Background: Osteoarthritis (OA) is a medical issue of joints caused by the degradation of cartilage. Patients with knee OA frequently complain about increasing pain, and it potentially causes patients fear of doing their activities, affecting their functional ability and quality of life (QoL).
Aim: This study objectives were examining the significant fall predictors, analyzing the effectiveness of combined exercise and physiotherapy intervention on functional activity, and investigating the effectiveness of low-level laser therapy (LLLT) on pain intensity, knee range of motion (ROM) and timed up and go test (TUG) among knee OA patients.
Hypotheses: For the 1st study, it was hypothesized that individuals with a history of falls within 6 months preceding study enrollment were more likely to have poorer proprioception, knee function, and fear of falls than those without a fall history. For the 2nd study, it was hypothesized that individuals with knee OA who received a longer period (12 weeks) of exercise intervention would demonstrate an improved pain relief, a better functional performance in daily activities such as chair stands and walking, and a better QoL than individuals with knee OA who underwent a shorter exercise intervention period (6 weeks), or participants who attended in 18 sessions of regular physiotherapy. While for the 3rd study, it was hypothesized that individuals with knee OA who received LLLT with higher wavelength intervention would demonstrate an improvement in pain relief, a better functional performance such as improved ROM, and a shorter TUG time than individuals with knee OA who underwent low-level laser therapy, or respondent who received sham intervention.
Methods: This present study utilized three study design for its sub studies. The 1st study conducted with cross-sectional study design and aimed at analyzing factors related to fall incidence among knee OA patients in Malang. During this first study, 372 participants were recruited using purposive sampling technique. Measurements used were sociodemographic questionnaire responses and medical history, visual analogue scale scores, Hopkins Falls Grading Scale scores, Fall Efficacy Scale-International scores, proprioception test results, knee injury and osteoarthritis outcome scores (KOOS), ROM, chair standing tests, and time of rise and TUG Test. While, chi-square test, independent t test, and multivariate logistic regression were conducted to identify predictors of falls. The 2nd study were conducted with quasi experimental design to investigate the effectiveness of combined exercise and physiotherapy intervention on functional activity during Muslim pray movements. There were 30 participants which divided into 3 (three) groups with Group I and II received intervention for 12 and 6 weeks, while Group III as the control group. Measurements used were WOMAC, VAS, 6MWT, chair standing test, and the 36-item Short Form Survey (SF-36) questionnaires. One-way ANOVA was used to compare variables in the three groups, while two-way mixed ANOVA was used to analyze the three group sample time interactions (initial, 1st and 2nd follow-up). While the 3rd study assigned a double-blind randomized controlled trial, and study protocols were prospectively registered with ClinicalTrials.gov before the first participant was enrolled with the clinical trial number at NCT04828252. Forty-four recruited participants were randomized into three groups, namely: Groups I and III were treated with low level laser therapy (LLLT) with different wavelengths (808nm & 606nm) on the knee joint with 15 minute per session, three days per week for eight weeks, while group II received sham LED intervention. Measurements used are VAS, ROM, and TUG. Meanwhile, to analyze the interaction between the 3 groups and the time of sampling (initial, 1st follow-up, and 2nd follow-up), two-way repeated measure ANOVA was used.
Results: From the 1st study, multivariate logistic regression analysis showed that knee proprioception and ROM serve as protective factors against falls with odds ratio (OR): 0.55, and 0.96, respectively. Whereas KOOS symptoms, fear of falls, low back pain, diabetes mellitus, and BMI were associated with a high risk of falls, with diabetes mellitus and fear of falls being the most significant risk factors (OR 1.41, 2.65, 1.27, 3.45, and 1.10, respectively). For the 2nd study, the findings showed that the implementation of the training activities for 12 weeks has a significant effect (p<0.05) on improving knee function and reducing the pain intensity of individuals with knee OA when performing daily life activities, including Muslim praying movements. The 3rd study laser therapy is an effective physical therapy modality for individual with knee OA. In fact, LLLT with higher wavelength was more effective than placebo whereas the effect of higher wavelength of LLLT provides better outcomes for reducing pain intensity (with p<0.05, and effect size of 0.08), and improve TUG score (with p<0.05, and effect size of 0.17).
Conclusion: Our study analyzing the predictors of falls for reducing pain intensity, and balance performance in OA. In fact, the pain intensity of individuals with knee OA when performing daily life activities, including Muslim praying move of falls, with diabetes mellitus and fear of falls being the most significant risk factors of falls. It also resulted that a significant improvement in knee function and a decrease in pain intensity are seen in patients with knee OA who participate in the training activities for 12 weeks, incorporating movements associated with Muslim prayer. Moreover, Low-Level Laser Therapy (LLLT) with higher wavelength (808nm) might serve as an effective modality to improve the pain intensity and TUG score among knee OA patients. These results may help policy makers create specific guideline programs integrated in the health policy on management of knee OA which focusing on controlling fall predictors, and its environment in order to minimalizing fall accident among knee OA patients. The program would provide individualized, person-centered care and enhance fall prevention techniques through a methodical process that included evaluation, intervention, and monitoring to reduce the risk of falls.
Keywords: knee osteoarthritis, falls, risk factors, function, walking ability, pain, muscle strength, ROM, Activity Daily of Living (ADL), QOL, ,

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