The Effects of Neuroscience-Based Sensorimotor Exercise Training Using Laser Pointer in Elderly with Chronic Knee Pain: Randomized Controlled Trial

Abstract

Objectives

Neuroscience-based sensorimotor exercise training using laser pointer (nbset) is a new aproach exercise training method. We aimed to investigate the effects of nbpet using laser pointer on different functional parameters.

Methods

In this randomized controlled study, we recruited 19 ( 14 females, 5 males) participants with chronic knee pain. Participants were divided into two groups (experimental (n=12), control (n=7)). Joint position errors were evaluated with the joint position error assessment method, range of motion with a goniometer, kinesiophobia with the Tampa kinesiophobia scale, pain with the McGill pain scale, quality of life with the Older People Quality of Life questionnaire (OPQoL-brief), and mobility with the time up and go test. Both groups were included in the exercise program with proprioceptive exercise training for 2 sessions per week for 6 weeks. In addition, the experimental group was trained with nbset using laser pointer at the same time.

Results

We found significant differences between groups in terms of joint position error (horizontal p=0.026 and global p=0.012), quality of life (p=0.022) and mobility (p=0.005) in favor of the experimental group. Although there were improvements in the groups in terms of range of motion (p=0.261), kinesiophobia (p=0.098) and pain (p=0.446) scores, there was no significant difference between the groups.

Conclusions

Nbset using laser pointer may reduce joint position error, improve quality of life and mobility in elderly with chronic knee pain. Long-term studies with large samples are needed to determine the effects on range of motion, kinesiophobia, and pain.

Zusammenfassung

Hintergrund

Neurowissenschaftlich fundiertes sensomotorisches Bewegungstraining mit Laserpointern (nbset) ist eine neue Methode des Bewegungstrainings. Unser Ziel war es, die Auswirkungen von nbpet mit Laserpointer auf verschiedene Funktionsparameter zu untersuchen.

Methoden

In dieser randomisierten, kontrollierten Studie rekrutierten wir 19 Teilnehmer (14 Frauen, 5 Männer) mit chronischen Knieschmerzen. Die Teilnehmer wurden in zwei Gruppen aufgeteilt (Experimentalgruppe (n=12), Kontrollgruppe (n=7). Die Gelenkstellungsfehler wurden mit der Jonit-Positionsfehler-Bewertungsmethode, der Bewegungsumfang mit einem Goniometer, die Kinesiophobie mit der Tampa-Kinesiophobie-Skala, die Schmerzen mit der McGill-Schmerzskala, die Lebensqualität mit dem Fragebogen zur Lebensqualität älterer Menschen (OPQoL-Brief) und die Mobilität mit dem Time-up-and-go-Test bewertet. Beide Gruppen nahmen 6 Wochen lang an einem Übungsprogramm mit propriozeptivem Bewegungstraining in 2 Sitzungen pro Woche teil. Zusätzlich wurde die Versuchsgruppe mit nbpet unter Verwendung eines Laserpointers zur gleichen Zeit trainiert.

Ergebnisse

Es wurde ein signifikanter Unterschied zwischen den Gruppen in Bezug auf den Gelenkstellungsfehler (horizontal p=0,026 und global p=0,012), die Lebensqualität (p=0,022) und die Mobilität (p=0,005) zugunsten der experimentellen Gruppe festgestellt. Obwohl es in den Gruppen Verbesserungen in Bezug auf den Bewegungsumfang (p=0,261), die Kinesiophobie (p=0,098) und die Schmerzen (p=0,446) gab, bestand kein signifikanter Unterschied zwischen den Gruppen.

Schlussfolgerungen

Die Nbset-Behandlung mit einem Laserpointer kann bei älteren Menschen mit chronischen Knieschmerzen die Fehlstellung des Gelenks verringern und die Lebensqualität und Mobilität verbessern. Es sind Langzeitstudien mit großen Stichproben erforderlich, um die Auswirkungen auf den Bewegungsumfang, die Kinesiophobie und die Schmerzen zu bestimmen.

Keywords

proprioceptive training - Elderly - Chronic knee pain - Laser pointer - Neuroscience based exercise

Schlüsselwörter

propriozeptives Training - Ältere Menschen - Chronische Knieschmerzen - Laserpointer - Neurowissenschaftlich fundiertes Training

