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A new integrated behavioural intervention for knee osteoarthritis: development and pilot study

Stephen J. Preece, Nathan Brookes, Anita E. Williams, Richard K. Jones, Chelsea Starbuck Orcid Logo, Anthony Jones, Nicola E. Walsh

BMC Musculoskeletal Disorders, Volume: 22, Issue: 1

Swansea University Author: Chelsea Starbuck Orcid Logo

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Abstract

Background: Exercise-based approaches have been a cornerstone of physiotherapy management of knee osteoarthritis for many years. However, clinical effects are considered small to modest and the need for continued adherence identified as a barrier to clinical efficacy. While exercise-based approaches...

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Published in: BMC Musculoskeletal Disorders
ISSN: 1471-2474
Published: Springer Science and Business Media LLC 2021
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While exercise-based approaches focus on muscle strengthening, biomechanical research has identified that people with knee osteoarthritis over activate their muscles during functional tasks. Therefore, we aimed to create a new behavioural intervention, which integrated psychologically informed practice with biofeedback training to reduce muscle overactivity, and which was suitable for delivery by a physiotherapist.Methods: Through literature review, we created a framework linking theory from pain science with emerging biomechanical concepts related to overactivity of the knee muscles. Using recognised behaviour change theory, we then mapped a set of intervention components which were iteratively developed through ongoing testing and consultation with patients and physiotherapists.Results: The underlying framework incorporated ideas related to central sensitisation, motor responses to pain and also focused on the idea that increased knee muscle overactivity could result from posturalcompensation. Building on these ideas, we created an intervention with five components: making sense of pain, general relaxation, postural deconstruction, responding differently to pain and functional muscle retraining. The intervention incorporated a range of animated instructional videos to communicate concepts related to pain and biomechanical theory and also used EMG biofeedback to facilitate visualization of muscle patterns. User feedback was positive with patients describing the intervention as enabling them to “create a new normal” and to be “in control of their own treatment.” Furthermore, large reductions in pain were observed from 11 patients who received a prototype version of the intervention.Conclusion: We have created a new intervention for knee osteoarthritis, designed to empower individuals with capability and motivation to change muscle activation patterns and beliefs associated with pain. We refer to this intervention as Cognitive Muscular Therapy. Preliminary feedback and clinical indications are positive, motivating future large-scale trials to understand potential efficacy. It is possible that this new approach could bring about improvements in the pain associated with knee osteoarthritis without the need for continued adherence to muscle strengthening programmes.Trial registration: ISRCTN51913166 (Registered 24-02-2020, Retrospectively registered)</abstract><type>Journal Article</type><journal>BMC Musculoskeletal Disorders</journal><volume>22</volume><journalNumber>1</journalNumber><paginationStart/><paginationEnd/><publisher>Springer Science and Business Media LLC</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1471-2474</issnElectronic><keywords>Knee osteoarthritis, Intervention, Behaviour change, Biopsychosocial, Biomechanical, Pain, Co-contraction, EMG</keywords><publishedDay>8</publishedDay><publishedMonth>6</publishedMonth><publishedYear>2021</publishedYear><publishedDate>2021-06-08</publishedDate><doi>10.1186/s12891-021-04389-0</doi><url/><notes/><college>COLLEGE NANME</college><department>Sport and Exercise Sciences</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>STSC</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>This paper presents independent research funded by the National Institute for Health Research (NIHR), UK, under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0816-20024.</funders><projectreference/><lastEdited>2022-10-31T13:11:00.3522137</lastEdited><Created>2022-07-21T16:02:16.2849942</Created><path><level id="1">College of Engineering</level><level id="2">Sports Science</level></path><authors><author><firstname>Stephen J.</firstname><surname>Preece</surname><order>1</order></author><author><firstname>Nathan</firstname><surname>Brookes</surname><order>2</order></author><author><firstname>Anita E.