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Knee osteoarthritis pendulum therapy: In vivo evaluation and a randomised, single-blind feasibility clinical trial

Lixia Huang, Zhidao Xia Orcid Logo, Derick Wade Orcid Logo, Jicai Liu, Guoyong Zhou, Chuanhua Yu, Helen Dawes, Patrick Esser, Shijun Wei Orcid Logo, Jiuhong Song

Journal of Orthopaedic Translation, Volume: 45, Pages: 266 - 276

Swansea University Author: Zhidao Xia Orcid Logo

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DOI (Published version): 10.1016/j.jot.2024.02.008

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BackgroundExercise is recommended as the first-line management for knee osteoarthritis (KOA); however, it is difficult to determine which specific exercises are more effective. This study aimed to explore the potential mechanism and effectiveness of a leg-swinging exercise practiced in China, called...

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Published in: Journal of Orthopaedic Translation
ISSN: 2214-031X
Published: Elsevier BV 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa65986
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fullrecord <?xml version="1.0" encoding="utf-8"?><rfc1807 xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:xsd="http://www.w3.org/2001/XMLSchema"><bib-version>v2</bib-version><id>65986</id><entry>2024-04-09</entry><title>Knee osteoarthritis pendulum therapy: In vivo evaluation and a randomised, single-blind feasibility clinical trial</title><swanseaauthors><author><sid>c9307abfed1b43987a19da0c0e30d7a4</sid><ORCID>0000-0002-2047-7282</ORCID><firstname>Zhidao</firstname><surname>Xia</surname><name>Zhidao Xia</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2024-04-09</date><deptcode>MEDS</deptcode><abstract>BackgroundExercise is recommended as the first-line management for knee osteoarthritis (KOA); however, it is difficult to determine which specific exercises are more effective. This study aimed to explore the potential mechanism and effectiveness of a leg-swinging exercise practiced in China, called ‘KOA pendulum therapy’ (KOAPT). Intraarticular hydrostatic and dynamic pressure (IHDP) are suggested to partially explain the signs and symptoms of KOA. As such this paper set out to explore this mechanism in vivo in minipigs and in human volunteers alongside a feasibility clinical trial. The objective of this study is 1) to analyze the effect of KOAPT on local mechanical and circulation environment of the knee in experimental animals and healthy volunteers; and 2) to test if it is feasible to run a large sample, randomized/single blind clinical trial.MethodsIHDP of the knee was measured in ten minipigs and ten volunteers (five healthy and five KOA patients). The effect of leg swinging on synovial blood flow and synovial fluid content depletion in minipigs were also measured. Fifty KOA patients were randomly divided into two groups for a feasibility clinical trial. One group performed KOAPT (targeting 1000 swings/leg/day), and the other performed walking exercise (targeting 4000 steps/day) for 12 weeks with 12 weeks of follow-up.ResultsThe results showed dynamic intra-articular pressure changes in the knee joint, increases in local blood flow, and depletion of synovial fluid contents during pendulum leg swinging in minipigs. The intra-articular pressure in healthy human knee joints was −11.32 ± 0.21 (cmH2O), whereas in KOA patients, it was −3.52 ± 0.34 (cmH2O). Measures were completed by 100% of participants in all groups with 95–98% adherence to training in both groups in the feasibility clinical trial. There were significant decreases in the Oxford knee score in both KOAPT and walking groups after intervention (p &lt; 0.01), but no significant differences between the two groups.ConclusionWe conclude that KOAPT exhibited potential as an intervention to improve symptoms of KOA possibly through a mechanism of normalising mechanical pressure in the knee; however, optimisation of the method, longer-term intervention and a large sample randomized-single blind clinical trial with a minimal 524 cases are needed to demonstrate whether there is any superior benefit over other exercises.