Ckc trials

Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Last Update Posted : April 20, See Contacts and Locations. Study Description. Detailed Description:. FDA Resources. Arms and Interventions. In the OKC exercise group, participants will be taught by a physiotherapist about open kinetic chain exercises. The untreated control group will receive patient's usual care of local government hospital which includes information about clinical manifestations, risk factors, diagnosis, treatment and nursing care for knee OA.

Outcome Measures. Primary Outcome Measures : Change from baseline of pain intensity score at post-intervention [ Time Frame: 8 weeks ] pain intensity will be assessed using a visual analogue scale.

Western Ontario and McMaster Universities Arthritis Index consists of a number of questions designed to assess the clinical severity of the disease 5 questions for pain, 2 questions for stiffness and 17 questions for physical function.

The Osteoarthritis Knee and Hip Quality of Life in Malay Version consists of 43 items divided into five dimensions: physical activity, mental health, pain, social support, and social functioning Each item in the five dimensions is measured on a numerical rating scale from 0 to The knee adduction moment calculated from the vertical ground reaction force will be collected during mid-stance phase of gait.

Eligibility Criteria. Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Contacts and Locations. Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its ClinicalTrials. More Information.

Only research team members can access the data. Within an exercise intervention protocol it is not possible to blind either therapist or participant, leaving the maximum score possible as 9 out of The included studies scored in the range of 6—9 on the PEDro scale see Figure 2.

Table 2 details the exercise parameters used in each of the studies. Open chain exercises were used in eight programs, while closed chain exercises were employed by eleven. Stretching was a feature of all but one protocol and was done concurrently with the strengthening program. All trials reported frequency per week and duration in weeks.

The most common frequency of exercise was a 6-week period of daily exercise employed by four of the ten included trials. Although Bakhtiary and Fatemi 7 had the shortest intervention period of 3 weeks, the frequency of exercise sessions were the greatest twice daily , bringing the total volume of exercise sessions more in line with the remaining literature that reported positive effects of exercise on PFPS.

Intensity ranged from varying percentages of maximum effort to failure to report. The included trials reported a minimum of ten repetitions, except two studies 9 , 16 which involved lengthy isometric contractions repeated a lesser number of times.

Studies included between one and four sets, with larger numbers of sets when the repetitions were lower see Crossley et al 16 or lower numbers of sets where the repetitions were higher see Bakhtiary and Fatemi 7. Although the majority of studies included specific instructions for aspects of the techniques applied, the overall explanation of the interventions was not mentioned. Studies also detailed amount of pain two studies 8 , depth of squat or lunge two studies 6 , 16 and used biofeedback to enhance selective muscle recruitment one study Stretching was included in eight of the ten trials.

The majority of trials 9 — 11 , 15 , 16 , 19 examined three repetitions of second duration. The frequency of stretching varied as it was performed concurrently with strengthening; further details can be found in Table 2. Table 3 summarizes these co-interventions. The additional interventions included advice to avoid symptom-producing activity, taping, education, nonsteroidal anti-inflammatory drugs, simple analgesics, bracing, and patella mobilizations.

Taping and education were the two most common co-interventions. This review provides evidence-based recommendations to clinicians who wish to use exercise programs to improve pain and function in patients with patellofemoral pain. The high frequency of both OKC and CKC exercises employed by the included studies indicates support for the use of both exercise types.

The majority of the trials reported an intervention period of 6 weeks, except Witvrouw et al 4 and Bakhtiary and Fatemi, 7 which reported 5- and 3-week intervention periods, respectively. Therefore, an intervention period of 6 weeks could be considered the starting length for programs targeting PFPS, as the studies with intervention periods of 6 or more weeks were most commonly reported and associated with positive outcomes.

The majority of studies eight out of ten prescribed 5 or more days of exercises per week. Thus, the choice of frequency is likely to be a reflection of goals of training, and the need for adequate recovery following higher intensity training. Based on these results, frequency of training should be chosen with respect to the type of exercise and the perceived goals of training, and principles of overload and progression should be considered where strength is a target of intervention.