</firstname><surname>Williams</surname><order>3</order></author><author><firstname>Richard K.</firstname><surname>Jones</surname><order>4</order></author><author><firstname>Chelsea</firstname><surname>Starbuck</surname><orcid>0000-0001-6266-2876</orcid><order>5</order></author><author><firstname>Anthony</firstname><surname>Jones</surname><order>6</order></author><author><firstname>Nicola E.</firstname><surname>Walsh</surname><order>7</order></author></authors><documents><document><filename>60584__24693__a56456249ff34bd7a6cc76ff0f01614d.pdf</filename><originalFilename>60584.pdf</originalFilename><uploaded>2022-07-21T16:07:38.8462857</uploaded><type>Output</type><contentLength>1371607</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>© The Author(s). 2021 This article is licensed under a Creative Commons Attribution 4.0 International License</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling v2 60584 2022-07-21 A new integrated behavioural intervention for knee osteoarthritis: development and pilot study b12b936789e5be3976b2f2c1c8988d4c 0000-0001-6266-2876 Chelsea Starbuck Chelsea Starbuck true false 2022-07-21 STSC Background: Exercise-based approaches have been a cornerstone of physiotherapy management of knee osteoarthritis for many years. However, clinical effects are considered small to modest and the need for continued adherence identified as a barrier to clinical efficacy. While exercise-based approaches focus on muscle strengthening, biomechanical research has identified that people with knee osteoarthritis over activate their muscles during functional tasks. Therefore, we aimed to create a new behavioural intervention, which integrated psychologically informed practice with biofeedback training to reduce muscle overactivity, and which was suitable for delivery by a physiotherapist.Methods: Through literature review, we created a framework linking theory from pain science with emerging biomechanical concepts related to overactivity of the knee muscles. Using recognised behaviour change theory, we then mapped a set of intervention components which were iteratively developed through ongoing testing and consultation with patients and physiotherapists.Results: The underlying framework incorporated ideas related to central sensitisation, motor responses to pain and also focused on the idea that increased knee muscle overactivity could result from posturalcompensation. Building on these ideas, we created an intervention with five components: making sense of pain, general relaxation, postural deconstruction, responding differently to pain and functional muscle retraining. The intervention incorporated a range of animated instructional videos to communicate concepts related to pain and biomechanical theory and also used EMG biofeedback to facilitate visualization of muscle patterns. User feedback was positive with patients describing the intervention as enabling them to “create a new normal” and to be “in control of their own treatment.” Furthermore, large reductions in pain were observed from 11 patients who received a prototype version of the intervention.Conclusion: We have created a new intervention for knee osteoarthritis, designed to empower individuals with capability and motivation to change muscle activation patterns and beliefs associated with pain. We refer to this intervention as Cognitive Muscular Therapy. Preliminary feedback and clinical indications are positive, motivating future large-scale trials to understand potential efficacy. It is possible that this new approach could bring about improvements in the pain associated with knee osteoarthritis without the need for continued adherence to muscle strengthening programmes.Trial registration: ISRCTN51913166 (Registered 24-02-2020, Retrospectively registered) Journal Article BMC Musculoskeletal Disorders 22 1 Springer Science and Business Media LLC 1471-2474 Knee osteoarthritis, Intervention, Behaviour change, Biopsychosocial, Biomechanical, Pain, Co-contraction, EMG 8 6 2021 2021-06-08 10.1186/s12891-021-04389-0 COLLEGE NANME Sport and Exercise Sciences COLLEGE CODE STSC Swansea University This paper presents independent research funded by the National Institute for Health Research (NIHR), UK, under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0816-20024. 2022-10-31T13:11:00.3522137 2022-07-21T16:02:16.2849942 College of Engineering Sports Science Stephen J. Preece 1 Nathan Brookes 2 Anita E. Williams 3 Richard K. Jones 4 Chelsea Starbuck 0000-0001-6266-2876 5 Anthony Jones 6 Nicola E. Walsh 7 60584__24693__a56456249ff34bd7a6cc76ff0f01614d.pdf 60584.pdf 2022-07-21T16:07:38.8462857 Output 1371607 application/pdf Version of Record true © The Author(s). 2021 This article is licensed under a Creative Commons Attribution 4.0 International License true eng http://creativecommons.org/licenses/by/4.0/
