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Pain Sensitization and Outcome Following Physiotherapy in Patients With Knee Osteoarthritis

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02310945
Recruitment Status : Unknown
Verified December 2014 by University College Dublin.
Recruitment status was:  Recruiting
First Posted : December 8, 2014
Last Update Posted : December 8, 2014
Health Research Board, Ireland
Information provided by (Responsible Party):
University College Dublin

Brief Summary:

Pain is the dominant symptom of knee osteoarthritis and recent evidence suggests factors outside of local joint pathology, such as pain sensitization, can contribute significantly to the pain experience. It is unknown how pain sensitization influences outcomes from commonly employed interventions such as physiotherapy.

The aims of this study are, firstly to identify people with knee OA who display signs and symptoms associated with pain sensitization using clinical tools and quantitative sensory testing. Secondly, we will investigate if indications of pain sensitization at baseline are associated with poor outcome following physiotherapy.

Methods and analysis:

This is a multi-centre prospective cohort study with 140 participants. Eligible patients with moderate/severe symptomatic knee osteoarthritis will be identified at hospital outpatient clinics. A baseline assessment will provide a comprehensive description of the somatosensory characteristics of each participant by means of clinical examination, quantitative sensory testing and validated questionnaires measuring pain and functional capacity. Participants will then undergo physiotherapy treatment, in line with current clinical guidelines. Follow-up post physiotherapy treatment (estimated to be at 3 months) will assess pain, disability (sub-scales of Western Ontario and McMasters University Score Osteoarthritis Index) and participants' global rating of change. These primary outcome measures will dichotomise participants into treatment 'responders' and 'non-responders' according to the Osteoarthritis Research Society International (OARSI) treatment responder criteria.

For data analysis results from pressure pain thresholds, temporal summation and conditioned pain modulation will create a composite score of pain sensitization. Logistic regression will explore the relationship between response to physiotherapy and pain sensitization at baseline while accounting for various cofounders.

Condition or disease Intervention/treatment
Knee Osteoarthritis Other: Physiotherapy

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Study Type : Observational
Estimated Enrollment : 140 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Pain Sensitization and the Risk of Poor Outcome Following Physiotherapy for Knee Osteoarthritis: A Protocol for a Prospective Cohort Study
Study Start Date : June 2014
Estimated Primary Completion Date : October 2015
Estimated Study Completion Date : January 2016

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Osteoarthritis

Group/Cohort Intervention/treatment
Knee osteoarthritis
People with moderate/severe symptomatic knee osteoarthritis referred for physiotherapy
Other: Physiotherapy
Individualised programme for each patient in line with current clinical guidelines. May include education, exercise (strengthening, range of motion exercise, aerobic), lifestyle advice and manual therapy

Primary Outcome Measures :
  1. Change in response to physiotherapy as measured by the pain and function sub-scales of Western Ontario and McMasters University Score Osteoarthritis Index (WOMAC) and patient's global rating of change. [ Time Frame: Baseline & at 3 months (estimated time point for physiotherapy treatment completion) ]
    These 3 outcome measures will gather data that will be applied to a set of treatment responder criteria by the Outcome Measures in Rheumatology - Osteoarthritis Research Society International (OMERACT-OARSI) to determine a positive response to physiotherapy or a 'treatment responder'

Secondary Outcome Measures :
  1. Quantitative sensory testing (pressure pain thresholds, temporal summation, conditioned pain modulation, mechanical detection thresholds) [ Time Frame: Baseline ]
    To describe the somatosensory characteristics of the sample and detect features of pain sensitization

  2. Central Sensitization Inventory [ Time Frame: Baseline ]
    Questionnaire to assess for symptoms not related to the musculoskeletal system but common to central sensitization syndromes

  3. Modified PainDETECT [ Time Frame: Baseline ]
    Questionnaire that records any neuropathic component to patient's symptoms

  4. Centre for Epidemiologic Studies Depression Scale (CES-D) [ Time Frame: Baseline ]
    A measure of depressive symptoms

  5. Overweight/Obesity [ Time Frame: Baseline ]
    Measured by recording participants' waist circumference to height ratio

  6. Manual tender point count [ Time Frame: Baseline ]
    Manual tender point examination to identify tender points according to the American College of Rheumatology criteria for fibromyalgia

