Steve Preece, Nathan Brookes

Ground-breaking physiotherapy treatment for knee osteoarthritis

Two new research studies are developing a ground-breaking physiotherapy treatment for people with painful knee osteoarthritis.

COGNITIVE MUSCULAR THERAPY (CMT) teaches people with this common condition how to stand and move with less muscle overactivity and to integrate this into their everyday life. Muscle overactivity is likely to increase pain through pressure on the joint and cartilage degeneration.

The therapy, which combines psychologically informed practice with muscle biofeedback training, was developed in Salford through a joint research programme at the University of Salford and Northern Care Alliance NHS Foundation Trust and funded by the National Institute for Health and Care Research. The work is led by Professor Stephen Preece, Director of the Centre for Health Sciences Research at the university and Nathan Brookes, Lead Physiotherapist and Honorary Research Fellow.

CMT has five components: making sense of pain, general relaxation, postural deconstruction, responding differently to pain and functional muscle retraining.

In early tests, patients said it enabled them to “create a new normal” and to be “in control of their own treatment.” Large reductions in pain were observed from 11 patients who received a prototype version of the intervention

Following this success, the team received an NIHR Research for Patient Benefit two- year grant to fund two studies – a training development study and a feasibility study.

The training study involved developing an online and face to face training course for physiotherapists, who then delivered the treatment to people with knee osteoarthritis. There was an average improvement in pain and function of 82%.

Now the researchers are recruiting patients with a diagnosis of knee osteoarthritis who haven’t experienced benefit from physiotherapy strength exercises to a feasibility study. Patients from Northern Care Alliance and Wigan, Wrightington and Leigh NHS Foundation Trusts and East Lancashire Hospitals NHS Trust will be involved in the comparison of cognitive muscular therapy and usual care between January and August 2023.

Mr Brookes, who is working towards a PhD by publication, said: “Our therapy guides patients through an individualised programme in which they learn to improve muscle coordination and to change the way they think about and react to pain. We’ve been delighted by the results so far and the positive feedback from patients and physiotherapists and are now taking the next steps to investigate whether this intervention can bring about long-term improvements in the pain associated with knee osteoarthritis.

“In addition, we are setting up a study for people who are on waiting lists for knee replacement to help us understand if cognitive muscular therapy is effective for patients at a later stage of the disease.”

This website Cognitive Muscular Therapy | Cognitive Muscular Therapy | University of Salford explains more about the background to the work and how it is being delivered.

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