A. Farrag1,2, T. Alqahtani3
1Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia, 2Cairo University, Basic Science Department, Faculty of Physical Therapy, Cairo, Egypt, 3King Fahd Military Medical Complex, Department of Physical Therapy, Dhahran, Saudi Arabia
Background: Knee osteoarthritis (OA) is an active pathological joint disorder associated with, not only clinical symptoms as joint pain and limited function, but also changes in inflammatory biomarkers. Clinical guidelines advocate for exercises as the first line of treatment for knee OA. Strengthening exercises can be in the form of open kinetic chain (OKC), or closed kinetic chain (CKC) exercises. Further investigation is required to obtain information regarding the impact of different types of strengthening exercises on clinical symptoms and biomarkers in knee OA.
Purpose: To investigate the impact of OCK versus CKC exercises on pain, function, and cartilage synthesis and degradation biomarkers after an eight-week rehabilitation program for knee OA patients.
Methods: This was a prospective, active control, three-parallel-group, assessor-blinded, randomized controlled trial. A convenient sample of 90 knee OA patients was recruited and randomly assigned to study groups at a 1:1:1 allocation ratio. Study groups were a) control group receiving quadriceps and hamstring stretching exercises and fifteen-minute TENS, b) OKC group receiving the control group program plus three sets of 10 repetitions of 60% of 1RM of Quadriceps seated strengthening and Hamstring curl-up exercises, and c) CKC group receiving similar exercise protocol of Seated leg press and Partial squat exercises. Patients received 24 treatment sessions (3 sessions/week) over 8 weeks. Western Ontario and McMaster Universities (WOMAC) scores and serum (cartilage oligomeric matrix protein (COMP), propetptide Type-II N-terminal (PIIANP) and C-reactive protein (CRP)) and urine (type-II Collagen telepeptide (CTX-II)) OA biomarkers were collected and recorded at baseline and after 8 weeks. Data were analyzed using a mixed linear model and Pearson correlation coefficient for testing outcomes changes and associations, respectively.
Results: The within-group analysis revealed significant improvement in both OKC (-15.7 point, p<0.01 and -12.3 point, p<0.01 for WOMAC total and physical function scores, respectively) and CKC (-15.1 point, p<0.01 and -11.7 point, p<0.01 for WOMAC total and physical function scores, respectively) groups only. Levels of CRP biomarkers also showed significant (p<0.05) improvement for the experimental groups only. Other serum biomarkers did not show significant changes. Between-group analysis showed significantly better WOMAC total (p=0.03) and function (p<0.01) scores for the experimental groups compared with the control group. The difference between CRP biomarker measurements for the OKC (4.57 ± 2.14) and CKC (4.49 ± 2.66) and control (5.82 ± 2.28) groups was obvious but insignificant. A significant, but weak, positive correlation was detected between OA serum biomarkers and WOMAC total (CRP r = 0.353, and COMP r =0.290, p<0.01), stiffness (CRP r = 0.329, p<0.01, and COMP r =0.251, p<0.05) and function (CRP r =0.382, and COMP r =0.306, p<0.01) scores.
Conclusion(s): Both exercise regimes significantly improved physical function and specific serum proinflammatory biomarkers. This was further supported by the significant positive association between the same biomarkers and the reported WOMAC total and function scores.
Implications: Kinetic chain exercises are effective knee OA rehabilitation exercise protocols that could also influence OA-relevant biomarkers. Thus, clinicians may selectively use biomarkers measurement for assessing knee OA prognosis and response to treatment.
Funding, acknowledgements: No funding was received for this project.
Keywords: kinetic exercises, osteoarthritis, biomarkers
Topic: Musculoskeletal: lower limb
Did this work require ethics approval? Yes
Institution: Imam Abdulrahman Bin Faisal University
Committee: Standing Committee for Research Ethics on Living Creatures (SCRELC)
Ethics number: HAP-05-D-003
All authors, affiliations and abstracts have been published as submitted.
