A COMPARATIVE STUDY OF STANDING BALANCEPERFORMANCE BETWEEN OA KNEE PATIENTS COMPARED WITH NORMAL AGE MATCHED CONTROLS

Alagappan Thiyagarajan.T MPT (Sports)*, DY, PGDFWM; Prem Karthik .GS MPT (Ortho)

ABSTRACT OBJECTIVE: To find out the standing balance performance among osteoarthritis of knee patients compared with normal age matched controls STUDY DESIGN: Descriptive study. SAMPLING TECHNIQUE: Non Probability convenient sampling. SETTING: Department of physiotherapy, Pallava Hospital, Chennai. SUBJECT: 20 osteoarthritis patients and 20 normal were taken for this study. METHOD: To assess the balance performance functional research test were administered to both osteoarthritis patients and control groups. RESULTS: Functional reach test score value, which is higher for control group compared with osteoarthritis patients. CONCLUSION: The results suggests that osteoarthritis of knee patients having significant loss of (proprioception) balance performance compared with normal age matched controls

INTRODUCTION

apophyseal joints. It is characterized by the is a heterogeneous focal areas of damage to the cartilage surfaces of the synovial joints and is associated with remodelling of the underlying bone and mild synovitis1.
Osteoarthritis is one of the most

Osteoarthritis

condition for which the prevalence, risk factors, clinical manifestation, and prognosis vary according to the joints affected. It most commonly affects knee, hips, hand and spinal

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prevalent

musculoskeletal

complaints

knee patients compared with normal age matched controls OSTEOARTHRITIS AN OVERVIEW CAUSES OF OSTEOARTHRITIS Over weight in the main cause Harmful stress upon the knee CLINICAL FEATURES Pain Muscle spasm Stiffness Loss of movement Muscle wasting and weakness Joint enlargement Deformity Crepitus Loss of function DURING ACTIVE INFLAMMATION Heat. Redness. Swelling. Pain. PAIN The onset is of low intensity and can be described as three types. 1. Pain on weight bearing, severe aching, due to stress on the synovial

worldwide. It is a major cause of impairment and disabling among the elderly. Individual with osteoarthritis of knee suffer progressive loss of function, displaying increasing dependency in

walking, stair climbing and other lower extremity tasks2.

Balance involving

is

complex

function

numerous

neuromuscular

mechanisms. Control of balance is dependent upon sensory input from the vestibular, visual, and somatosensory systems. Central

processing of this information results in coordinated neuromuscular response that

ensures the center of mass remains within the base of the support in situation when balance is disturbed3. Effective control of balance thus relives not only on account sensory input but also on timely response of strong muscles. Balance is an integral component of activities of daily living. Balance impairments are associated with an increased risk of falls and poorer mobility in the elderly population3. Most of our clinical practice while treating osteoarthritis patients we use to concentrated to relieve pain and swelling and increase the muscle power and so on. But nobody performance. concentrated The
4,5,6,7

membrane and later due to the bone surfaces, which are rich in nerve endings, coming into contact. 2. During and after exercise there is pain described as being around the joint. 3. AT night especially after a very active day there is severe aching. NATURE OF PAIN 1. Aching is dominant, at first

on

balance are

recent

literatures

suggests that osteoarthritis patients having significance loss of proprioception that leads to imbalance. So, this study helps to find out balance performance among osteoarthritis of
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fleeting and then becoming more constant.

Scientific Research Journal of India Volume: 2, Issue: 4, Year: 2013

2.

Referred pain is described as passing down a limb distally from the affected joint.

eburnated

bone

ends

grate

with

characteristic sound on movement. LOSS OF FUNCTION Pain, muscle,

3.

