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Vascular Occlusion for Optimizing Functional Improvement in Patients With Knee Osteoarthritis (VOFIKO)

Primary Purpose

Blood Flow Restriction

Status
Recruiting
Phase
Not Applicable
Locations
Belgium
Study Type
Interventional
Intervention
Blood Flow Restriction (by using smart-cuff pro devices, acting as pressurized tourniquet) combined low load strengh training
Standardised low load strength training
Sham-BFR (by using smart-cuff pro devices, acting as pressurized tourniquet) combined with low load strength training
Sponsored by
University Hospital, Ghent
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Blood Flow Restriction focused on measuring Blood Flow Restriction, Strength training, Knee Osteoarthritis

Eligibility Criteria

30 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Diagnosed with knee osteoarthritis
  • Speak Dutch, French or English
  • No other pathology restricting patients to participate safe
  • Time and motivation to visit 2x/w for 12 weeks

Exclusion Criteria:

  • Neurological disorders
  • previous surgery or disorder with blood vessels.
  • (Symptomatic) heart or vascular disease
  • Increased risk for DVT
  • Avoiding physical exercise due to medical conditions.
  • Rheumatoid arthritis
  • BMI >30
  • Recent severe trauma or surgery in the lower extremity

Sites / Locations

  • Ghent UniversityRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Sham Comparator

Active Comparator

Arm Label

Blood flow restriction group

Sham group

Control group

Arm Description

patients in this group will undergo a standard strength training program combined with an occlusion cuff. The cuff will reduce the amount of blood flow and therefore increase the metabolic stimulus. The cuff will be used only during one quadriceps exercise, 2 times a week for 12 weeks.

patients in this group will undergo the same standard strength training program as the BFR-group, combined with an occlusion cuff but pressurized so there is no significant effect on the lower limb blood flow. The cuff will be used only during one quadriceps exercise, 2 times a week for 12 weeks.

patients in this group will undergo the same standard strength training program as the BFR-group and placebo-group, but without a tourniquet.

Outcomes

Primary Outcome Measures

Assessing change within Knee Injury and Osteoarthritis Outcome Score (KOOS)
A comprehensive analysis of patient function at level of activities of daily living as well as in sports participation. KOOS consists of 5 subscales: (1) Pain, (2) other Symptoms, (3) Function in daily living (ADL), (4) Function in sport and recreation (Sport/Rec) and (5) knee related Quality of life (QOL).

Secondary Outcome Measures

Assessing change within Pain Catastrophizing Scale (PCS)
The Pain Catastrophizing Scale (PCS) will evaluate the patient's tendency towards pain catastrophizing and risk of developing chronic pain, and as such the quality of the patients psychosocial health status.
Assessing change within thigh muscle strength
objectified by means of Hand Held Dynamometry (HHD) assessment (maximal isometric muscle strength) of the quadriceps and hamstring muscle. Each muscle will be tested in a standardized fashion and sequence. The patient will be informed about the purpose and the content of each strength test, after which the investigator will demonstrate which muscle will be tested, the starting position that should be adopted as well as the specific location and direction at/in which the static resistance will be applied. Afterwards, the participants will be tested once at submaximal and twice at maximal level of isometric strength output, after which the best trial will be taken into account for data registration and processing.
Assessing change within Single leg Hop for Distance (SHD)
unilateral jump and landing. Patient get 3 attempts on both sides
Assessing change within Knee Bent Test (KBT)
unilateral knee flexion and extension (~unilateral squat)
Assessing change within 6 minute walk test (6MWT)
walk as far as possible within 6 minutes. Patient is allowed to take a break during the test, although time keeps counting down.
Assessing change within 40m FPWT
40m walking as fast as possible
Assessing change within chair stand test
go from sit (on a chair) to stand as much as possible within 30 seconds
assessing change within stair climb test
go 11 steps upwards and downwards on a stair as fast as possible (although safe)
Assessing change within International physical activity questionnaire (IPAQ)
The purpose of the questionnaires is to provide common instruments that can be used to obtain internationally comparable data on health-related physical activity from the last 7 days

