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Preoperative Pain Neuroscience Education Combined With Knee Joint Mobilization for Knee Osteoarthritis: A Randomized Controlled Trial

Lluch Enrique PT PhD; Dueñas, Lirios PT, PhD; Falla, Deborah PT, PhD; Baert, Isabel PT, PhD; Meeus, Mira PT, PhD; Sánchez-Frutos, Jose MD, PhD; Nijs, Jo PT, PhD
The Clinical Journal of Pain: Post Acceptance: May 16, 2017
doi: 10.1097/AJP.0000000000000511
Original Article: PDF Only

Objectives:

This study aimed to first compare the effects of a preoperative treatment combining pain neuroscience education (PNE) with knee joint mobilization versus biomedical education with knee joint mobilization on central sensitization (CS) in patients with knee osteoarthritis, both before and after surgery. Second, we wanted to compare the effects of both interventions on knee pain, disability, and psychosocial variables.

Materials and Methods:

Forty-four patients with knee osteoarthritis were allocated to receive 4 sessions of either PNE combined with knee joint mobilization or biomedical education with knee joint mobilization before surgery. All participants completed self-administered questionnaires and quantitative sensory testing was performed at baseline, after treatment and at a 1 month follow-up (all before surgery), and at 3 months after surgery.

Results:

Significant and clinically relevant differences before and after surgery were found after treatments for both knee pain and disability, and some measures of CS (ie, widespread hyperalgesia, CS inventory), with no significant between-group differences. Other indicators of CS (ie, conditioned pain modulation, temporal summation) did not change over time following either treatment, and in some occasions the observed changes were not in the expected direction. Patients receiving PNE with knee joint mobilization achieved greater improvements in psychosocial variables (pain catastrophizing, kinesiophobia) both before and after surgery.

Discussion:

Preoperative PNE combined with knee joint mobilization did not produce any additional benefits over time for knee pain and disability, and CS measures compared with biomedical education with knee joint mobilization. Superior effects in the PNE with knee joint mobilization group were only observed for psychosocial variables related to pain catastrophizing and kinesiophobia.

The authors declare no conflict of interest.

Reprints: Enrique Lluch, PT, PhD, Physical Therapy Department, Faculty of Physiotherapy, University of Valencia, C/Gascó Oliag, 5. 46010 Valencia, España (e-mail: enrique.lluch@uv.es).

Received November 15, 2016

Accepted April 23, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.