Sharp stabbing pain is associated with a loose body becoming impacted in the joint.

weakness, giving way lead to inability to use the limb normally and can be severely disabling. CLINICAL FEATURES RELATING TO KNEE JOINTPain is described as round and through the joint. And may be referred up the anterior aspect of the tight or down to the ankle. Muscle spasm may be present in the hamstring muscles. Deformity from prolonged hamstring spasm is flexion and there is deformation of the tibia with valgus

MUSCLE SPASM This occurs over one aspect of the joint and is initially protective but where it remains beyond the acute episode it must be treated to prevent contractures. STIFFNESS This is present after rest and takes a little time to wear off with movement. It may be due to loss of joint lubrication, chronic oedema in the periarticular structures or swelling of the articular cartilage. LOSS OF JOINT MOVEMENTThis is different from stiffness because it does not wear off. It may be permanent where there is articular cartilage destruction but will respond to physiotherapy where it is due to muscle spasm or soft-tissue contracture. MUSCLE WASTING AND WEAKNESS Muscle become weak often on the aspect of the joint which is opposite to contracures. (E.g. his extensors). JOINT ENLARGEMENT Chronic oedema of the synovial membrane and capsule together with muscle wasting makes the joint appear large. DEFORMITY Each joint tends to adopt a characteristic deformity. CREPITUS The flaked cartilage and

deformity. The joint is enlarged and there is quadriceps atrophy especially vastus medialis. There is a limp due to pain and a tendency for the joint to give way especially during stepping down. PATHOLOGY This will be considered in relation to each joint structure as follows: 1. 2. 3. 4. 5. 6. Articular Cartilage Bone Synovial membrane Capsule Ligaments Muscles

1. ARTICULAR CARTILAGE Erosion occurs, often central and frequently in the weight- bearing areas. Cartilage is usually the first structure to be affected. Fibrillation which cause softening, splitting and fragmentation of the cartilage occurs in both weight bearing and non weight bearing areas.

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Collagen fibres split and there is disorganization of the proteoglycan- collagen relationship such that water is attracted into the cartilage which causes further softening and flaking flakes of cartilage break off and may be impacted between the join surfaces causing locking and inflammation.

aspect of the joint become contracted or elongated. 5. CAPSULE This undergoes fibrous

degeneration and there are low grade chronic inflammatory changes. 6. MUSCLE These undergo atrophy which may be related to disuse because pain limits movement and function. Without adequate exercise the muscles may undergo fibrous

Proliferation occurs at the periphery of the cartilage. 2. BONEEburnation the bone

surfaces become hard and polished as there is loss of protection from the cartilage

atrophy.

METHODOLOGY Cystic cavities form in the subcondalar bone because eburnated bone is brittle and microfractures occur allowing the passage of synovial fluid into the bone tissue. There can also be venour congestion in the subchondral bone. Osteophytes form of the margin of articular surfaces where they may project in to the joint or into the capsule and ligaments. Bone of the weight bearing joints alters in shape- the femoral head becomes flat and mushroom shaped. The tibial condyles INCLUSION CRITERIA Age between (45-65years) Patient Body mass index (BMI) value between (25-30) Kg/m2 3. SYNOVIAL MEMBRANE and is This The patient who has diagnosed undergoes oedematour. hypertrophy Later there becomes fibrour SETTING - Department of Physiotherapy, A.C.S General Hospital, Chennai SAMPLE - 20 osteoarthritis Patients20 control Subjects SAMPLING TECHNIQUES Non STUDY DESIGN - The design of the study is Descriptive study.

probability convenient sampling

become flattened.

osteoarthritis of knee from orthopedic department of A.C.S. General

degeneration. Reduction of synovial fluid secretion results in loss of nutrition and lubrication of the articular cartilage. 4. LIGAMENTS This undergo the same changes as the capsule and according to the
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Hospital, Chennai. EXCLUSION CRITERIA H/o injuries and multiple falls Uncorrected visual impairments