Full Information

First Posted
July 12, 2021
Last Updated
December 5, 2022
Sponsor
University Hospital, Ghent
Collaborators
Fund for Scientific Research, Flanders, Belgium
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1. Study Identification

Unique Protocol Identification Number
NCT04996680
Brief Title
Vascular Occlusion for Optimizing Functional Improvement in Patients With Knee Osteoarthritis
Acronym
VOFIKO
Official Title
Vascular Occlusion for Optimizing Functional Improvement in Patients With Knee Osteoarthritis
Study Type
Interventional

2. Study Status

Record Verification Date
December 2022
Overall Recruitment Status
Recruiting
Study Start Date
July 14, 2021 (Actual)
Primary Completion Date
August 31, 2024 (Anticipated)
Study Completion Date
March 31, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University Hospital, Ghent
Collaborators
Fund for Scientific Research, Flanders, Belgium

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
Yes

5. Study Description

Brief Summary
Recent research in strength training physiology revealed that implementation of occlusion garments around the proximal aspect of the lower limbs in combination with low load strength training causes a reduced blood flow and thus providing a high metabolic stimulus, causing a training effect similar to high load training. This study will investigate the added effect of BFR focussing on functional outcome, pain-management and lower limb strength in patients with knee osteoarthritis. Therefore, 234 patiens will be divided into three equal groups (n=78), (control group, sham group and BFR-group) which will be subjected to a 12-week during standard strength training program, 2 times a week for 60 minutes. The first group, which will be submitted to low load resistance training commonly used in contemporary physiotherapy for OA, will serve as a control group whereas both the BFRT and Sham groups will objectify the additional value of implementing vascular occlusion in respective low load resistance training protocol.
Detailed Description
Recent research in strength training physiology, revealed that implementation of occlusion garments around the proximal aspect of the segment submitted to strength training (i.e. the upper thigh, in case of lower limb and knee joint training) results in significant increments in metabolic and mechanical muscle loading, facilitating neuromuscular responses in terms of muscle fiber recruitment and muscle fiber hypertrophy/gains in muscle mass, even at fairly low training dosages (<50% of 1RM). As a consequence, BFR guided resistance training at low training intensities renders a training response similar to what can be expected from high intensity strength training. Occlusion at the proximal site of the segment submitted to strength training, reduces both vascular in- and outflow. This reduced blood flow is thought to induce an ischemic/hypoxic environment that enhances the training effect in the exercising muscle, leading to increased muscle mass and strength. In accordance with this theoretic framework, results of a recent study which compared the training effects between High Intensity Resistance Training (HIRT), Low Intensity Resistance Training (LIRT) and Low Intensity Resistance Training with BFR (BFRT), demonstrated that both the HIRT and the BFRT resulted in similar significant improvements in 1RM knee extension strength, functional performance and Quadriceps Cross Sectional Area (CSA), whereas no differences were found after a 12 week period of LIRT. On the contrary, pain scores objectified by means of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) significantly reduced in the BFRT, whereas this was not the case for the HIRT group in which 4 patients were also excluded due to the onset of exercise-induced knee pain. Although previous scientific research has already provided a quite solid proof of concept by assessing the short term results of BFR training in small sample sizes of patients at risk of or suffering from knee OA, ready-to-use guidelines and specific implementation instructions of BFR-based physical therapy and strength training are non-existent at present. With this TBM project, it is our intention to reinforce the scientific evidence regarding the substantial benefits and significant added value of BFR-guided low intensity resistance training in both the stabilization and rehabilitation of knee osteoarthritis, as well as to provide the clinicians ((para)medics and trainers) in hospital, clinical practice and fitness/training settings with specific guidelines with regard to practical implementation of respective exercise protocols. This will be done using a large scale Randomized Clinical Trial Design in which a standardized strength training protocol will be implemented for functional rehabilitation purposes in a population of 234 participants diagnosed with knee OA, using three different loading categories: (n=78) Low Load Resistance Training (Control) (n=78) Blood Flow Restricted Low Load Resistance Training (BFRT) (n=78) Low Load Resistance Training with sham BFR component (Sham). The first group, which will be submitted to low load resistance training commonly used in contemporary physiotherapy for OA, will serve as a control group whereas both the BFRT and Sham groups will objectify the additional value of implementing vascular occlusion in respective low load resistance training protocol. The intervention consists of a 12 week during standardised strength program, 2 times a week for 60 minutes. To evaluate and objectify any training effect, patient overall Quality of Life (QoL) and knee function, 4 screening moments are planned; at baseline (week 0), after 6 weeks, post intervention (13 weeks) and a follow-up screening after 6 months to assess the retention effect and thus, the sustainability of this training modality.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Blood Flow Restriction
Keywords
Blood Flow Restriction, Strength training, Knee Osteoarthritis

