Feasibility of a Group-based Programme Combining Vestibular Rehabilitation and Lower-limb Strengthening in Older Women with Bilateral Knee Osteoarthritis: A Single-arm Pilot Study with Exploratory Clinical, Functional and Electromyographic Outcomes
Guilherme Gallo Costa Gomes *
University of Ribeirão Preto (UNAERP), Physiotherapy Program, Ribeirão Preto, SP, Brazil.
Edson Donizetti Verri
University of Ribeirão Preto (UNAERP), Physiotherapy Program, Ribeirão Preto, SP, Brazil and University of Ribeirão Preto (UNAERP), Medicine Program, Ribeirão Preto, SP, Brazil.
Christian Rafael Rodrigues Farina
University of Ribeirão Preto (UNAERP), Physiotherapy Program, Ribeirão Preto, SP, Brazil.
Sabrina Maria Martinez Rodrigues
University of Ribeirão Preto (UNAERP), Physiotherapy Program, Ribeirão Preto, SP, Brazil.
João Fernando Barros Bellanda
University of Ribeirão Preto (UNAERP), Physiotherapy Program, Ribeirão Preto, SP, Brazil.
Bárbara Barros B. de Souza
University of Ribeirão Preto (UNAERP), Physiotherapy Program, Ribeirão Preto, SP, Brazil.
Emely Rodrigues Moreira
University of Ribeirão Preto (UNAERP), Physiotherapy Program, Ribeirão Preto, SP, Brazil.
Julia Castanheiro Veloso
University of Ribeirão Preto (UNAERP), Physiotherapy Program, Ribeirão Preto, SP, Brazil.
Gisele Cristina Rodrigues Lima
University of Ribeirão Preto (UNAERP), Physiotherapy Program, Ribeirão Preto, SP, Brazil.
Rafaela Caram Younes
University of Ribeirão Preto (UNAERP), Physiotherapy Program, Ribeirão Preto, SP, Brazil and University of Ribeirão Preto (UNAERP), Medicine Program, Ribeirão Preto, SP, Brazil.
Carlos Alberto Gíglio
University of Ribeirão Preto (UNAERP), Physiotherapy Program, Ribeirão Preto, SP, Brazil.
Bruno Cimatti
University of Ribeirão Preto (UNAERP), Physiotherapy Program, Ribeirão Preto, SP, Brazil.
Lucas Sartori Manoel
University of Ribeirão Preto (UNAERP), Physiotherapy Program, Ribeirão Preto, SP, Brazil.
Gabriel Pádua da Silva
University of Ribeirão Preto (UNAERP), Physiotherapy Program, Ribeirão Preto, SP, Brazil.
Tatiana Lemos de Almeida Mestriner
University of Ribeirão Preto (UNAERP), Physiotherapy Program, Ribeirão Preto, SP, Brazil.
*Author to whom correspondence should be addressed.
Abstract
Aims: This study assessed the feasibility of a group-based programme combining vestibular rehabilitation and muscle strengthening in women with bilateral knee osteoarthritis and, as exploratory objectives, estimated pre- to post-intervention changes in pain, isometric muscle strength, electromyographic activity, proprioception, postural instability and overall functionality, so as to generate parameters for sizing a definitive trial.
Study Design: Non-randomised, single-arm feasibility pilot study with pre- and post-intervention assessments, reported in accordance with TREND and CONSORT guidance for pilot trials.
Place and Duration of Study: Physiotherapy Teaching Clinic, University of Ribeirão Preto (UNAERP), Brazil; 25 sessions, twice weekly.
Methodology: Seven older women (74.29 ± 6.10 years) completed 25 sessions of lower-limb elastic resistance plus vestibular rehabilitation. Assessments comprised Timed Up and Go (TUG), hand-held dynamometry, Dizziness Handicap Inventory (DHI), Fukuda stepping test, algometry and electromyography during the sharpened Romberg test.
Results: All seven participants completed the programme and both assessments (100% retention, no adverse events). In exploratory, uncorrected pre- to post-intervention comparisons, TUG time decreased from 13.34 ± 3.17 to 10.30 ± 2.07 s and left knee extensor strength increased from 11.46 to 14.51 kgf (both P = .01). Left medial gastrocnemius activation fell 30.8% with eyes open (P = .03). DHI, Fukuda, and algometry outcomes were unchanged (P > .05). All comparisons were uncorrected for multiplicity and are reported as exploratory pre- to post-intervention changes rather than as evidence of efficacy.
Limitations: The single-arm design, seven participants and the absence of randomisation and of a control group preclude causal inference. Multiple comparisons were uncorrected, strengthening cannot be separated from the vestibular exercises, and the lack of objective vestibular testing limits interpretation.
Conclusion: The protocol proved feasible in a teaching-clinic setting. Because the design was single-arm and included no control group, the observed changes cannot be attributed to the programme; the exploratory findings are hypothesis-generating and suggest a possible contribution of peripheral musculoskeletal pathways. Definitive trials require objective vestibular screening, a control group, and an adequate sample.
Keywords: Knee osteoarthritis, vestibular rehabilitation, postural balance, electromyography, muscle strength, proprioception, Timed Up and Go, pressure pain threshold, feasibility study, older women