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H/o stroke and cerebellar disorder H/o hospitalization in last two months EQUIPMENTS AND MATERIALS Inch tape Weight machine Wooden Scale METHOD: The functional reach test is developed as a quick screen for balance problems in older adults. For performing this test subjects stand with feet shoulder distance apart and with the arm raised to 90flexion without moving their feet, subjects reach as for forward as they can, while still maintaining their balance. The distance reached is measured and compared to age-related norms3. Twenty osteoarthritis knee patients and twenty normal subjects were participated in this study. To assess the balance performance the functional reach test is administered to both the groups. Before applying the test, the procedure was clearly explained to the patient. To perform the functional reach test subjects stand with feet shoulder distance apart and with the arm raised to 900 flexion without moving their feet, subjects reach as for forward as they can, while still Functional Reach Test By Patient

maintaining their balance. The measuring scale is placed on the wall. SAMPLE The sample consists of 20 Osteoarthritis, patients and 20 control subjects.
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TABLE -1 FUNCTIONAL REACH SCORES OF

MALE SUBJECTS (45-65 YRS)

OA KNEE 11.2 10.5 9.5 10.4 11 8.9 9.3 10.6 8.5 9.2 CONTROL 16.3 15.6 15.2 16 17 14.8 15.6 16.8 16.5 16.7

TABLE 2 (MALES) BETWEEN GROUP ANALYSIS USING PAIRED T-TEST FOR MALES

OA KNEE Mean 9.91

CONTROL Mean 16.05

SIGNIFICANT

(p <0.001) SD 0.9409 S.D 0.7337

Functional Reach Test By Patient

RESULTS:

Table 2 shows the value of mean and S.D functional reach test score between OA knee patients and control subjects. For OA patients mean value is 9.91 and standard deviation
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(S.D) 0.9409. For control subjects mean value 16.05 and S.D 0.7337. In order to find out the level of significance. I used paired T- test. The

results shows that level of significance p value <0.001.

BAR DIAGRAM

BETWEEN GROUP ANALYSIS USING PAIRED TTEST FOR MALES

20 15 10 5 0 OA (MALE)
TABLE 3 FUNCTIONAL REACH SCORES OF FEMALE SUBJECTS (45-65YRS) OA KNEE 9.3 8.5 9.4 10.5 CONTROL 14.6 13.3 12.6 14.5

CONTROL(MALE)

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8.9 9.2 10.1 9.5 8.5 10.2

13.3 14 14.2 12.5 13.9 14.5

FUNCTIONAL REACH TEST SCORES OF FEMALES(45 TO 65 YRS)

16 14 FRT SCORES 12 10 8 6 4 2 0 SUBJECTS OA CONTROL

TABLE 4 (FEMALES) BETWEEN GROUP ANALYSIS OF FEMALE USING PAIRED T-TEST

OA KNEE

CONTROL

SIGNIFICANT

Mean

9.4

Mean

13.74 (p <0.005)

SD

0.688

S.D

0.7763

RESULTS: Table 4 shows the value of mean and standard

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deviation of functional reach test score between OA patients and control subjects. For

Scientific Research Journal of India Volume: 2, Issue: 4, Year: 2013

OA patients mean value 9.4 and SD 0.688. For control subjects mean value 13.74 and SD 0.7763. In order to find out the level of

significance I used paired t-test. The results shows that the level of significance p-value < 0.005.

BAR DIAGRAM
BETWEEN GROUP ANALYSIS OF FEMALE USING PAIRED T-TEST

15

10

0 OA KNEE CONTROL

DISCUSSION The aim of this study is to identify the standing balance performance between OA knee patients and age matched normal controls. Table -1 Shows that value of functional reach test score for male. The value of functional reach score which is high for control subjects compared with AO patients. Table 2 shows the value of mean and S.D functional reach test score between OA knee patients and control subjects. For OA patients mean value is 9.91 and standard deviation (S.D) 0.9409. For control subjects mean value