Publication History

Received: 15 October 2024

Accepted after revision: 21 May 2025

Article published online:
03 July 2025

• References

• 1 Dahlhamer J, Lucas J, Zeleya C. et al. Prevalence of chronic pain and high-impact chronic pain among adults – United States, 2016. MMWR Morbidity and Mortality Weekly Report 2018; 67: 1001-1006
• 2 Tsang A, Von Korff M, Lee S. et al. Common chronic pain conditions in developed and developing countries: Gender and age differences and comorbidity with depression-anxiety disorders. J Pain 2008; 9: 883-891
• 3 Patel KV, Guralnik JM, Dansie EJ. et al. Prevalence and impact of pain among older adults in the United States: Findings from the 2011 National Health and Aging Trends Study. Pain. 2013; 154: 2649-2657
• 4 Pitcher MH, Von Korff M, Bushnell MC. et al. Prevalence and profile of high-impact chronic pain in the United States. J Pain 2018;
• 5 Bernfort L, Gerdle B, Rahmqvist M. et al. Severity of chronic pain in an elderly population in Sweden: Impact on costs and quality of life. Pain. 2015; 156: 521-527
• 6 Macfarlane GJ, Barnish MS, Jones GT. Persons with chronic widespread pain experience excess mortality: Longitudinal results from the UK Biobank and meta-analysis. Ann Rheum Dis 2017; 76: 1815-1822
• 7 Whitlock EL, Diaz-Ramirez LG, Glymour MM. Association between persistent pain and memory decline and dementia in a longitudinal cohort of elders. JAMA Intern Med 2017; 177: 1146-1153
• 8 Domenichiello AF, Ramsden CE. The silent epidemic of chronic pain in older adults. Prog Neuropsychopharmacol Biol Psychiatry 2019; 93: 284-290
• 9 Berteau J-P. Knee pain from osteoarthritis: Pathogenesis, risk factors, and recent evidence on physical therapy interventions. J Clin Med 2022; 11: 3252
• 10 Jamal H, Bennett KJ. Osteoarthritic knee pain. In Osteoarthritis pp. 173-180 2023;
• 11 Moseng T, Vliet Vlieland TP, Battista S. et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update. Ann Rheum Dis 2024; 83: 730-740
• 12 American Academy of Orthopaedic Surgeons. Management of osteoarthritis of the knee (non-arthroplasty) evidence-based clinical practice guideline. 2021 https://www.aaos.org/oak3cpg
• 13 Hunter CW, Deer TR, Jones MR. et al. Consensus guidelines on interventional therapies for knee pain (STEP guidelines) from the American Society of Pain and Neuroscience. J Pain Res 2022; 15: 2683-2745
• 14 Page CJ, Hinman RS, Bennell KL. Physiotherapy management of knee osteoarthritis. Int J Rheum Dis 2011; 14: 145-151
• 15 Semmons J. The role of physiotherapy in the management of chronic pain. Anaesth Intensive Care Med 2016; 17: 445-447
• 16 Jiang L, Zhang L, Huang W. et al. The effect of proprioception training on knee kinematics after anterior cruciate ligament reconstruction: A randomized control trial. J Back Musculoskelet Rehabil 2022; 35: 1085-1095
• 17 Mirali G, Shukla Y. Effect of proprioceptive training using biofeedback (Equiboard) on pain, function, and proprioception in osteoarthritic knee – An interventional study. Int J Sci Healthc Res 2020; 5: 232-237
• 18 Hajouj E, Hadian MR, Mir SM. et al. Effects of innovative aquatic proprioceptive training on knee proprioception in athletes with anterior cruciate ligament reconstruction: A randomized controlled trial. Arch Bone Jt Surg 2021; 9: 519
• 19 Hajouj E, Hadian MR, Mir SM. et al. Effects of Innovative Land-based Proprioceptive Training on Knee Joint Position Sense and Function in Athletes with Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial. Arch Neurosci 2021; 8
• 20 Genevsky A, Garrett CT, Alexander P. et al. Cognitive training in schizophrenia: A neuroscience-based approach. Dialogues Clin Neurosci 2010; 12: 416-421
• 21 Kleim JA, Hogg TM, VandenBerg PM. et al. Cortical synaptogenesis and motor map reorganization occur during late, but not early, phase of motor skill learning. J Neurosci 2004; 24: 628-633
• 22 Phakkharawat S. Electroencephalographic changes as neuroscience-based cognitive skill training program. Asian J Med Sci 2020; 11: 63-68
• 23 Butler DS, Moseley GL. Explain Pain 2nd Edn. Noigroup publications; 2013
• 24 Melzack R. The short-form McGill pain questionnaire. Pain 1987; 30: 191-197
• 25 Yakut Y, Yakut E, Bayar K. et al. Reliability and validity of the Turkish version short-form McGill pain questionnaire in patients with rheumatoid arthritis. Clin Rheumatol 2007; 26: 1083-1087
• 26 Vafadar AK, Côté JN, Archambault PS. Interrater and intrarater reliability and validity of 3 measurement methods for shoulder-position sense. J Sport Rehabil 2016; 25
