Task Specific Exercise Training versus Graded Motor Imagery on Pain, Function, Knee Muscle Torque and Task Performance for Knee Osteoarthritis

Background: Individuals with knee osteoarthritis (OA) might not be comfortable with vigorous manual therapy approaches due to severe pain. Complementary therapies can be effective in such situations. Task specific exercise training (TSET) and graded motor imagery (GMI) are two such therapies which are less explored for their effectiveness in knee OA. So, the aim of this study was to determine and compare the effects of TSET and GMI on pain, function, task performance, mobility and muscle torque in knee OA.
Methods: Thirty-two individuals aged 40-65 years with grade 2 and above knee OA and pain intensity of > 4 on verbal scale were randomly assigned to TSET (n=16) and GMI (n=16) groups who received intervention thrice a week for 3 weeks. Pre (session 1) and post (session 9) outcome analysis was done for pain intensity by Numerical Pain Rating Scale, Knee injury and osteoarthritis outcome score for quality of life (QOL), three performance-based tests [30-second chair climb test, timed stair climb test and floor transfer test], peak torque and ratio for quadriceps and hamstrings using Isokinetic testing system and knee range of motion by goniometry.
Results: Statistically significant difference was seen within both groups for all the outcomes (P<0.05). Both groups were equally effective for pain (P= 0.731), QOL (P=0.863) as well as all the objective based outcomes (performance-based tests, knee ROM, peak torque and ratio)
Conclusion: Both TSET and GMI are effective complementary therapy approaches to treat knee OA in terms of pain, function and task performance.

背景：膝骨关节炎（knee osteoarthritis, OA）患者常因剧烈疼痛难以耐受高强度徒手治疗方案。在此类临床场景中，补充疗法可发挥积极作用。任务特异性运动训练（Task specific exercise training, TSET）与分级运动想象疗法（graded motor imagery, GMI）即属于此类疗法，目前针对二者在膝骨关节炎中应用效果的相关探索仍较为有限。因此本研究旨在明确并比较TSET与GMI对膝骨关节炎患者疼痛、功能、任务表现、活动能力及肌肉扭矩的影响。
方法：本研究纳入32名年龄40~65岁、膝骨关节炎分级为2级及以上且语言疼痛评分＞4分的受试者，将其随机分为TSET组（n=16）与GMI组（n=16），两组均接受每周3次、共计3周的干预治疗。分别于干预前（第1次访视）与干预后（第9次访视）开展结局指标评估：采用数字疼痛评分量表（Numerical Pain Rating Scale）评估疼痛强度，使用膝损伤与骨关节炎结局评分（Knee injury and osteoarthritis outcome score）评价生活质量（Quality of Life, QOL），完成3项基于表现的测试[30秒坐站试验（30-second chair climb test）、计时爬梯试验（timed stair climb test）及平地转移试验（floor transfer test）]，通过等速测试系统（Isokinetic testing system）测定股四头肌（quadriceps）与腘绳肌（hamstrings）的峰值扭矩及扭矩比值，采用量角器测量法（goniometry）测量膝关节活动度（knee range of motion, ROM）。
结果：两组受试者的所有结局指标组内比较均存在统计学显著性差异（P<0.05）。在疼痛改善（P=0.731）、生活质量提升（P=0.863）以及所有客观结局指标（基于表现的测试、膝关节活动度、峰值扭矩及扭矩比值）方面，两组疗效相当。
结论：TSET与GMI均为治疗膝骨关节炎的有效补充疗法，可改善患者的疼痛症状、躯体功能及任务表现。