Proprioceptive Neuromuscular Facilitation compared to usual resistance exercise therapy in individuals with knee osteoarthritis: a randomized clinical trial protocol
Keywords:Osteoarthritis; Functional capacity performance; Arthralgia; Muscle stretching exercise.
Background/Aims: Knee osteoarthritis (KOA) is characterized by functional impairment in performing of daily life activities. Proprioceptive Neuromuscular Facilitation (PNF) is a treatment concept that recommends performing exercises within a context of functionality. To develop a protocol to evaluate the efficacy of (PNF) compared to conventional physiotherapy (CPT group) on pain reduction and improvement in physical functioning and quality of life in individuals with KOA. Methods: A protocol for a randomized controlled trial was proposed to evaluate the effectiveness of the PNF protocol in pain reduction, improvement physical functioning, quality of life and evaluation of adverse effects, according Consolidated Standards of Reporting Trials. Participants will be randomly assigned (1:1) to PNF or CPT group and twelve weekly sessions will be carried out for three months. To assess primary outcome measures are knee pain severity (Numeric Rating Scale) and physical functioning (The Western Ontario and McMaster Universities questionnaire). The outcomes will be performed at baseline, 12th session (6 weeks), 24th session (12 weeks) and three-month follow-up. Intention-to-treat will be performed. Results: A PNF protocol was developed for KOA, consisting of seven illustrated exercises. Biomechanical objectives, observations, positions of individuals and therapists, load progression, PNF principles, procedures and techniques have been described. Conclusion: The detailed elaboration of a physical therapy treatment protocol based on the PNF-concept allows a treatment approach based on the principles of learning and motor control, favoring the mitigating and improving physical functioning and quality of life of the individuals with KOA.
Adler, S.S., Beckers, D.& Buck, M. (2014). PNF in practice. 4th ed. Berlin, Heidelberg: Springer‐Verlag.
American College of Sports Medicine. (2012). Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise. 2011. Med Sci Sports Exerc, 43(7),1334-59. DOI: 10.1249/MSS.0b013e318213fefb.
American Geriatrics Society Panel on Exercise and Osteoarthritis. (2001) Exercise prescription for older adults with osteoarthritis pain: consensus practice recommendations. J Am Geriatr Soc, 9(6), 808-23. DOI: 10.1046/j.1532-5415.2001.00496.x
Anastakis, D.J., Malessy, M.J.A., Chen, R., Davis, K.D. & Mikulis, D. (2008). Cortical plasticity following nerve transfer in the upper extremity. Hand Clinics, 24(4), 425–444. https://doi.org/10.1016/j. hcl.2008.04.005
Bellamy, N., Buchanan, W.W., Goldsmith, C.H., Campbell, J. & Stitt, L.W. (1988). Validation study of WOMAC: a health status instrument for measuring clinically important individual relevant outcomes to antirheumatic drug therapy in individuals with osteoarthritis of the hip or knee. J Rheumatol, 15(12),1833- 40.
Bennell, K.L., Dobson, F. & Hinman, R.S. (2014). Exercise in osteoarthritis: Moving from prescription to adherence. Best Pract Res Clin Rheumatol, 28(1), 93-117. DOI: 10.1016/j.berh.2014.01.009.
Bertichamp, U. (2012) Concept PNF: facilitation proprioceptive neuromusculaire (concept Kabat-Knott- Voss). Encyclop médico-chirurgicale, 26, 1-10.
Brandt, K.D., & Dieppe P. (2009). Etiopathogenesis of osteoarthritis. Med Clin North Am, 93(1),1-24. DOI: 10.1016/j.mcna.2008.08.009.
Cano-de-la-Cuerda, R., Molero-Sánchez, A., Carratalá-Teiada, M., Alguacil-Diego, I.M., Molina-Rueda, F., Miangolarra-Page, J.C. &Torricelli, D. (2015). Theories and control models and motor learning: clinical applications in neuro-rehabilitation. Neurologia, 30(1),32-41. DOI: 10.1016/j.nrl.2011.12.010.
Chan, A.W., Tetzlaff, J.M., Altman, D.G, Laupacis, A., ...& Moher, D. (2013). SPIRIT 2013 Statement: Defining standard protocol items for clinical trials. Ann Intern Med., 158(3),200-207.
Chow, T.P. & Ng, G.Y. (2010). Active, passive and proprioceptive neuromuscular facilitation stretching are comparable in improving the knee flexion range in people with total knee replacement: a randomized controlled trial. Clin Rehabil, 24 (10),911-18. DOI: 10.1177/0269215510367992.
Ciconelli, R.M., Ferraz, M.B., Santos, W., Meinão, I. & Quaresma, MR.. (1999). Tradução para a língua portuguesa e validação do questionário da qualidade de vida Sf-36 (BrasilSF-36). Revista Brasileira de Reumatologia, 39 (1), 143-150.
Correa, M. (2007). Functional neuroanatomy of implicit learning: associative, motor and habit. Rev Neurol, 44(4), 234-42.
Dobson, F., Hinman, R.S., Ross, E.M., Abbott, J.H., Stratford, P., ...& Bennel, K.L. (2013). OARSI recommendes performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Osteoarthritis CartilageI, 21(8), 1042-53. DOI: 10.1016/j.joca.2013.05.002.
Domingues, L. & Cruz, E. (2014). Adaptação Cultural e Contributo para a Validação da Escala Patient Global Impression of Change. Ifisionline, 2(1), 31–37. Retrieved from http://comum.rcaap.pt/handle/ 123456789/4256.
