Effects of neuromuscular training (NEMEX-TJR) on patient-reported outcomes and physical function in severe primary hip or knee osteoarthritis: a controlled before-and-after study

Abstract

BackgroundThe benefits of exercise in mild and moderate knee or hip osteoarthritis (OA) are apparent, but the evidence in severe OA is less clear. We recently reported that neuromuscular training was well tolerated and feasible in patients with severe primary hip or knee OA. The aims of this controlled before-and-after study were to compare baseline status to an age-matched population-based reference group and to examine the effects of neuromuscular training on patient-reported outcomes and physical function in patients with severe primary OA of the hip or knee.Methods87 patients (60–77 years) with severe primary OA of the hip (n = 38, 55% women) or knee (n = 49, 59% women) awaiting total joint replacement (TJR) had supervised, neuromuscular training (NEMEX-TJR) in groups with individualized level and progression of training. A reference group (n = 43, 53% women) was included for comparison with patients’ data. Assessments included self-reported outcomes (HOOS/KOOS) and measures of physical function (chair stands, number of knee bends/30 sec, knee extensor strength, 20-meter walk test) at baseline and at follow-up before TJR. Analysis of covariance (ANCOVA) was used for comparing patients and references and elucidating influence of demographic factors on change. The paired t-test was used for comparisons within groups.ResultsAt baseline, patients reported worse scores than the references in all HOOS/KOOS subscales (hip 27–47%, knee 14–52%, of reference scores, respectively) and had functional limitations (hip 72–85%, knee 42–85%, of references scores, respectively). NEMEX-TJR (mean 12 weeks (SD 5.6) of training) improved self-reported outcomes (hip 9–29%, knee 7–20%) and physical function (hip 3–18%, knee 5–19%) (p < 0.005). Between 42% and 62% of hip OA patients, and 39% and 61% of knee OA patients, displayed a clinically meaningful improvement (≥15%) in HOOS/KOOS subscales by training. The improvement in HOOS/KOOS subscale ADL was greater for patients with knee OA than hip OA, while the improvement in subscale Sport/Rec was greater for patients with hip OA than knee OA.ConclusionsBoth self-reported outcomes and physical function were clearly worse compared with the reference group. Neuromuscular training with an individualized approach and gradual progression showed promise for improving patient-reported outcomes and physical function even in older patients with severe primary OA of the hip or knee.

Strategies for the prevention of knee osteoarthritis

“…71 Neuromuscular exercise therapy, like aerobic exercise and strength training, also provides effective pain relief in individuals with established OA. [72][73][74] The first neuromuscular exercise program developed for use in patients with OA was published in 2010. 75 Meta-analyses of the effectiveness of neuromuscular exercise should include consideration of additional outcomes such as perceived instability, tendency to give way, confidence in the knee and biomechanical outcomes.…”

Identifying yoga-based knee strengthening exercises using the knee adduction moment

“…While exercise programs may not alter external KAMs Williams et al, 2010), strengthening programs improve peak torque generation and clinical performance measures (Ageberg et al, 2013;Bennell et al, 2013;Lange et al, 2008;Pelland et al, 2004;Roddy, 2005).…”

“…In the current study, Tree posture produced the highest KAM of all postures; however it is likely an underestimate because the force applied by the secondary leg on the tibia of the standing leg has been neglected in calculating the KAM. Many exercise programs for knee OA include single-leg activities (Ageberg et al, 2013;Bennell et al, 2010). These exercises require further evaluation because they may increase medial loading.…”

A comparison of multidisciplinary team residential rehabilitation with conventional outpatient care for the treatment of non-arthritic intra-articular hip pain in UK Military personnel – a protocol for a randomised controlled trial

“…Proprioceptive deficits routinely occur in conjunction with articular injuries of the hip [48]. Labral injuries lead to an inhibited motor response and decreased neuromuscular stabilisation of the joint [49].…”