Effect of eccentric isokinetic strengthening in the rehabilitation of patients with knee osteoarthritis: Isogo, a randomized trial

Trials

Emmanuel Coudeyre¹  Nicolas Andant²  Bruno Pereira²  Anne-Gaëlle Jegu¹ 

[1] Service de Médecine Physique et de Réadaptation, Clermont University, Université d’Auvergne, F-63000 Clermont-Ferrand; CHU Clermont-Ferrand, 58, rue de Montalembert, Clermont-Ferrand F-63000, France;CHU Clermont-Ferrand, Biostatistics Unit, Délégation Recherche Clinique & Innovation (DRCI), Villa annexe IFSI, Clermont-Ferrand F-63003, France

关键词: rehabilitation;    knee osteoarthritis;    isokinetic;    strength;    Eccentric;   

Others  :  807099
DOI  :  10.1186/1745-6215-15-106

 received in 2013-08-30, accepted in 2014-03-20,  发布年份 2014

【 摘 要 】

Background

Femorotibial knee osteoarthritis is associated with muscle weakness in the lower limbs, particularly in the quadriceps, which results in disease progression. The interest of having muscular strengthening as part of the therapeutic arsenal for the medical treatment of knee osteoarthritis is now well established.

The functional disability induced by knee osteoarthritis manifests itself principally when walking, notably downhill, during which the muscles are called upon to contract eccentrically.

We can therefore think that eccentric muscular strengthening could bring a functional benefit that is superior to concentric muscular strengthening.

Methods/Design

This is a prospective, randomized, bicenter, parallel-group, international study. Eighty patients aged from 40 to 75 years old, suffering from medical-stage knee osteoarthritis, will undertake 6 weeks of isokinetic muscular strengthening. Randomization determines the mode of muscular strengthening: either exclusively eccentric or exclusively concentric.

The principal objective is to demonstrate the superiority of the improvement in the quadriceps isokinetic torque after isokinetic muscular strengthening by the eccentric mode compared to the concentric mode.

The following parameters are also evaluated: the variations in the level of pain, the parameters of walking (maximum speed over 10 and 200 meters, analysis on a computerized Gaitrite™ treadmill), static equilibrium (on a FUSYO™ force platform), and the functional status of the patient using the Western Ontario and MacMaster Universities osteoarthritis index (WOMAC) questionnaire after the strengthening period and at 6 months.

Discussion

A better knowledge of the most effective mode of muscular strengthening is needed to optimize the functional benefits to the patients. In case of superiority in terms of efficacy of the eccentric mode, the latter could be given priority in the rehabilitation treatment of knee osteoarthritis patients.

Trial registration

Clinical trials.gov number: NCT01586130.