  7. EQ-5D 5L [ Time Frame: Baseline ]
    Questionnaire to measure health related quality of life

  8. Self Administered Comorbidity Questionnaire [ Time Frame: Baseline ]
    Questionnaire to record presence of comorbid conditions

  9. Widespread pain [ Time Frame: Baseline ]
    Widespread pain is defined according to the American College of Rheumatology classification criteria using pain drawings marked by participants on a body manikin

  10. Patient adherence monitored over the course of physiotherapy treatment (Sports Injury Rehabilitation Adherence Scale (SIRAS) and Home Exercise Compliance Assessment (HECA) ) [ Time Frame: Recorded at each physiotherapy appointment (approx 6 times between 0 and 3 months) ]
    SIRAS records physiotherapist's perceptions of patient's rehab adherence. HECA is a self-report method for patients to measure their own adherence

  11. Change in medication use and use of co-interventions [ Time Frame: At 3 months (estimated time point for physiotherapy treatment completion) ]
    Any self reported change in medications and co-interventions. Recorded at 3 months using follow-up questionnaire.

  12. Change in knee pain and disability at 6 months [ Time Frame: Baseline and at 6 months ]
    Measured with pain and disability sub-scales of Western Ontario and McMasters University Score Osteoarthritis Index (WOMAC)

Information from the National Library of Medicine

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Ages Eligible for Study:   50 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

The cohort will be recruited from patients with moderate/severe symptomatic knee OA attending outpatient orthopaedic and rheumatology clinics and referred for physiotherapy treatment by a hospital consultant or clinical specialist physiotherapist.

At the time of recruitment knee pain must be the participant's primary musculoskeletal complaint they are seeking treatment for, and physiotherapy must be the main treatment being undertaken over the study period


Inclusion Criteria:

  • Knee osteoarthritis diagnosed by American College of Rheumatology clinical criteria
  • Knee pain must be the primary musculoskeletal complaint participant is seeking treatment for
  • Pain duration greater than 3 months
  • Pain severity ≥ 5/10 on Numerical Rating Scale
  • Willing to abstain from simple analgesics and NSAIDs for 24 hours prior to testing
  • Willing and able to give full consent

Exclusion Criteria:

  • Lumbar or cervical radiculopathy,
  • Systematic inflammatory disease,
  • Positive screen for diabetic neuropathy
  • Past medical history
  • Previous surgery or disease of the peripheral or central nervous system,
  • Sensory loss secondary to chemotherapy or radiotherapy
  • Fibromyalgia
  • Chronic fatigue syndrome
  • Cognitive or psychiatric disorder interfering with ability to cooperate with assessment
  • Injection or physiotherapy treatment for knee joint within previous 3 months
  • Taking anti-depressant or anti-convulsant medication

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 identifier (NCT number): NCT02310945

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Contact: Helen O'Leary, BSc Physio 353860665530
Contact: Catherine Doody, BSc Physio 00353 17166514

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St. James's Hospital Recruiting
Dublin, Ireland, 2
Contact: Jennie Cronin, BSc Physio    00353 14162503   
Contact: Niamh Murphy, BSc Physio    00353 14162503   
St. Vincent's University Hospital Recruiting
Dublin, Ireland, 4
Contact: Keith Smart, BSc Physio    00353 12214467   
Contact: McLoughlin Catherine, BSc Physio    00353 12214467   
Principal Investigator: Helen O'Leary, BSc Physio         
Tallaght Hospital Recruiting
Dublin, Ireland
Contact: Aisling Brennan, BSc Physio    00353 14142750   
Contact: Rachel Burke, BSc Physio    00353 14142750   
Sponsors and Collaborators
University College Dublin
Health Research Board, Ireland
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Principal Investigator: Helen O'Leary, BSc Physio University College Dublin
Study Director: Catherine Doody, BSc Physio University College Dublin
Study Chair: Keith Smart, BSc Physio St. Vincent's University Hospital
Study Chair: Niamh Moloney, BSc Physio University College Dublin

Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: University College Dublin Identifier: NCT02310945    
Other Study ID Numbers: HPF/2013/44
First Posted: December 8, 2014    Key Record Dates
Last Update Posted: December 8, 2014
Last Verified: December 2014
Keywords provided by University College Dublin:
central nervous system sensitization
Additional relevant MeSH terms:
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Osteoarthritis, Knee
Joint Diseases
Musculoskeletal Diseases
Rheumatic Diseases