Traditional exercise therapy programs for knee osteoarthritis (OA) primarily focus on addressing lower extremity strength and joint motion deficits and have yielded fair to moderate improvements in functional status. Recently, there has been increasing evidence that alterations in lower extremity biomechanical factors during weight bearing activities, such as, alterations in movement and muscle activity patterns, ground reaction forces, and lower extremity loading rates, may have substantial impact on functional status and perhaps progression of disease in individuals with knee OA. Based on these findings, it has been suggested that the effectiveness of exercise therapy programs might be improved by incorporating activities that address altered biomechanical factors. We believe that in addition to strength and joint mobility exercises, incorporating balance and agility training techniques (knee stability training) may improve the effectiveness of exercise therapy by inducing favorable changes in lower extremity biomechanics and allowing for greater improvements in functional status than what can be achieved by strength and joint mobility exercise alone. The overall aim of this project is to test the effectiveness of supplementing traditional exercise therapy with knee stability training techniques, tailored for individuals with knee OA, for improving pain, physical function, and lower extremity biomechanics in individuals with knee OA. We will compare individuals with knee OA who receive a standard exercise therapy program (standard group) to those who receive the same standard program, supplemented with knee stability training techniques (stability training group). The study will be a two group, repeated measures, randomized, blinded clinical trial to compare changes in pain, physical function, lower extremity kinematics, kinetics, and electromyography during gait and a step down task, and changes in spatial/temporal characteristics of gait between subjects with knee OA who receive a standard rehabilitation program and those receiving the same standard program that is supplemented with the knee stability training program. The results of this study will assist in determining whether knee stability training techniques are likely to enhance lower extremity biomechanical and neuromuscular function as well as physical performance and disability over standard training techniques in patients with knee OA. Information gained from this study may improve the ability to refine rehabilitation and prevention programs for individuals with knee OA with the purpose of improving the overall quality of life for individuals with this age related progressive disorder.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR048760-03
Application #
7077807
Study Section
Geriatrics and Rehabilitation Medicine (GRM)
Program Officer
Lester, Gayle E
Project Start
2004-04-01
Project End
2008-03-31
Budget Start
2006-04-01
Budget End
2007-03-31
Support Year
3
Fiscal Year
2006
Total Cost
$458,159
Indirect Cost
Name
University of Pittsburgh
Department
Other Health Professions
Type
Schools of Allied Health Profes
DUNS #
004514360
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
O'Connell, Megan; Farrokhi, Shawn; Fitzgerald, G Kelley (2016) The role of knee joint moments and knee impairments on self-reported knee pain during gait in patients with knee osteoarthritis. Clin Biomech (Bristol, Avon) 31:40-6
Gustafson, Jonathan A; Gorman, Shannon; Fitzgerald, G Kelley et al. (2016) Alterations in walking knee joint stiffness in individuals with knee osteoarthritis and self-reported knee instability. Gait Posture 43:210-5
Farrokhi, Shawn; O'Connell, Megan; Gil, Alexandra B et al. (2015) Altered gait characteristics in individuals with knee osteoarthritis and self-reported knee instability. J Orthop Sports Phys Ther 45:351-9
Farrokhi, Shawn; O'Connell, Megan; Fitzgerald, G Kelley (2015) Altered gait biomechanics and increased knee-specific impairments in patients with coexisting tibiofemoral and patellofemoral osteoarthritis. Gait Posture 41:81-5
Farrokhi, Shawn; Piva, Sara R; Gil, Alexandra B et al. (2013) Association of severity of coexisting patellofemoral disease with increased impairments and functional limitations in patients with knee osteoarthritis. Arthritis Care Res (Hoboken) 65:544-51
Fitzgerald, G Kelley; White, Daniel K; Piva, Sara R (2012) Associations for change in physical and psychological factors and treatment response following exercise in knee osteoarthritis: an exploratory study. Arthritis Care Res (Hoboken) 64:1673-80
Williams, Valerie J; Piva, Sara R; Irrgang, James J et al. (2012) Comparison of reliability and responsiveness of patient-reported clinical outcome measures in knee osteoarthritis rehabilitation. J Orthop Sports Phys Ther 42:716-23
Teixeira, Paulo E P; Piva, Sara R; Fitzgerald, G Kelley (2011) Effects of impairment-based exercise on performance of specific self-reported functional tasks in individuals with knee osteoarthritis. Phys Ther 91:1752-65
Fitzgerald, G Kelley; Piva, Sara R; Gil, Alexandra B et al. (2011) Agility and perturbation training techniques in exercise therapy for reducing pain and improving function in people with knee osteoarthritis: a randomized clinical trial. Phys Ther 91:452-69
Woollard, Jason D; Gil, Alexandra B; Sparto, Patrick et al. (2011) Change in knee cartilage volume in individuals completing a therapeutic exercise program for knee osteoarthritis. J Orthop Sports Phys Ther 41:708-22

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