The clinical effects of mobilization with passive ankle dorsiflexion using a passive ankle dorsiflexion apparatus on older patients with knee osteoarthritis: A randomized trial

Abstract

BACKGROUND:

Active exercise is the only proven effective intervention for knee osteoarthritis (OA). The addition of manual therapy has shown to improve outcome of exercises. Passive mobilization with submaximal bilateral passive ankle dorsiflexion was examined in a double-blinded randomized controlled clinical trial. A passive ankle dorsiflexion apparatus was used to standardize the frequency, range of motion, and duration parameters.

OBJECTIVES:

The purpose of the study was to determine whether a simple standardised mobilization technique could be incorporated as a safe and unsupervised conservative treatment for knee OA.

METHODS:

In total, 73 participants were randomly assigned to the experimental ( $n=$ 37) or control group ( $n=$ 36). All participants performed active exercises and received six sessions of 10-minute dorsiflexion intervention, either real or sham, for two weeks. Pre- and post-experimental assessments for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain, and range of motion of the knee were conducted.

RESULTS:

Results were analyzed using two-way repeated measures analysis of variance and Independent-Samples Mann-Whitney U Test. The mean score of WOMAC for the experimental and control groups changed from 31.84 to 18.19 and 34.74 to 21.06, respectively, after the intervention. The VAS also showed significant improvements. Significant improvements were observed in WOMAC in both groups after the intervention; however, differences between the groups were not statistically significant.

CONCLUSIONS:

Exercise with either 30 ${}^{\circ }$ or 5 ${}^{\circ }$ of passive dorsiflexion yielded favorable clinical effects. Although submaximal bilateral ankle dorsiflexion was proven to be safe for elderly participants with osteoarthritis of the knee, whether it provided extra benefits to exercises alone was unclear. Further research is required to determine the effectiveness of dorsiflexion and optimal range of mobilization.