title A new integrated behavioural intervention for knee osteoarthritis: development and pilot study
spellingShingle A new integrated behavioural intervention for knee osteoarthritis: development and pilot study
Chelsea Starbuck
title_short A new integrated behavioural intervention for knee osteoarthritis: development and pilot study
title_full A new integrated behavioural intervention for knee osteoarthritis: development and pilot study
title_fullStr A new integrated behavioural intervention for knee osteoarthritis: development and pilot study
title_full_unstemmed A new integrated behavioural intervention for knee osteoarthritis: development and pilot study
title_sort A new integrated behavioural intervention for knee osteoarthritis: development and pilot study
author_id_str_mv b12b936789e5be3976b2f2c1c8988d4c
author_id_fullname_str_mv b12b936789e5be3976b2f2c1c8988d4c_***_Chelsea Starbuck
author Chelsea Starbuck
author2 Stephen J. Preece
Nathan Brookes
Anita E. Williams
Richard K. Jones
Chelsea Starbuck
Anthony Jones
Nicola E. Walsh
format Journal article
container_title BMC Musculoskeletal Disorders
container_volume 22
container_issue 1
publishDate 2021
institution Swansea University
issn 1471-2474
doi_str_mv 10.1186/s12891-021-04389-0
publisher Springer Science and Business Media LLC
college_str College of Engineering
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hierarchy_top_id collegeofengineering
hierarchy_top_title College of Engineering
hierarchy_parent_id collegeofengineering
hierarchy_parent_title College of Engineering
department_str Sports Science{{{_:::_}}}College of Engineering{{{_:::_}}}Sports Science
document_store_str 1
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description Background: Exercise-based approaches have been a cornerstone of physiotherapy management of knee osteoarthritis for many years. However, clinical effects are considered small to modest and the need for continued adherence identified as a barrier to clinical efficacy. While exercise-based approaches focus on muscle strengthening, biomechanical research has identified that people with knee osteoarthritis over activate their muscles during functional tasks. Therefore, we aimed to create a new behavioural intervention, which integrated psychologically informed practice with biofeedback training to reduce muscle overactivity, and which was suitable for delivery by a physiotherapist.Methods: Through literature review, we created a framework linking theory from pain science with emerging biomechanical concepts related to overactivity of the knee muscles. Using recognised behaviour change theory, we then mapped a set of intervention components which were iteratively developed through ongoing testing and consultation with patients and physiotherapists.Results: The underlying framework incorporated ideas related to central sensitisation, motor responses to pain and also focused on the idea that increased knee muscle overactivity could result from posturalcompensation. Building on these ideas, we created an intervention with five components: making sense of pain, general relaxation, postural deconstruction, responding differently to pain and functional muscle retraining. The intervention incorporated a range of animated instructional videos to communicate concepts related to pain and biomechanical theory and also used EMG biofeedback to facilitate visualization of muscle patterns. User feedback was positive with patients describing the intervention as enabling them to “create a new normal” and to be “in control of their own treatment.” Furthermore, large reductions in pain were observed from 11 patients who received a prototype version of the intervention.Conclusion: We have created a new intervention for knee osteoarthritis, designed to empower individuals with capability and motivation to change muscle activation patterns and beliefs associated with pain. We refer to this intervention as Cognitive Muscular Therapy. Preliminary feedback and clinical indications are positive, motivating future large-scale trials to understand potential efficacy. It is possible that this new approach could bring about improvements in the pain associated with knee osteoarthritis without the need for continued adherence to muscle strengthening programmes.Trial registration: ISRCTN51913166 (Registered 24-02-2020, Retrospectively registered)
published_date 2021-06-08T13:10:59Z
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