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Vascular occlusion for optimising the functional improvement in patients with knee osteoarthritis: a randomised controlled trial
  1. Ewoud Jacobs1,
  2. Lenka Stroobant2,
  3. Jan Victor2,
  4. Dirk Elewaut3,4,
  5. Thomas Tampere2,
  6. Steven Wallaert5,
  7. Erik Witvrouw1,
  8. Joke Schuermans1,
  9. Evi Wezenbeek1,6
  1. 1Department of Rehabilitation Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
  2. 2Department of Orthopaedic Surgery, University Hospital Ghent, Ghent, Belgium
  3. 3Department of Rheumatology, University Hospital Ghent, Ghent, Belgium
  4. 4Unit for Molecular Immunology and Inflammation, VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
  5. 5Department of Biostatistics, Ghent University, Ghent, Belgium
  6. 6Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
  1. Correspondence to Ewoud Jacobs; ewoud.jacobs{at}ugent.be

Abstract

Objectives Knee osteoarthritis (KOA) is a leading cause of global disability with conventional exercise yielding only modest improvements. Here we aimed to investigate the benefits of integrating blood flow restriction (BFR) into traditional exercise programmes to enhance treatment outcomes.

Methods The Vascular Occlusion for optimizing the Functional Improvement in patients with Knee Osteoarthritis randomised controlled trial enrolled 120 patients with KOA at Ghent University Hospital, randomly assigning them to either a traditional exercise programme or a BFR-enhanced programme over 24 sessions in 12 weeks. Assessments were conducted at baseline, 6 weeks, 12 weeks and 3 months postintervention using linear mixed models with Dunn-Sidak corrections for multiple comparisons. Primary outcome was the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire at 3 months follow-up with knee strength, Pain Catastrophizing Scale questionnaire and functional tests as secondary outcomes. Analysis followed an intention-to-treat approach (NCT04996680).

Results The BFR group showed greater improvements in KOOS pain subscale (effect size (ES)=0.58; p=0.0009), quadriceps strength (ES=0.81; p<0.0001) and functional tests compared with the control group at 12 weeks. At 3 months follow-up, the BFR group continued to exhibit superior improvements in KOOS pain (ES=0.55; p=0.0008), symptoms (ES=0.59; p=0.0004) and quality of life (QoL) (ES=0.66; p=0.0001) with sustained benefits in secondary outcomes. Drop-out rates were similar in both groups.

Conclusion Incorporating BFR into traditional exercise programmes significantly enhances short-term and long-term outcomes for patients with KOA demonstrating persistent improvements in pain, symptoms, QoL and functional measures compared with conventional exercise alone. These findings suggest that BFR can provide the metabolic stimulus needed to achieve muscle strength and functional gains with lower mechanical loads. Reduced pain and increased strength support a more active lifestyle, potentially maintaining muscle mass, functionality and QoL even beyond the supervised intervention period.

Trial registration number NCT04996680.

  • Osteoarthritis, Knee
  • Physical Therapy Modalities
  • Rehabilitation
  • Orthopedic Procedures

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request. Requests for data sharing from appropriate researchers and entities will be considered on a case-by-case basis. Interested parties should contact EJ.

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Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request. Requests for data sharing from appropriate researchers and entities will be considered on a case-by-case basis. Interested parties should contact EJ.

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Footnotes

  • Handling editor Josef S Smolen

  • Contributors JV, EWi, JS, EWe and EJ conceptualised the study. SW performed the formal analysis and visualisation and was responsible for data curation. EJ, JS, EWi and EWe wrote the original draft. All authors reviewed and edited the manuscript. EWi, JV and EWe supervised the study. EJ is guarantor of the study.

  • Funding This research was funded by the Fonds voor Wetenschappelijk Onderzoek Vlaanderen (FWO); grant number T001620N. The funding source had no involvement in the study design, interpretation, writing or publication of the manuscript.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.