COMPARATIVE EFFECT OF TARGETED DYNAMIC BALANCE AND NEUOMUSCULAR TRAINING ON DYNAMIC BALANCE IN KNEE OSTEOARTHRITIS PATIENTS: A ROMDOMIZED CONTROLLED TRIAL

P. Wattanapisitkul¹, N. Mitchuairot², Y. Tawato³, S. Kwanthong⁴

Background: The important problems in people with medial tibiofemoral osteoarthritis (OA) are pain , muscle weakness and  poor dynamic balance control. Exercises are proved to be one of the necessary interventions for solving these problems. Various exercise protocols are implemented to patients with knee osteoarthritis. Balance control exercise is one of the most important regimen including in these exercise programs. Previous studies showed the limited comparison evidence about the effect of targeted dynamic balance training and neuromuscular training on dynamic balance in patients with knee osteoarthritis.

Purpose: This study aimed to compare the effectiveness of 6-week targeted dynamic balance training and neuromuscular training in patients with knee osteoarthritis.

Methods: Twenty-eight patients diagnosed with knee OA were eligible and randomized into 2 groups in this study. Twenty six participants completed through the study program. The control group consisted of twelve participants (1 male and 11 females, mean age 62.50 (57.75,65.00) received standard exercise and neuromuscular training. The experimental group consisted of fourteen participants (2 males and 12 females,mean age 65.50(62.75,68.00)received standard exercise and targeted dynamic balance training. Both groups were assigned with 6-week home exercise program and self-care education. Evaluation of Oxford Knee Score (OKS), the Y- BalanceTest , Timed Up and Go test (TUG), Numeric Rating Scale (NRS) and repetitions of 30 second Chair Stand Test (30s-CST) were conducted at baseline, week 4 and  week 6 respectively.

Results: The significant differences were found in the score of OKS, distance of Y- Balance test, duration of TUG, score of NRS and repetitions of 30s-CST as compared within group at week 6. It could be explained that the exercise program in both groups consisted of closed chain exercise which improved the proprioception ,pain , lower limb strength and balance in patients with knee OA. Comparisons between groups showed significant differences in the distance of Y- Balance test of anterior at  week 4(p = 0.0027), week 6 (p = 0.024) and posteromedial directions at  week 6 (p = 0.040) of the experimental group but no significant difference in other parameters. . . Adherence to exercise in control and experimental groups were 86.4% and 80.46%   respectively.

Conclusion(s): Both targeted dynamic balance and neuromuscular training in this study presented the improvement of all outcomes within group. Significant differences between groups were found in the distance of Y- Balance test of anterior and posteromedial directions of experimental group. Improvement in distance of anterior and posteromedial directions showed the superior dynamic balance of experimental group. The results  from the scope of this study suggested that targeted dynamic balance training should be included in exercise programs for knee OA patients to improve dynamic balance and prevent risk of fall. Age,sex categorization and larger sample size should be considered for future study to maximize the suitability and benefits of exercise program for knee OA patients.

Implications: Targted dynamic balance exercise might be included in one of the standard exercise programs for  patients with knee osteoarthritis. It could be the useful exercise regimen for improving balance control, prevention of falling risk and eventually leading to better quality of life.

Funding, acknowledgements: The study is funded by Faculty of Medicine, Prince of Songkla University, Thailand.

Keywords: 1. osteoarthritis, 2. neuromuscular, 3. dynamic-balance

Topic: Musculoskeletal: lower limb

Did this work require ethics approval? Yes

Institution: Faculty of Medicine, Prince of Songkla University, Thailand

Committee: Human Research Ethics Committee

Ethics number: 60-428-30-2