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
234 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Blood flow restriction group
Arm Type
Experimental
Arm Description
patients in this group will undergo a standard strength training program combined with an occlusion cuff. The cuff will reduce the amount of blood flow and therefore increase the metabolic stimulus. The cuff will be used only during one quadriceps exercise, 2 times a week for 12 weeks.
Arm Title
Sham group
Arm Type
Sham Comparator
Arm Description
patients in this group will undergo the same standard strength training program as the BFR-group, combined with an occlusion cuff but pressurized so there is no significant effect on the lower limb blood flow. The cuff will be used only during one quadriceps exercise, 2 times a week for 12 weeks.
Arm Title
Control group
Arm Type
Active Comparator
Arm Description
patients in this group will undergo the same standard strength training program as the BFR-group and placebo-group, but without a tourniquet.
Intervention Type
Device
Intervention Name(s)
Blood Flow Restriction (by using smart-cuff pro devices, acting as pressurized tourniquet) combined low load strengh training
Other Intervention Name(s)
Kaatsu, partial vascular occlusion
Intervention Description
This group will undergo standard, traditional low load strength training consisting of calf, thigh, glute and core exercises, combined with optimal pressurized blood flow restriction
Intervention Type
Other
Intervention Name(s)
Standardised low load strength training
Intervention Description
This group will undergo standard, traditional low load strength training consisting of calf, thigh, glute and core exercises
Intervention Type
Device
Intervention Name(s)
Sham-BFR (by using smart-cuff pro devices, acting as pressurized tourniquet) combined with low load strength training
Intervention Description
This group will undergo standard, traditional low load strength training consisting of calf, thigh, glute and core exercises, combined with blood flow restriction, but pressurized so the occlusion cuff has no significant effect on the lower limb blood flow.
Primary Outcome Measure Information:
Title
Assessing change within Knee Injury and Osteoarthritis Outcome Score (KOOS)
Description
A comprehensive analysis of patient function at level of activities of daily living as well as in sports participation. KOOS consists of 5 subscales: (1) Pain, (2) other Symptoms, (3) Function in daily living (ADL), (4) Function in sport and recreation (Sport/Rec) and (5) knee related Quality of life (QOL).
Time Frame
assessing change at 4 time points; 1) baseline screening (week 0), 2) after 6 weeks, 3) post intervention after 13 weeks and 4) follow-up screening after 24 weeks.
Secondary Outcome Measure Information:
Title
Assessing change within Pain Catastrophizing Scale (PCS)
Description
The Pain Catastrophizing Scale (PCS) will evaluate the patient's tendency towards pain catastrophizing and risk of developing chronic pain, and as such the quality of the patients psychosocial health status.
Time Frame
4 times; 1) baseline screening (week 0), 2) after 6 weeks, 3) post intervention after 13 weeks and 4) follow-up screening after 24 weeks.
Title
Assessing change within thigh muscle strength
Description
objectified by means of Hand Held Dynamometry (HHD) assessment (maximal isometric muscle strength) of the quadriceps and hamstring muscle. Each muscle will be tested in a standardized fashion and sequence. The patient will be informed about the purpose and the content of each strength test, after which the investigator will demonstrate which muscle will be tested, the starting position that should be adopted as well as the specific location and direction at/in which the static resistance will be applied. Afterwards, the participants will be tested once at submaximal and twice at maximal level of isometric strength output, after which the best trial will be taken into account for data registration and processing.
