The effects of aquatic therapy combined with transcranial direct current stimulation (tDCS) on proprioception and gait speed in older adults with knee osteoarthritis: an eight-week randomized sham-controlled trial | BMC Geriatrics

  • Driban JB, McAlindon TE, Amin M, Price LL, Eaton CB, Davis JE, et al. Risk factors can classify individuals who develop accelerated knee osteoarthritis: data from the osteoarthritis initiative. J Orthop Research®. 2018;36(3):876–80.

    CAS 

    Google Scholar 

  • Li E, Tan J, Xu K, Pan Y, Xu P. Global burden and socioeconomic impact of knee osteoarthritis: a comprehensive analysis. Front Med. 2024;11: 1323091.

    Google Scholar 

  • Shamsi M, Safari A, Soroush A, Safari Y. The survey of knee osteoarthritis in the population over age 50 visited in the health bus in kermanshah, Iran. J Aging Res. 2021;2021(1):9809565.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Demir UG, Demir AN, Toraman NF. Neuropathic pain in knee osteoarthritis. Adv Rheumatol. 2021;61:67.

    PubMed 

    Google Scholar 

  • Wojcieszek A, Kurowska A, Majda A, Liszka H, Gądek A. The impact of chronic pain, stiffness and difficulties in performing daily activities on the quality of life of older patients with knee osteoarthritis. Int J Environ Res Public Health. 2022;19(24): 16815.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Jang S, Lee K, Ju JH. Recent updates of diagnosis, pathophysiology, and treatment on osteoarthritis of the knee. Int J Mol Sci. 2021;22(5): 2619.

    CAS 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Alexander NB. Gait disorders in older adults. 1996.

  • Panza F, Custodero C, Solfrizzi V. Physical activity, interleukin-6 change, and gait speed. Aging. 2023;15(11):4568.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Morone NE, Abebe KZ, Morrow LA, Weiner DK. Pain and decreased cognitive function negatively impact physical functioning in older adults with knee osteoarthritis. Pain Med. 2014;15(9):1481–7.

    PubMed 

    Google Scholar 

  • Cesari M. Role of gait speed in the assessment of older patients. JAMA. 2011;305(1):93–4.

    CAS 
    PubMed 

    Google Scholar 

  • Kutner NG, Zhang R, Huang Y, Painter P. Gait speed and mortality, hospitalization, and functional status change among hemodialysis patients: a US renal data system special study. Am J Kidney Dis. 2015;66(2):297–304.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Raizah A, Reddy RS, Alshahrani MS, Tedla JS, Dixit S, Gular K, et al. Investigating knee joint proprioception and its impact on limits of stability using dynamic posturography in individuals with bilateral knee osteoarthritis—a cross-sectional study of comparisons and correlations. J Clin Med. 2023;12(8):2764.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Rosadi R, Jankaew A, Wu P-T, Kuo L-C, Lin C-F. Factors associated with falls in patients with knee osteoarthritis: a cross-sectional study. Medicine (Baltimore). 2022;101(48):e32146.

    PubMed 

    Google Scholar 

  • Gayretli Atan S, Pehlivan E, Bağçacı S. Evaluation of the effectiveness of proprioceptive training according to radiological stages in patients with knee osteoarthritis. Medicina (Kaunas). 2025;61(3): 546.

    PubMed 

    Google Scholar 

  • Williams VJ, Piva SR, Irrgang JJ, Crossley C, Fitzgerald GK. Comparison of reliability and responsiveness of patient-reported clinical outcome measures in knee osteoarthritis rehabilitation. J Orthop Sports Phys Therapy. 2012;42(8):716–23.

    Google Scholar 

  • Chao J, Jing Z, Xuehua B, Peilei Y, Qi G. Effect of systematic exercise rehabilitation on patients with knee osteoarthritis: a randomized controlled trial. Cartilage. 2021;13(1suppl):S1734–40.

    Google Scholar 

  • Jamtvedt G, Dahm KT, Christie A, Moe RH, Haavardsholm E, Holm I, et al. Physical therapy interventions for patients with osteoarthritis of the knee: an overview of systematic reviews. Phys Ther. 2008;88(1):123–36.

    PubMed 

    Google Scholar 

  • Wang Y, Wu Z, Chen Z, Ye X, Chen G, Yang J, et al. Proprioceptive training for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Front Med. 2021;8: 699921.

    Google Scholar 

  • Kumar S, Kumar A, Kumar R. Proprioceptive training as an adjunct in osteoarthritis of knee. J Musculoskelet Res. 2013;16(01): 1350002.

    Google Scholar 

  • Segal NA, Glass NA, Teran-Yengle P, Singh B, Wallace RB, Yack HJ. Intensive gait training for older adults with symptomatic knee osteoarthritis. Am J Phys Med Rehabil. 2015;94(10S):848–58.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Ota S, Fujita R, Ohko H, Imai A. Effects of gait and activities of daily, living modifications for improving knee joint function in community-dwelling middle-aged and older people. A randomized control study. J Musculoskelet Res. 2021;24(02): 2150007.

    Google Scholar 

  • Lozano-Meca J, Montilla-Herrador J, Gacto-Sánchez M. The effects of combined transcranial direct current stimulation with physiotherapy for physical function in subjects with knee osteoarthritis: a systematic review and meta-analysis. Physiother Theory Pract. 2025;41(4):844–60.

