-reported levels of pain, stiffness and difficulties with day-to-day functional tasks (WOMAC). Primary outcome measures will be isometric quadriceps strength, knee flexion range of motion, timed single-leg standing balance and the "Four Balance Test Scale" at 12 weeks. The exercises will be taught and progressed by an experienced physiotherapist, with reference to a "menu" of agreed exercises for each of the impairments, over the course of six fortnightly home visits, alternating with six fortnightly telephone calls. Each participant will be asked to undertake a programme of exercises, targeted at their particular combination and degree of impairment(s), over the course of twelve weeks.
Participants will all have at least one of the three physical impairments of weak quadriceps, a reduced range of knee flexion and poor standing balance. We aim to recruit 60 participants from an existing observational cohort of community-dwelling older adults with knee pain. It is a first step towards testing the effectiveness of this more individually-tailored approach. This uncontrolled before-after study (TargET-Knee-Pain) aims to test the principle that exercises targeted at the specific physical impairments of older adults with knee pain may be able to significantly improve those impairments. One reason for this might be that clinical trials tend to use a one-size-fits-all approach to exercise, effectively disregarding the details of their participants' clinical presentations. Yet systematic reviews point to only modest benefits from exercise interventions. Exercise therapy for knee pain and osteoarthritis remains a key element of conservative treatment, recommended in clinical guidelines.