Time Frame
assessing change at 4 time points; 1) baseline screening (week 0), 2) after 6 weeks, 3) post intervention after 13 weeks and 4) follow-up screening after 24 weeks.
Title
Assessing change within Single leg Hop for Distance (SHD)
Description
unilateral jump and landing. Patient get 3 attempts on both sides
Time Frame
assessing change at 4 time points; 1) baseline screening (week 0), 2) after 6 weeks, 3) post intervention after 13 weeks and 4) follow-up screening after 24 weeks.
Title
Assessing change within Knee Bent Test (KBT)
Description
unilateral knee flexion and extension (~unilateral squat)
Time Frame
assessing change at 4 time points; 1) baseline screening (week 0), 2) after 6 weeks, 3) post intervention after 13 weeks and 4) follow-up screening after 24 weeks.
Title
Assessing change within 6 minute walk test (6MWT)
Description
walk as far as possible within 6 minutes. Patient is allowed to take a break during the test, although time keeps counting down.
Time Frame
assessing change at 4 time points; 1) baseline screening (week 0), 2) after 6 weeks, 3) post intervention after 13 weeks and 4) follow-up screening after 24 weeks.
Title
Assessing change within 40m FPWT
Description
40m walking as fast as possible
Time Frame
assessing change at 4 time points; 1) baseline screening (week 0), 2) after 6 weeks, 3) post intervention after 13 weeks and 4) follow-up screening after 24 weeks.
Title
Assessing change within chair stand test
Description
go from sit (on a chair) to stand as much as possible within 30 seconds
Time Frame
assessing change at 4 time points; 1) baseline screening (week 0), 2) after 6 weeks, 3) post intervention after 13 weeks and 4) follow-up screening after 24 weeks.
Title
assessing change within stair climb test
Description
go 11 steps upwards and downwards on a stair as fast as possible (although safe)
Time Frame
assessing change at 4 time points; 1) baseline screening (week 0), 2) after 6 weeks, 3) post intervention after 13 weeks and 4) follow-up screening after 24 weeks.
Title
Assessing change within International physical activity questionnaire (IPAQ)
Description
The purpose of the questionnaires is to provide common instruments that can be used to obtain internationally comparable data on health-related physical activity from the last 7 days
Time Frame
assessing change every week, starting from baseline (Week 0) until the follow-up after 24 weeks.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
30 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosed with knee osteoarthritis Speak Dutch, French or English No other pathology restricting patients to participate safe Time and motivation to visit 2x/w for 12 weeks Exclusion Criteria: Neurological disorders previous surgery or disorder with blood vessels. (Symptomatic) heart or vascular disease Increased risk for DVT Avoiding physical exercise due to medical conditions. Rheumatoid arthritis BMI >30 Recent severe trauma or surgery in the lower extremity
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Ewoud Jacobs
Phone
0473476160
Email
ewoud.jacobs@ugent.be
First Name & Middle Initial & Last Name or Official Title & Degree
Erik Witvrouw, Prof. dr.
Email
erik.witvrouw@ugent.be
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Erik Witvrouw, Prof. dr.
Organizational Affiliation
Rehabilitation science & Physiotherapy Ghent University
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Jan Victor, Prof. Dr.
Organizational Affiliation
Orthopedics & Traumatology Ghent University Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Ghent University
City
Ghent
State/Province
Oost-Vlaanderen
ZIP/Postal Code
9000
Country
Belgium
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ewoud Jacobs, Msc
Phone
0473476160
Email
ewoud.jacobs@ugent.be

12. IPD Sharing Statement

Learn more about this trial

Vascular Occlusion for Optimizing Functional Improvement in Patients With Knee Osteoarthritis

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