Feber, R., Osterning, L. & Gravelle, D. (2002). Effect of PNF stretch techiniques on knee flexor muscle EMG activity in older adults. J Electrom Kinesiol, 2 (5), 391-397. DOI: 10.1016/s1050- 6411(02)00047-0.
Fransen,, M., Osterning, L., Harmer, A.R., Van der Esch, M., Simic, M. & Bennell, K.L. (2015) Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br J Sports Med, 49(24),1554-7. DOI: 10.1136/bjsports-2015-095424.
Greene, P.H.(1982). Why is it easy to control your arms? J Moth Behave Journal, 14(4),260-86. DOI: 10.1080/00222895.1982.10735280.
Guiu‐Tula, F.X., Cabanas‐Valdés, R., Sitjà‐Rabert, M., Urrútia, G. & Gómara‐Toldrà, N. (2017) The efficacy of the proprioceptive neuromuscular facilitation (PNF) approach in stroke rehabilitation to improve basic activities of daily living and quality of life: A systematic review and meta‐analysis protocol. BMJ Open, 7(12), e016739. https://doi.org/10.1136/bmjopen-2017-016739
Gür, H., Cakin, N., Akova, B., Okay, E. & Küçükoğlu, S. (2002). Concentric versus combined concentric- eccentric isokinetic training: effects on functional capacity and symptons in individuals with psteoarthritis of the knee. Arch Phys Med Rehabil, 83(3),308-16. DOI: 10.1053/apmr.2002.30620
Hochberg, M.C., Altman, R.D., Abril, K.T., Benhalti, M., Guyatt, G., ... & Tugwell, P. (2012). American college of rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken), 64(4),465-74. DOI: 10.1002/acr.21596
Kantak, S.S., Sullivan, K.J., Fisher, B.E., Knowlton, B.J. & Winstein, C.J. (2010). Neural substrates of motor memory consolidation depend on practice strucuture. Nat Neurosc, 13(8),923-25. DOI: 10.1038/nn.2596.
Kim, B., Yi, D. & Yim, J. (2019) Effect of the combined isotonic technique for proprioceptive neuromuscular facilitation and taping on pain and grip strength in patients with lateral epicondylitis: A randomized clinical trial. Journal of Exercise Rehabilitation,15(2), 16–321.
Kofotolis,N. & Kellis, K. (2006). Effects of two 4- week proprioceptive neuromuscular facilitation programs on muscle endurance, flexibility, and functional performance in women with chronic low back pain. Phys Ther, 86 (7),1001-2.
Lee, J.H., Park, S.J. & Na, S.S. (2013). The effect proprioceptive neuromuscular facilitation therapy on pain and function. J Phys Ther Science, 25(6), 713-16. DOI: 10.1589/jpts.25.713.
Li, Y., Su, Y., Chen, S., Zhang, Y., Zhang, Z., Liu, C., ... &Zheng, N. (2016). The effects of resistance exercise in individuals with knee osteoarthritis: a systematic review and meta-analysis. Clin Rehabil, 30(10), 947-59. DOI: 10.1177/0269215515610039.
Messier, S.P., Mihalko, S.L., Beavers, D.P., Nicklas, B., De Vita, P., ... & Loeser, R.F. (2013). Strength training for arthritis trial (START): design and rationale. BMC Musculoskelet Disord, 14, 208. DOI: 10.1186/1471-2474-14-208.
Michael, J.W., Schlüter-Brust, K.U. & Eysel, P. (2010) The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Deutsches Ärzteblatt International, 107(9), 152-62. DOI: 10.3238/arztebl.2010.0152.
Moher, D., Hopewell, S., Schulz, K.F., Montori, V., ...& Altman, D.G. CONSORT. (2010). CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol, (8),1–37. DOI: 10.1016/j.ijsu.2011.10.001.
Rosis, R.G., Massabki, O.S. & Kairalla, M. (2010). Osteoartrite: avaliação clínica e epidemiológica de pacientes idosos em instituição de longa permanência. Rev Bras Clin Med, 8(2),101-108.
Shumway‐cook A & Woolacott MH. (2012).Motor control: Translating research into clinical practice. 4th ed. Philadelphia: Lippincott Williams & Wilkins.
Smedes, F., Heidmann, M., Schäfer, C., Fischer, N. & Stępień, A. (2016). The proprioceptive neuromuscular facilitation‐concept; the state of the evidence, a narrative review. Physical Therapy Reviews, 21(1), 17– 31. https://doi.org/10.1080/10833196.2016.1216764
Tedla, J.S. & Sangadala, D.R. (2019). Proprioceptive neuromuscular facilitation techniques in adhesive capsulitis: A systematic review and meta‐analysis. J Musculoskel Neuronal Interact, 19(4),482–491.
Weng, M.C., Lee, C.L., Chen, C.H., Hsu, J.J., Lee, W.D., Huang, M.H. & Chen, T.W. (2009). Effects of different stretching techniques on the outcomes of isokinetic exercise in individuals with knee osteoarthritis. The Kaohsiu J Med Sci. , 25 (6), 396-15. DOI: 10.1016/S1607-551X (09)70521-2.
How to Cite
Copyright (c) 2022 Thaís Ferreira Lopes Diniz Maia; Angélica da Silva Tenório; José Vicente Pereira Martins; Pollianna Tavares de Barros; Franciele Borges de Oliveira; Paulo José Moté Barboza; Débora Wanderley; Daniella Araújo de Oliveira
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.