Osteoarthritis Knees Both Post-Traumatic Clinical Trial
Official title:
Preventing Post-traumatic Osteoarthritis and Other Health Consequences Following Knee Joint Injury: A Pilot Randomized Controlled Trial
This study evaluates the preliminary efficacy of an 8-week exercise and education intervention on musculoskeletal health of young adults with a previous sport-related knee injury that are at high risk of post-traumatic osteoarthritis. In addition, the purpose of this pilot randomized controlled trial is to determine the feasibility of the study methods and procedures to inform the design of a future randomized controlled trial.
PURPOSE
The purpose of this study is to determine the preliminary efficacy of an 8-week exercise and
education intervention on musculoskeletal health of young adults with a previous
sport-related knee injury that are at high risk of post-traumatic osteoarthritis. In
addition, the purpose is to determine the feasibility of the study methods and procedures. In
addition, the longitudinal changes in health-related factors in participants who are
recruited from a previous cohort study will be described, as well as the estimated cost of
healthcare utilization during one year in a population of young adults with history of
sport-related knee injury.
METHODS
Study design and participants
This is a pilot randomized controlled trial stepped-wedge design. Participants will include
40 men and women, age 21 to 33 years, who sustained a physician-confirmed youth (≤ 18 years
of age) sport-related intra-articular knee injury 5 to 16 years ago.
Participants will be randomly assigned to the intervention group (n=20) or the control group
(n=20) in permuted blocks of varying size and stratified during randomization by sex. To
ensure allocation concealment, the trial biostatistician, who is not involved in participant
recruitment or baseline testing, will generate the randomization sequence. After the
participant has been tested at baseline, the study physiotherapist will open the envelope and
informed the participant about allocation to intervention or control group. If a participant
expresses that they are unable to participate in the group they were allocated to, they will
not be excluded from this pilot study. Instead, they are permitted to participate in the
group that is suitable to them. The number of these cases will be recorded and reported.
All participants will undergo baseline testing at the same time. Intervention group will then
complete the 8-week intervention, while the control group will not begin the intervention
until 8 weeks after their baseline measurements. Intervention group will complete a 16-week
maintenance period while control group will complete eight weeks of maintenance. All
participants will undergo functional (i.e. balance and strength) tests, body composition
measurements, 7-day physical activity monitoring and fill self-report tools (i.e. Knee Injury
and Osteoarthritis Outcome Score, knee self-efficacy) at four time points: baseline, 8-weeks,
16-weeks and 24-weeks.
Experimental Intervention: the SHRED Osteoarthritis program
Exercise Component:
Previous research on the effects of neuromuscular training after knee injuries and on
patients with knee OA, research on neuromuscular control, exercise training principles and
the research group's clinical experience were considered when designing the exercise
component of the SHRED Osteoarthritis program. The SHRED Osteoarthritis program consists of
an an 8-minute warm-up, 42-minute circuit training through seven exercise stations, 5 minutes
of specialized skill and control exercises and 5-minute cool down inclusive of flexibility
exercises.
The SHRED Osteoarthritis program will be delivered through two 60-minute group exercise
classes per week for 8 weeks (16 classes). In addition, participants will complete a
30-minute home exercise session once a week (8 sessions). The SHRED Osteoarthritis exercise
classes will be lead by a study physiotherapist assisted by kinesiologists, kinesiology
students or physiotherapy students with a supervision rate of one instructor for every four
participants.
The 30-minute home exercise sessions will consist of a warm-up (8 min) and four exercises
from the SHRED Osteoarthritis program. The physiotherapist leading the SHRED Osteoarthritis
classes will assign specific exercises to each participant, based on individual needs and the
program will be revised weekly.
Education Component:
Patient education is embedded into the 16, one-hour supervised group exercise classes.
Education components will include the causes and course of knee pain, identification of a
flare-up, management and first aid for self-management of knee pain or flare-ups, appropriate
imaging, exercise progression and treatment options (conservative vs. surgical). This content
was built from clinical practice guidelines, expert recommendations, patient interviews and
theoretical frameworks that outline patient needs, modifiable risk factors, proposed change
objects and performance objectives.
Maintenance Component:
After the 8-week intervention has been completed, participants will enter a maintenance
stage. During this time (16 weeks for intervention group, 8 weeks for control group), the
participants will be asked to complete an individualized home exercise program twice a week.
During the maintenance period, participants have the opportunity to contact the study
physiotherapist via phone or email to discuss their progression and possible changes to their
program. In addition, drop-in times will be available twice a week. During these times,
participants can come to discuss their program with the study physiotherapist.
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