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BMJ Open ; 10(1): e033230, 2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31900273


INTRODUCTION: Stair ascent and descent require complex integration between sensory and motor systems; individuals with knee osteoarthritis (KOA) have an elevated risk for falls and fall injuries, which may be in part due to poor dynamic postural control during locomotion. Tai chi exercise has been shown to reduce fall risks in the ageing population and is recommended as one of the non-pharmocological therapies for people with KOA. However, neuromuscular mechanisms underlying the benefits of tai chi for persons with KOA are not clearly understood. Postural control deficits in performing a primary motor task may be more pronounced when required to simultaneously attend to a cognitive task. This single-blind, parallel design randomised controlled trial (RCT) aims to evaluate the effects of a 12-week tai chi programme versus balance and postural control training on neuromechanical characteristics during dual-task stair negotiation. METHODS AND ANALYSIS: Sixty-six participants with KOA will be randomised into either tai chi or balance and postural control training, each at 60 min per session, twice weekly for 12 weeks. Assessed at baseline and 12 weeks (ie, postintervention), the primary outcomes are attention cost and dynamic postural stability during dual-task stair negotiation. Secondary outcomes include balance and proprioception, foot clearances, self-reported symptoms and function. A telephone follow-up to assess symptoms and function will be conducted at 20 weeks. The findings will help determine whether tai chi is beneficial on dynamic stability and in reducing fall risks in older adults with KOA patients in community. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Ethics Committee of the Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine (#2018KY-006-1). Study findings will be disseminated through presentations at scientific conferences or publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ChiCTR1800018028.

Zhongguo Zhen Jiu ; 37(5): 457-462, 2017 May 12.
Artigo em Chinês | MEDLINE | ID: mdl-29231603


OBJECTIVE: To evaluate the clinical efficacy of warm-needling moxibustion for knee osteoarthritis (KOA), and to explore its effects on isokinetic strength of lower limb muscle. METHODS: Fifty cases of KOA were randomly divided into an observation group (25 cases) and a control group (21 cases), but 4 cases lost contact. The observation group was treated with warm-needling moxibustion at Dubi (ST 35), Neixiyan (EX-LE 4), Xuehai (SP 10), Liangqiu (ST 34), Yinlingquan (SP 9), Yanglingquan (GB 34), Weizhong (BL 40), Heyang (BL 55) and Fengshi (GB 31) for 40 min per treatment. The first 6 treatments were given once a day, and the last 6 treatments were given once every other day. 12 treatments were taken as one course, and totally 3-week treatment was given. No treatment was given in the control group for 3 weeks. The isokinetic strength of extensor muscle and flexor muscle, including the total work, absolute peak torque (aPT) and relative peak torque (rPT), and Western Ontario and McMaster Universities Arthritis Index (WOMAC), and comprehensive efficacy were observed and compared in the two groups. RESULTS: Compared before treatment, the total work, aPT and rPT of the extensor and flexor muscle increased significantly after treatment in the observation group (P<0.01, P<0.05), but the flextion/extention ratio was lowered (P<0.05). In the control group, aPT and rPT of flexor muscle were reduced after treatment (P<0.05, P<0.01). The total work, aPT and rPT of the extensor muscle in the observation group were higher than those in the control group after treatment (P<0.05, P<0.01), but the flextion/extention ratio was lowered (P<0.05). The item score and total score of WOMAC were reduced in the observation group after treatment (all P<0.01), but no significant change was observed in the control group (all P>0.05). The pain score, stiffness scores and total score of WOMAC in the observation group were lower than those in the control group (P<0.01, P<0.05); the score of daily function activities was declined in the observation group, but not significantly different from that in the control group (P>0.05). The total effective rate was 88.0% (22/25) in the observation group. CONCLUSIONS: Warm-needling moxibustion could relieve pain, improve function and muscle balance, strengthen extensor and flexor muscle power, especially extensor, which has superior clinical efficacy.

Moxibustão/métodos , Osteoartrite do Joelho/terapia , Pontos de Acupuntura , Humanos , Perna (Membro) , Força Muscular , Medição da Dor , Resultado do Tratamento
Zhongguo Zhen Jiu ; 37(10): 1027-34, 2017 Oct 12.
Artigo em Chinês | MEDLINE | ID: mdl-29354968


OBJECTIVE: To observe the kinetic change that reflects joint loading in different planes during stair climbing in knee osteoarthritis (KOA) after electroacupuncture (EA) by three-dimensional motion analysis, so as to provide reference for its biomechanical mechanism treated with acupuncture. METHODS: Forty KOA patients, in accordance with the random number table, were assigned into an observation group and a control group, 20 cases in each one and finally 18 cases completed. Acupoints in the observation group were Neixiyan (EX-LE 4), Dubi (ST 35), Yanglingquan (GB 34), Yinlingquan (SP 9), Xuehai (SP 10), Liangqiu (ST 34) and Zusanli (ST 36); points in the control groups were located about 2 cm next to the above acupoints with shallow acupuncture. EA was connected at Neixiyan (EX-LE 4) and Yinlingquan (SP 9), Liangqiu (ST 34) and Yanglingquan (GB 34). The frequency was 2 Hz with continuous wave in the observation group and there was no current in the control group for the corresponding points. All the treatment was given for 3 weeks, totally 11 times. Climbing stairs gait was measured before and after treatment. Velocities and kinetic parameters during ascending and descending stairs were analyzed, including flexion and extension peak torques of hip, knee, ankle on the vertical plane, external knee adduction moment on the coronal plane. RESULTS: After treatment in the observation group, velocities during ascending and descending stairs significantly increased (P<0.05, P<0.01); maximal ankle plantar flexor moments during ascending and descending stairs and the second peak external knee adduction moment (PEKAM2) during ascending stairs significantly increased (P<0.05, P<0.01). After treatment in the control group, the first peak external knee adduction moment (PEKAM1) and PEKAM2 during descending stairs were less than those before treatment (P<0.05, P<0.01). In the observation group, the difference value (DV) of velocity before and after treatment was positively correlated to DV in the torque of ankle plantar flexors during ascending stairs in the observation group (r=0.598,P<0.01). Excluding the impact of velocity, the DV of the maximal torque of ankle plantar flexors during ascending stairs didn't show difference in the observation group (P>0.05). CONCLUSION: EA can increase the velocities of ascending and descending stairs of KOA patients. It improves the loading capacity of knee joint on both sagittal and coronary planes. But its effect during ascending may be correlated with the increase of velocity. The mechanism of different effects between EA and minimal acupuncture on joint moments is still unclear and warrants further study.

Eletroacupuntura/métodos , Osteoartrite do Joelho/terapia , Subida de Escada/fisiologia , Pontos de Acupuntura , Fenômenos Biomecânicos , Humanos , Articulação do Joelho , Osteoartrite do Joelho/fisiopatologia