</abstract><type>Journal Article</type><journal>Journal of Orthopaedic Translation</journal><volume>45</volume><journalNumber/><paginationStart>266</paginationStart><paginationEnd>276</paginationEnd><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>2214-031X</issnPrint><issnElectronic/><keywords>Clinical trials; Intraarticular pressure; Knee osteoarthritis (KOA); Knee osteoarthritis pendulum therapy (KOAPT)</keywords><publishedDay>1</publishedDay><publishedMonth>3</publishedMonth><publishedYear>2024</publishedYear><publishedDate>2024-03-01</publishedDate><doi>10.1016/j.jot.2024.02.008</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>Self-funded research</funders><projectreference/><lastEdited>2024-05-28T15:14:37.1165995</lastEdited><Created>2024-04-09T12:47:14.4457494</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Biomedical Science</level></path><authors><author><firstname>Lixia</firstname><surname>Huang</surname><order>1</order></author><author><firstname>Zhidao</firstname><surname>Xia</surname><orcid>0000-0002-2047-7282</orcid><order>2</order></author><author><firstname>Derick</firstname><surname>Wade</surname><orcid>0000-0002-1188-8442</orcid><order>3</order></author><author><firstname>Jicai</firstname><surname>Liu</surname><order>4</order></author><author><firstname>Guoyong</firstname><surname>Zhou</surname><order>5</order></author><author><firstname>Chuanhua</firstname><surname>Yu</surname><order>6</order></author><author><firstname>Helen</firstname><surname>Dawes</surname><order>7</order></author><author><firstname>Patrick</firstname><surname>Esser</surname><order>8</order></author><author><firstname>Shijun</firstname><surname>Wei</surname><orcid>0000-0001-5105-0196</orcid><order>9</order></author><author><firstname>Jiuhong</firstname><surname>Song</surname><order>10</order></author></authors><documents><document><filename>65986__30210__e0dee26fea6b45f4a5608d60ca24177e.pdf</filename><originalFilename>65986.pdf</originalFilename><uploaded>2024-05-01T13:58:09.7833705</uploaded><type>Output</type><contentLength>2593326</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>This is an open access article under the CC BY-NC-ND license.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>https://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling v2 65986 2024-04-09 Knee osteoarthritis pendulum therapy: In vivo evaluation and a randomised, single-blind feasibility clinical trial c9307abfed1b43987a19da0c0e30d7a4 0000-0002-2047-7282 Zhidao Xia Zhidao Xia true false 2024-04-09 MEDS BackgroundExercise is recommended as the first-line management for knee osteoarthritis (KOA); however, it is difficult to determine which specific exercises are more effective. This study aimed to explore the potential mechanism and effectiveness of a leg-swinging exercise practiced in China, called ‘KOA pendulum therapy’ (KOAPT). Intraarticular hydrostatic and dynamic pressure (IHDP) are suggested to partially explain the signs and symptoms of KOA. As such this paper set out to explore this mechanism in vivo in minipigs and in human volunteers alongside a feasibility clinical trial. The objective of this study is 1) to analyze the effect of KOAPT on local mechanical and circulation environment of the knee in experimental animals and healthy volunteers; and 2) to test if it is feasible to run a large sample, randomized/single blind clinical trial.MethodsIHDP of the knee was measured in ten minipigs and ten volunteers (five healthy and five KOA patients). The effect of leg swinging on synovial blood flow and synovial fluid content depletion in minipigs were also measured. Fifty KOA patients were randomly divided into two groups for a feasibility clinical trial. One group performed KOAPT (targeting 1000 swings/leg/day), and the other performed walking exercise (targeting 4000 steps/day) for 12 weeks with 12 weeks of follow-up.ResultsThe results showed dynamic intra-articular pressure changes in the knee joint, increases in local blood flow, and depletion of synovial fluid contents during pendulum leg swinging in minipigs. The intra-articular pressure in healthy human knee joints was −11.32 ± 0.21 (cmH2O), whereas in KOA patients, it was −3.52 ± 0.34 (cmH2O). Measures were completed by 100% of participants in all groups with 95–98% adherence to training in both groups in the feasibility clinical trial. There were significant decreases in the Oxford knee score in both KOAPT and walking groups after intervention (p < 0.01), but no significant differences between the two groups.ConclusionWe conclude that KOAPT exhibited potential as an intervention to improve symptoms of KOA possibly through a mechanism of normalising mechanical pressure in the knee; however, optimisation of the method, longer-term intervention and a large sample randomized-single blind clinical trial with a minimal 524 cases are needed to demonstrate whether there is any superior benefit over other exercises. Journal Article Journal of Orthopaedic Translation 45 266 276 Elsevier BV 2214-031X Clinical trials; Intraarticular pressure; Knee osteoarthritis (KOA); Knee osteoarthritis pendulum therapy (KOAPT) 1 3 2024 2024-03-01 10.1016/j.jot.2024.02.008 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee Self-funded research 2024-05-28T15:14:37.1165995 2024-04-09T12:47:14.4457494 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Biomedical Science Lixia Huang 1 Zhidao Xia 0000-0002-2047-7282 2 Derick Wade 0000-0002-1188-8442 3 Jicai Liu 4 Guoyong Zhou 5 Chuanhua Yu 6 Helen Dawes 7 Patrick Esser 8 Shijun Wei 0000-0001-5105-0196 9 Jiuhong Song 10 65986__30210__e0dee26fea6b45f4a5608d60ca24177e.pdf 65986.pdf 2024-05-01T13:58:09.7833705 Output 2593326 application/pdf Version of Record true This is an open access article under the CC BY-NC-ND license. true eng https://creativecommons.org/licenses/by/4.0/