16.05 and S.D 0.7337. In order to find out the level of significance. I used paired T- test. The results shows that level of significance p value <0.001. Table 3 Shows that the value of functional reach test score for female. The value of functional reach test score which is high for control subjects compared with OA patients. Table 4 shows the value of mean and standard deviation of functional reach test score between OA patients and control subjects. for OA patients mean value 9.4 and SD 0.688. For control subjects mean value 13.74 and SD 0.7763. In order to find out the level of significance I used paired t-test. The results

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shows that the level of significance p-value < 0.005. KORALEWICZ12et-all 2000 concludes knee proprioception in middle aged and elderly persons with advanced knee arthritis are reduced in comparison with that in middle aged and elderly persons without arthritis. HASSON11et-all 2001 June concluded

Based on the results it is suggests that OA knee patients having significant loss of (Proprioception) compared with balance normal performance controls. While

comparing the functional reach test score value between male and female, male

obtaining more value than female. It suggests that female having more risk of imbalance than man. CONCLUSION To conclude from the results of this study osteoarthritis knee patients having significant loss of (Proprioception) balance performance compared with normal age match controls. RECOMMENDATION This study can be carried out large sample size. This study can be carried out different BM.

compared with age sex mateched controls, subjects with symptomatic knee osteoarthritis have quadriceps weakness reduced knee proprioception and increased postural way. PAI Y.C.6et-all 2005 concludes

proprioception declines with age and is further impaired in elderly patients with knee osteoarthritis contribute to poor proprioception impairment may in

functional

osteoarthritis.

REFRENCES
1. 2. 3. Tidys physiotherapy 4th Edition Page No. 107-109 Author TIDYS and THOMSON. Orthopaedics and Traumatology 6th Edition Author - NATARAJAN Motor control theory and practical applications Page No.208-209 Author ANNE SHUMWAY, MARJORIE WOOILACOTT 4. 5. 6. 7. Effects of kinaesthesia and balance exercises in knee osteoarthritis 2005 Dec., DIRACOGLU .D, AYDIN. R Effects of age and osteoarthritis on knee proprioception 12th Dec., 2005 PAI.Y.C Impaired proprioception and osteoarthritis 1997 May SHARMA .L, PAI.Y.C Is knee joint proprioception worse in the arthritic knee versus the unaffected knee in unilateral knee osteoarthritis 1997 August- HOLT KAMP .K, 8. RYMER WZ

Relationship of knee joint proprioception to pain and disability in individuals with knee osteoarthritis 2000KIM.L, BENNELL, RANA.S.

9.

Static postural sway, proprioception and maximal voluntary quadriceps contraction in patterns with knee osteoarthritis and normal control subjects, January 2001, HASSAN B.S. , MOCKETT.S

10. Effect of pain reduction on postural sway. Proprioception and quadriceps strength in subjects with knee osteoarthritis 2002 May- HASSAN B.S., DOHERTHY. S.A.
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11. Influence of elastic bandage on knee pain. Proprioception and postural sway in subjects with knee osteoarthritis 2002- B. HASSAN, S. MOCKETT 12. Comparison of proprioception in arthritic and age matched normal knees 2000- KORALEWICZ L.M. ENGH. G.A. 13. The incidence and neutral history of knee osteoarthritis in the elderly- 1995, OCT., FILSON D.T. , ZHANQ.Y 14. Incidence and progression of osteoarthritis in women with unilateral knee disease in the general population the effect of obesity Sept., 1994- D.V. DOYLE, D.J. HART 15. Incidence and risk factor for radiographic knee osteoarthritis in middle aged women 22 May 2001- KIM.D. DEBORAH, J. HART. 16. The influence of pathology pain balance and self-efficacy on function in women with osteoarthritis of the knee Sept., 2004 A.L. HARRISON.

17. Strategies for enhancing proprioception and neuromuscular control of the knee 2002 Sep., - WILLIAMS AND
WILKINS.

CORRESPONDING AUTHOR:

* Department of physiotherapy Pallava hospitals

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