Background
Methods/Design
Design
Setting
Sample
Eligibility criteria
Male | Female | |
---|---|---|
Range of knee joint flexion | ||
55-64 years | < 128° | < 127° |
65-74 years | < 125° | < 122° |
75+ years | < 120° | < 117° |
Isometric quadriceps strength (kilograms force) | ||
55-64 years | < 18.1 | < 11.3 |
65-74 years | < 17.2 | < 9.4 |
75+ years | < 13.9 | < 9.0 |
Single-leg standing balance (seconds) | ||
55-64 years | < 8 | < 5 |
65-74 years | < 3 | < 3 |
75+ years | < 2 | < 2 |
Recruitment
Consent procedure
-
Practising of daily home exercises, and keeping of a daily exercise diary.
-
Study nurse visits in weeks 1, 6 and 12 of the study (Figure 2), involving measurement of quadriceps strengths, degree of knee flexion and standing balance, and completion of a self-report questionnaire, taking 10-20 minutes.
Interventions
-
The presence and degree of the three impairment(s).
-
The safety of the participant.
-
Participant ease of performance when practising the exercises under the supervision of the physiotherapist.
-
The preferences, motivations and concerns of the individual participant.
-
Explicit identification of activities of daily living that could be improved by an improvement in the identified impairment(s).
-
Education regarding the importance of strong quadriceps and/or good flexion range of motion and/or good balance both to the health of the knee joints and to overall function.
-
Advice and reassurance regarding the expected adverse effects of the exercises, such as temporary pain and stiffness, including advice about the benign nature of these side-effects and the use of ice, heat and simple analgesia to manage them.
-
Reassurance that the individual can contact one of the study physiotherapists by telephone at any time regarding any queries or concerns.
-
By the physiotherapist cultivating a clinical partnership of shared decision-making with the participant that takes into account their individual preferences, motivations and concerns.
-
By weekly physiotherapist contact with each of the participants, by either home visit or telephone conversation.
-
By recording participants' progress with each of the relevant impairments at each home visit using pin-up wall-chart graphs.
-
By encouraging participants to complete daily exercise diaries, which include details of which exercises were done how many times and how often, and any comments about the exercises and their performance.
Outcome measures
Primary outcome measures - impairments
-
Maximal isometric quadriceps strengths (continuous scale)
-
Degree of active end-range knee flexion (continuous scale).
Secondary outcome measures - symptoms
-
Global change in the knee problem (measured via Likert-response-type questions at 6 and 12 weeks) [34].
-
Adherence to the exercise programme (measured via one Likert-response type question at 6 and 12 weeks, and via one free-text-response-type question at 12 weeks).
-
Barriers to adherence to the exercise programmes, their acceptability and ways in which participants feel that they can be improved will be measured via two Likert-response-type questions and five free-text-response-type questions at 12-weeks only.
Data analysis
Primary analyses
Sensitivity analyses
-
Not having done any of the exercises at all in the course of at least one rolling calendar week throughout the 12 week period of their involvement in the study (according to the daily exercise diaries).
-
Not having done any of the exercises at all on a cumulative total of 12 days throughout the 12 week period of their involvement in the study (according to the daily exercise diaries).
-
Participant self-report of not having done their exercises as often as they were advised to in either the 6 or 12 week questionnaires.