Knee impairments: Comparison between new clinical classification by cluster analysis and movement system impairment model.

BACKGROUND: Although Movement System Impairment (MSI) model classifies patients with knee impairments, it has some limitations. This study compares MSI model with a new Partitioning Around Medoids (PAM) model in knee pain patients. METHODS: In this cross-sectional study, knee movement impairments (signs) and symptoms. (pain) of 200 patients were studied in eight different functional positions. After modification of impairments, the examinations were repeated to record the changes in symptoms. The patients were then classified based on the signs and symptoms firstly by MSI model and secondly using PAM clustering by R software. RESULTS: PAM model has a similar acceptable grouping compared to MSI because most patients are in 4 similar categories in both methods: valgus, varus, hyperextension and hypomobility. However, due to low discriminative power of the tests used for finding hypermobility and patellar dysfunctions, these sub-clusters are absent in PAM model. Instead, two new sub-clusters of self-management and valgus with hypomobility were found. Most importantly, the PAM model sorted the signs and symptoms based on their discriminative power and eliminated trivial tests so that the therapist can classify patients more quickly by performing clinically relevant tests. CONCLUSION: The new PAM method can be advantageous for therapists since it defines the importance of signs over symptoms in examination, prioritizes examination tests, and outlines tests with lower discriminative power. In PAM model, patients in the hypermobility and patellar subgroups of MSI model merged into other sub-clusters due to low discriminating power of their characteristics.

Dry needling trigger points around knee and hip joints improves function in patients with mild to moderate knee osteoarthritis.

INTRODUCTION: Dry needling may be an effective method to alleviate pain and improve range of motion. Controversial results have been found in previous studies using dry needling in knee problems. So, the aim of current study is to exert dry needling technique on unilateral muscles around the hip and knee joints and evaluate its effects on knee osteoarthritic patients. METHOD: For this double-blind randomized clinical trial, 40 female patients with mild to moderate knee osteoarthritis (aged 45-70 years old) were recruited. They entered the study if they had any trigger points around the hip or knee joints of the examined side and randomized into two groups. Pain, sensitivity of trigger points, balance and function measured by visual analogue scale, algometer, Y-balance test, timed up and go, self-paced walk tests beside KOOS questionnaire respectively before and after intervention. The intervention group received 3 sessions of dry needling on marked trigger points while the sham group received sham treatment consisting of only the plastic cover of a needle. Both groups reexamined 2 weeks after primary evaluation. RESULTS: Comparing results before and after implementing dry needling revealed significant improvements in all measured variables in treatment group whereas, pain and timed up and go increased and peak pain pressure decreased in sham group. Between group comparison revealed significant differences in all variables. CONCLUSION: Using 3 sessions of dry needling can increase functional activity, sensitivity and balance and decrease pain in patients with knee osteoarthritis in short term.

The effect of exergaming on knee proprioception in older men: A randomized controlled trial.

BACKGROUND: Proprioception is the ability to sense the body position, muscle sense, joint stability and posture. As balance decreases during the process of aging, knee proprioception has a critical role in body balance and daily activities. Exergaming has shown to be a potentially effective and more enjoyable form of exercise delivery. OBJECTIVE: The purpose of this study was to determine the effect of an 8-week Xbox Kinect exercise program on knee proprioception in healthy older adults. METHODOLOGY: Thirty-two elderly men who were 65 years of age or older were randomly allocated to either a control or experimental group (allocation ratio 1:1). The experimental group received an exergame intervention that included Xbox Kinect with games focusing on movements of the knee joint for 8 weeks (three times per week and 40min per sessions). A Biodex Isokinetic Dynamometer was used to measure knee joint position sense before and after the exercise program. RESULTS: After eight weeks of training, knee proprioception significantly improved in the intervention group for several knee joint angles: 30° (3.5±1.1), 45° (3.1±0.9), and 60° (3.0±0.6) compared to the control group 30° (5.2±0.8), 45° (5.2±0.8), and 60° (6.2±0.9) (dominant leg F1, 28=23.469, p=0.001. ƞ2=0.456; non-dominant leg F1, 28=23.076, p=0.001. ƞ2=0.452). CONCLUSION: The results from this study indicate that exergame intervention can enhance knee proprioception in elderly men.