Bennell Kim L, Dobson Fiona, Roos Ewa M, Skou Søren T, Hodges Paul, Wrigley Tim V, Kyriakides Mary, Metcalf Ben, Hunt Michael A, Hinman Rana S
University of Melbourne, Melbourne, Victoria, Australia.
University of Southern Denmark, Odense, Denmark.
Arthritis Care Res (Hoboken). 2015 Sep;67(9):1281-1288. doi: 10.1002/acr.22558.
To investigate whether selected biomechanical characteristics influence changes in pain and physical function with exercise in people with medial knee osteoarthritis (OA) and varus malalignment.
We conducted post hoc exploratory analyses from a randomized controlled trial involving 100 people with medial knee OA and varus malalignment who were randomly allocated to one of two 12-week exercise programs (quadriceps strengthening [QS] or neuromuscular exercise [NEXA]). The outcome measures were change in overall average knee pain (visual analog scale) and self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index). Candidate biomechanical characteristics measured at baseline were visually observed varus thrust during walking, obesity (determined by body mass index), static varus alignment, and isometric quadriceps strength. Data were analyzed with separate two-way analyses of covariance using the interaction term of exercise group by biomechanical characteristic.
Ninety-two participants were analyzed for each characteristic except varus thrust, for which 85 participants were included. For change in pain, there was a significant interaction effect between type of exercise and both varus thrust (P = 0.001) and obesity (P = 0.023). NEXA was more effective for nonobese participants (mean change 29.5 mm [95% confidence interval (95% CI) 20.5, 38.5]) and for those with varus thrust (mean change 28.7 mm [95% CI 19.4, 38.1]), whereas QS was more effective for obese people (mean change 24.7 mm [95% CI 14.9, 34.4]) and for those without varus thrust (mean change 29.4 mm [95% CI 21.2, 37.7]). Biomechanical characteristics did not influence the effect of exercise on physical function (P > 0.05).
These preliminary findings suggest that varus thrust and obesity influence the pain-relieving effects of 2 different types of exercise. Further research is needed to confirm whether or not exercise that is prescribed according to specific biomechanical characteristics optimizes knee OA outcomes.
探讨特定生物力学特征是否会影响内侧膝关节骨关节炎（OA）合并内翻畸形患者运动时疼痛和身体功能的变化。
我们对一项随机对照试验进行了事后探索性分析，该试验纳入了100名内侧膝关节OA合并内翻畸形的患者，他们被随机分配到两个为期12周的运动项目之一（股四头肌强化训练[QS]或神经肌肉运动[NEXA]）。结局指标为总体平均膝关节疼痛的变化（视觉模拟量表）和自我报告的身体功能（西安大略和麦克马斯特大学骨关节炎指数）。在基线时测量的候选生物力学特征包括步行时目测的内翻推力、肥胖（由体重指数确定）、静态内翻对线和等长股四头肌力量。使用运动组与生物力学特征的交互项，通过单独的双向协方差分析对数据进行分析。
除内翻推力外，对每个特征分析了92名参与者，内翻推力纳入了85名参与者。对于疼痛变化，运动类型与内翻推力（P = 0.001）和肥胖（P = 0.023）之间均存在显著的交互作用。NEXA对非肥胖参与者（平均变化29.5 mm[95%置信区间（95%CI）20.5, 38.5]）和有内翻推力的参与者（平均变化28.7 mm[95%CI 19.4, 38.1]）更有效，而QS对肥胖者（平均变化24.7 mm[95%CI 14.9, 34.4]）和无内翻推力的参与者（平均变化29.4 mm[95%CI 21.2, 37.7]）更有效。生物力学特征不影响运动对身体功能的效果（P>0.05）。
这些初步研究结果表明，内翻推力和肥胖会影响两种不同类型运动的止痛效果。需要进一步研究以确认根据特定生物力学特征制定的运动是否能优化膝关节OA的结局。