• 27 Clarkson HM. Musculoskeletal assessment: joint range of motion and manual muscle strength. Lippincott Williams & Wilkins; 2000
• 28 Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. FA Davis; 2016
• 29 Silva MDC, Woodward AP, Fearon AM. et al. Minimal clinically important change of knee flexion in people with knee osteoarthritis after non-surgical interventions using a meta-analytical approach. Syst Rev 2024; 13: 50
• 30 Woby SR, Roach NK, Urmston M. et al. Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia. Pain 2005; 117: 137e44
• 31 Tkachuk GA, Harris CA. Psychometric properties of the Tampa Scale for Kinesiophobia-11 (TSK-11). J Pain 2012; 13: 970-977
• 32 Yilmaz O, Yakut Y, Uygur F. et al. Turkish version of the Tampa Scale for Kinesiophobia and its test-retest reliability. Turk J Physiother Rehabil 2011; 22: 44-49
• 33 Chimenti RL, Pacha MS, Glass NA. et al. Elevated kinesiophobia is associated with reduced recovery from lower extremity musculoskeletal injuries in military and civilian cohorts. Physical Therapy 2022; 102: pzab262
• 34 Bowling A, Hankins M, Windle G. et al. A short measure of quality of life in older age: The performance of the brief Older People's Quality of Life questionnaire (OPQOL-brief). Arch Gerontol Geriatr 2013; 56: 181-187
• 35 Çalışkan H, Aycicek G, Özsürekci C. et al. Turkish validation of a new scale from older people’s perspectives: older people’s quality of life-brief (OPQOL-brief). Arch Gerontol Geriat 2019; 83: 91-95
• 36 Wall JC, Bell C, Campbell S. et al. The timed get-up and go test revisited: measurement of component tasks. J. Rehabil. Res. Dev. 2000; 37: 109-113
• 37 Greene BR, O’Donovan A, Romero-Ortuno R. et al. Quantitative falls risk assessment using the timed up and go test. IEEE Trans. Biomed. Eng. 2010; 57: 2918-2926
• 38 Alghadir A, Anwer S, Brismée JM. The reliability and minimal detectable change of Timed Up and Go test in individuals with grade 1–3 knee osteoarthritis. BMC Musculoskelet Disord 2015; 16: 174
• 39 Pavneet SS, Mayur S. Effect of Proprioceptive Training on Kinesiophobia and Balance in Geriatric Population. Int J Physiother Res 2022; 10: 4286-4290
• 40 Faul F, Erdfelder E, Buchner A. et al. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods 2009; 41: 1149-1160
• 41 Winter L, Huang Q, Sertic JV. et al. The Effectiveness of Proprioceptive Training for Improving Motor Performance and Motor Dysfunction: A Systematic Review. Front. Rehabilit. Sci. 2022; 3: 830166
• 42 Cai X, Qian B, Cao L. et al. The effects of proprioception training and intra-articular injections of sodium hyaluronate on knee osteoarthritis in the elderly. Chin J Phys Med Rehabil 2014; 12: 445-448
• 43 Harry-Leite P, Paquete M, Teixeira J. et al. Acute Impact of Proprioceptive Exercise on Proprioception and Balance in Athletes. Appl. Sci. 2022; 12: 830
• 44 Lisi J, Wang Y, Huang W. The effect of proprioception training on knee kinematics after anterior cruciate ligament reconstruction. J Orthop Surg Res 2020;
• 45 Song Q, Shen P, Mao M. et al. Proprioceptive neuromuscular facilitation improves pain and descending mechanics among elderly with knee osteoarthritis. Scand J Med Sci Sports 2020; 30: 1655-1163
• 46 Katherine B. Kinesiophobia and Fear Avoidance in Older Adults: A Systematic Review on Constructs and Related Measures. J Geriatr Phys Ther 2022; 45: 207-214
• 47 Alpalhao V, Cordeiro N, Pezarat-Correia P. Kinesiophobia and Fear Avoidance in Older Adults: A Scoping Review on the State of Research Activity. J Aging Phys Act 2022; 30: 1075-1084
• 48 Ferlinc A, Fabiani E, Velnar T. et al. The Importance and Role of Proprioception in the Elderly: a Short Review. Materia socio-medica 2019; 31: 219-221
• 49 Alshehri SHS, Reddy RS, Alshahrani MS. et al. Unraveling the impact of kinesiophobia on proprioception and balance: Mediation by pain, mobility, and psychological wellbeing in post-total hip replacement recovery. PloS one 2024; 19: e0314627
• 50 Rogers MW, Tamulevicius N, Semple SJ. et al. Efficacy of home-based kinesthesia, balance & agility exercise training among persons with symptomatic knee osteoarthritis. J Sports Sci Med 2012; 11: 751-758
• 51 Mascarenhas CHM, Silva IES, Carneiro JAO. et al. Effects of conventional proprioceptive training and virtual reality on functionality and fear of falling in elderly women: Randomized clinical trial. J Clin Med Surg 2023; 3: 1074
• 52 Souza LA, Fernandes AB, Patrizzi LJ. et al. Effects of supervised multisensory training for six weeks on balance and quality of life in elderly people. RMRP 2016; 49: 223-231