title Knee osteoarthritis pendulum therapy: In vivo evaluation and a randomised, single-blind feasibility clinical trial
spellingShingle Knee osteoarthritis pendulum therapy: In vivo evaluation and a randomised, single-blind feasibility clinical trial
Zhidao Xia
title_short Knee osteoarthritis pendulum therapy: In vivo evaluation and a randomised, single-blind feasibility clinical trial
title_full Knee osteoarthritis pendulum therapy: In vivo evaluation and a randomised, single-blind feasibility clinical trial
title_fullStr Knee osteoarthritis pendulum therapy: In vivo evaluation and a randomised, single-blind feasibility clinical trial
title_full_unstemmed Knee osteoarthritis pendulum therapy: In vivo evaluation and a randomised, single-blind feasibility clinical trial
title_sort Knee osteoarthritis pendulum therapy: In vivo evaluation and a randomised, single-blind feasibility clinical trial
author_id_str_mv c9307abfed1b43987a19da0c0e30d7a4
author_id_fullname_str_mv c9307abfed1b43987a19da0c0e30d7a4_***_Zhidao Xia
author Zhidao Xia
author2 Lixia Huang
Zhidao Xia
Derick Wade
Jicai Liu
Guoyong Zhou
Chuanhua Yu
Helen Dawes
Patrick Esser
Shijun Wei
Jiuhong Song
format Journal article
container_title Journal of Orthopaedic Translation
container_volume 45
container_start_page 266
publishDate 2024
institution Swansea University
issn 2214-031X
doi_str_mv 10.1016/j.jot.2024.02.008
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Biomedical Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Biomedical Science
document_store_str 1
active_str 0
description BackgroundExercise is recommended as the first-line management for knee osteoarthritis (KOA); however, it is difficult to determine which specific exercises are more effective. This study aimed to explore the potential mechanism and effectiveness of a leg-swinging exercise practiced in China, called ‘KOA pendulum therapy’ (KOAPT). Intraarticular hydrostatic and dynamic pressure (IHDP) are suggested to partially explain the signs and symptoms of KOA. As such this paper set out to explore this mechanism in vivo in minipigs and in human volunteers alongside a feasibility clinical trial. The objective of this study is 1) to analyze the effect of KOAPT on local mechanical and circulation environment of the knee in experimental animals and healthy volunteers; and 2) to test if it is feasible to run a large sample, randomized/single blind clinical trial.MethodsIHDP of the knee was measured in ten minipigs and ten volunteers (five healthy and five KOA patients). The effect of leg swinging on synovial blood flow and synovial fluid content depletion in minipigs were also measured. Fifty KOA patients were randomly divided into two groups for a feasibility clinical trial. One group performed KOAPT (targeting 1000 swings/leg/day), and the other performed walking exercise (targeting 4000 steps/day) for 12 weeks with 12 weeks of follow-up.ResultsThe results showed dynamic intra-articular pressure changes in the knee joint, increases in local blood flow, and depletion of synovial fluid contents during pendulum leg swinging in minipigs. The intra-articular pressure in healthy human knee joints was −11.32 ± 0.21 (cmH2O), whereas in KOA patients, it was −3.52 ± 0.34 (cmH2O). Measures were completed by 100% of participants in all groups with 95–98% adherence to training in both groups in the feasibility clinical trial. There were significant decreases in the Oxford knee score in both KOAPT and walking groups after intervention (p < 0.01), but no significant differences between the two groups.ConclusionWe conclude that KOAPT exhibited potential as an intervention to improve symptoms of KOA possibly through a mechanism of normalising mechanical pressure in the knee; however, optimisation of the method, longer-term intervention and a large sample randomized-single blind clinical trial with a minimal 524 cases are needed to demonstrate whether there is any superior benefit over other exercises.
published_date 2024-03-01T15:14:35Z
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score 11.012678

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