Strength as a target of treatment was explicitly stated by nine of the ten studies. The exercise interventions incorporated into protocols demonstrating positive results knee extension, squats, stationary cycling, static quadriceps, active straight leg raise, and step up and step down exercises contain an implicit strengthening component.

Targets of strengthening exercises varied according to the trial; however, frequently included quadriceps, gluteals, hip abductors, and external rotators, and occasionally included hip adductors. Nakagawa et al 9 reported significant improvement with the addition of hip and core strengthening compared with controls receiving quadriceps strengthening only.

The high reporting of exercises that strengthened both hip and knee muscle groups among programs which demonstrated positive outcomes supports their inclusion in exercise programs and reflects the hip and knee strength deficits that have been shown to exist in patients with PFPS.

Stretching of various lower limb musculatures was included as an adjunct to exercise in eight of the ten trials. Of these, seven trials specified the stretched muscles, with all seven including hamstring and quadriceps stretches, six including gastrocnemius, five including the iliotibial band ITB , and two including anterior hip stretches. To date only one randomized controlled trial 20 has specifically investigated the effect of stretching on PFPS in isolation, concluding that although it seemed to improve flexibility and knee function there was no statistically significant improvement in pain or function with stretching alone.

In a cohort study, Tyler et al 21 reported that successful outcomes were correlated to demonstrated improvements in ITB and iliopsoas flexibility. The frequent inclusion of stretching in studies reporting positive outcomes further supports the use of stretching as an inclusion in exercise protocols. There has been a great emphasis on deficits in VMO strength and timing in interventions which selectively train this muscle. Interestingly, only two of the included studies 10 , 16 showing positive effects of exercise incorporated selective VMO training.

Syme et al 10 found significant improvements with general and VMO selective strengthening compared with controls; however, there was no between-group difference. The authors 10 recommend that it not be overly focused on for progressing rehabilitation. The review revealed a minimum of 20—40 total repetitions should be considered when prescribing exercises for patellofemoral pain.

This review focused on exercises undertaken as part of a structured exercise program rather than general exercises such as walking and unstructured exercises such as Pilates. As such, this review does not provide any insight into the role of general physical activity and unstructured exercises in the management of patients with PFPS.

Like previous reviews, this review has highlighted risk of bias, due to poor methodology, in some of the primary research. One study did not report concealing of subject allocation, two did not report blinding of the primary outcome assessor, and intention to treat analysis was not reported in two of the eight studies. Co-interventions such as taping, education, and patella mobilization were also a common feature. Taping for example is reported to provide benefits independent of exercise, 15 leading to opportunities for confounding.

This does, however, reflect clinical practice where exercise is frequently combined with co-interventions. This systematic review builds on the current body of evidence which supports the use of exercise in reducing pain and increasing function ability in patients with PFPS. This review provides clinicians with specific parameters in order to devise an evidence-based exercise program to treat PFPS.

Based on evidence from the literature, results are optimal when exercises are performed on a daily basis for 6 or more weeks. The interventions shown to be most effective are knee extension, squats, stationary cycling, static quadriceps, active straight leg raise, and step up and step down exercises combined with flexibility exercises.

The evidence suggests that a progressive program of two to four sets of ten or more repetitions has the most benefit.

These myriad of exercise options provide clinicians with the flexibility to tailor their exercise programs to suit individual needs and requirements of their patients.

The findings from this review also suggest that exercise programs can be effective when used independently, or in combination with other treatments such as patella mobilization, taping, and education. Click here for a full list of profiles.

Health Breed Facts. The first Field Trial was held on 11 th. November The CKC was started with a sporting dog and most of the interest, in those days, was with the value of a dog as a worker.

Field Trials for retrievers are meant to produce a winner. The sport grew very fast and became very competitive.