【 授权许可】

   
2014 Jegu et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Woolf AD, Pfleger B: Burden of major musculoskeletal conditions. Bull World Health Organ 2003, 81:646-656.
• [2]Le Pen C, Reygrobellet C, Gérentes I: Financial cost of osteoarthritis in France. The “COART” France study. Joint Bone Spine 2005, 72:567-570.
• [3]Fernandes L, Hagen KB, Bijlsma JWJ, Andreassen O, Christensen P, Conaghan PG, Doherty M, Geenen R, Hammond A, Kjeken I, Lohmander LS, Lund H, Mallen CD, Nava T, Oliver S, Pavelka K, Pitsillidou I, da Silva JA, de la Torre J, Zanoli G, Vliet Vlieland TP, European League against Rheumatism (EULAR): EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis 2013, 72:1125-1135.
• [4]Lankhorst GJ, Van de Stadt RJ, Van der Korst JK: The relationships of functional capacity, pain, and isometric and isokinetic torque in osteoarthrosis of the knee. Scand J Rehabil Med 1985, 17:167-172.
• [5]Hurley MV, Newham DJ: The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early. Unilateral osteoarthritic knees. Rheumatology 1993, 32:127-131.
• [6]Slemenda C, Heilman DK, Brandt KD, Katz BP, Mazzuca SA, Braunstein EM, Byrd D: Reduced quadriceps strength relative to body weight: a risk factor for knee osteoarthritis in women? Arthritis Rheum 1998, 41:1951-1959.
• [7]O’Reilly SC, Jones A, Muir KR, Doherty M: Quadriceps weakness in knee osteoarthritis: the effect on pain and disability. Ann Rheum Dis 1998, 57:588-594.
• [8]Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P: OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 2008, 16:137-162.
• [9]Huang M-H, Lin Y-S, Yang R-C, Lee C-L: A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis. Semin Arthritis Rheum 2003, 32:398-406.
• [10]Tüzun EH, Aytar A, Eker L, Daşkapan A: Effectiveness of two different physical therapy programmes in the treatment of knee osteoarthritis. Pain Clin 2004, 16:379-387.
• [11]Elliott J: Assessing muscle strength isokinetically. JAMA 1978, 240:2408-2410.
• [12]LaStayo PC, Woolf JM, Lewek MD, Snyder-Mackler L, Reich T, Lindstedt SL: Eccentric muscle contractions: their contribution to injury, prevention, rehabilitation, and sport. J Orthop Sports Phys Ther 2003, 33:557-571.
• [13]Gür H, Cakin N, Akova B, Okay E, Küçükoğlu S: Concentric versus combined concentric-eccentric isokinetic training: effects on functional capacity and symptoms in patients with osteoarthrosis of the knee. Arch Phys Med Rehabil 2002, 83:308-316.
• [14]Yu J, Park D, Lee G: Effect of eccentric strengthening on pain, muscle strength, endurance, and functional fitness factors in male patients with achilles tendinopathy. Am J Phys Med Rehabil 2013, 92:68-76.
• [15]Rochcongar P: Évaluation isocinétique des extenseurs et fléchisseurs du genou en médecine du sport: revue de la littérature. Ann Readapt Med Phys 2004, 47:274-281.
• [16]Sekiya N, Nagasaki H, Ito H, Furuna T: Optimal walking in terms of variability in step length. J Orthop Sports Phys Ther 1997, 26:266-272.
• [17]AFP: Normes 85. 66, rue de Lisbonne 75008. Paris: Association Posture et Équilibre; 1985.
• [18]Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW: 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, 15:1833-1840.
• [19]Verbeke G, Molenberghs G: Linear Mixed Models for Longitudinal Data. New York: Springer; 2009.
• [20]Verbeke G, Molenberghs G: Linear Mixed Models for Longitudinal Data. 2nd edition. Springer Series in Statistics; 2009.
• [21]Beunckens C, Molenberghs G, Verbeke G, Mallinckrodt C: A latent-class mixture model for incomplete longitudinal Gaussian data. Biometrics 2008, 64:96-105.
• [22]Bennell KL, Hunt MA, Wrigley TV, Lim B-W, Hinman RS: Muscle and Exercise in the Prevention and Management of Knee Osteoarthritis: an Internal Medicine Specialist’s Guide. Med Clin North Am 2009, 93:161-177.
• [23]Lange AK, Vanwanseele B, Fiatarone Singh MA: Strength training for treatment of osteoarthritis of the knee: a systematic review. Arthritis Rheum 2008, 59:1488-1494.
• [24]Noorizadeh Dehkordi S, Talebian S, Olyaei G, Montazeri A: Reliability of isokinetic normalized peak torque assessments for knee muscles in post-stroke hemiparesis. Gait Posture 2008, 27:715-718.
• [25]Pipes TV, Wilmore JH: Isokinetic vs isotonic strength training in adult men. Med Sci Sports 1975, 7:262-274.
• [26]Isner-Horobeti M-E, Dufour SP, Vautravers P, Geny B, Coudeyre E, Richard R: Eccentric exercise training: modalities, applications and perspectives. Sports Med 2013, 43:483-512.