Conventional non-surgical management of knee osteoarthritis (OA) stresses on improving knee muscle strength and range of motion. However, the results may not be satisfactory. Recent studies show that neuromuscular training is the key to enhance knee control and functional limitations in patients with knee OA. Knee OA management programmes such as the Good life with osteoarthritis in Denmark (Gla:D) and Better management of patients with osteoarthritis (BOA) in Sweden are successful examples. The essential elements of neuromuscular training are: emphasis on quality of movement, knee joint control with normal biomechanics and muscle activation and postural control to perform functional activities.
Locally, the Comprehensive Osteoarthritic ManagEment program (COME) of MacLehose Medical Rehabilitaion Centre commenced in January 2016, with 100 patients (30 males and 70 females with age 65.3±13.3 and 64.1±7.4 respectively) recruited and completed a three-month and one-year evaluation in February 2019. All patients had completed a six-week and 12-session intensive training programme, including neuromuscular control, muscle strengthening, flexibility and aerobic training.
There were statistically and clinically significant improvements (p<0.05) from (a) baseline to (b) six weeks, (c) three months and (d) one year post training in the following (mean±SD):
1. One-minute chair test in repetitions – (a) 30.3±11.2, (b) 40.5±11.9, (c) 43.2±13.8
2. Stairs management in seconds – (a) 7.1±3.3, (b) 5.4±1.6, (c) 5.4±1.7
3. Pain in weight bearing movement – (a) 4.2±2.6, (b) 2.9±2.5, (c) 2.9±2.5, (d) 3.2±2.5
4. Patient specific functional score (PSFS) – (a) 3.1±2.1, (b) 6.6±1.8, (c) 6.9±1.7, (d) 6.9±1.7
The results are promising and there were no adverse events reported from the patients. It is recommended that neuromuscular exercise be the essential component in the non-surgical management of knee OA.
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