    PubMed 

    Google Scholar 

  • Coons JM, Theiss C, Barry VW, Stevens S. An exploratory study of the effects of aquatic walking on function and muscle activity in knee osteoarthritis: part 2. Int J Aquat Res Educ. 2023;14(1):5.

    Google Scholar 

  •  Jain P, Shinde S. Effect of aquatic resistance, balance, and proprioception training on lower limb muscle performance in bilateral knee osteoarthritis. J Musculoskelet Surg Res. 2025;9(1):104-11.

  • Aldaihan MM. The impact of aquatic therapy on balance and mobility in individuals with spinal cord injury-a systematic review and meta-analysis. J Pioneer Med Sci. 2023;12(2):27.

    Google Scholar 

  • Lobanov AA, Grishechkina IA, Andronov SV, Barashkov GN, Popov AI, Fesyun AD, Ivanova EP, Maccarone MC, Masiero S. Can aquatic exercises contribute to the improvement of the gait stereotype function in patients with Long COVID outcomes?. Eur J Transl Myol. 2022;32(3):10698.

  • Lim C-g. Effect of underwater treadmill gait training with water-jet resistance on balance and gait ability in patients with chronic stroke: a randomized controlled pilot trial. Front Neurol. 2020;10:1246.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Jamebozorgi A, Rahimi A, Daryabor A, Kazemi SM, Jamebozorgi F. The effects of transcranial direct current stimulation (tDCS) and biofeedback on proprioception and functional balance in athletes with ACL-deficiency. Health Stud. 2023;10:e130364.

  • Toktas N, Duruturk N, Güzel Ş, Yürük Ö, Özen S. The effect of transcranial direct current stimulation on balance, gait function and quality of life in patients with stroke. Neurol Res. 2024. https://doi.org/10.1080/01616412.2024.2362583.

    PubMed 

    Google Scholar 

  • Yang JM, Li CC, Wang Y, Li JY, Xu JM, Liang MG, et al. Transcranial direct current stimulation for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Arthritis Care Res. 2024;76(3):376–84.

    Google Scholar 

  • Wu Y-l, Luo Y, Yang J-m, Wu Y-q, Zhu Q, Li Y, et al. Effects of transcranial direct current stimulation on pain and physical function in patients with knee osteoarthritis: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2024;25(1): 703.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Xiao S, Wang B, Yu C, Shen B, Zhang X, Ye D, et al. Effects of intervention combining transcranial direct current stimulation and foot core exercise on sensorimotor function in foot and static balance. J Neuroeng Rehabil. 2022;19(1): 98.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Rahimi F, Nejati V, Nassadj G, Ziaei B, Mohammadi HK. The effect of transcranial direct stimulation as an add-on treatment to conventional physical therapy on pain intensity and functional ability in individuals with knee osteoarthritis: a randomized controlled trial. Neurophysiol Clin. 2021;51(6):507–16.

    PubMed 

    Google Scholar 

  • Teixeira PE, Alawdah L, Alhassan HAA, Guidetti M, Priori A, Papatheodorou S, et al. The analgesic effect of transcranial direct current stimulation (tdcs) combined with physical therapy on common musculoskeletal conditions: a systematic review and meta-analysis. Principles and practice of clinical research. 2015;6(1):23.

    Google Scholar 

  • Liebetanz D, Nitsche MA, Tergau F, Paulus W. Pharmacological approach to the mechanisms of transcranial DC-stimulation‐induced after‐effects of human motor cortex excitability. Brain. 2002;125(10):2238–47.

    PubMed 

    Google Scholar 

  • Nitsche MA, Seeber A, Frommann K, Klein CC, Rochford C, Nitsche MS, et al. Modulating parameters of excitability during and after transcranial direct current stimulation of the human motor cortex. J Physiol. 2005;568(1):291–303.

    CAS 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Khaje S, Daneshjoo A, Sahebozamani M, Karimi Afshar F. The effects of Water-based neuromuscular exercises on knee proprioception and pain in older women with 2nd/3rd grade knee osteoarthritis: A clinical trial. Sci J Rehabilitation Med. 2024;13(5):948–59.

    Google Scholar 

  • Puspita WH, Tamtomo DG, Prasetya H. Meta-analysis the effect of aquatic therapy on functional ability in patients with knee osteoarthritis. 2022.

  • Yuan X, Zhong X, Wang C, Yang Y, Jiang C. Evaluation of transcranial direct current stimulation in motor function and neural rehabilitation. J ECT. 2023;39(4):235–41.

    PubMed 

    Google Scholar 

  • Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World health organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451–62.

    PubMed 

    Google Scholar 

  • Kohn MD, Sassoon AA, Fernando ND. Classifications in brief: Kellgren-Lawrence classification of osteoarthritis. Clin Orthop Relat Research®. 2016;474:1886–93.

    Google Scholar 

  • Corrêa FI, Carneiro Costa G, Leite Souza P, Marduy A, Parente J, Ferreira da Cruz S, et al. Additive effect of transcranial direct current stimulation (tDCS) in combination with multicomponent training on elderly physical function capacity: a randomized, triple blind, controlled trial. Physiother Theory Pract. 2023;39(11):2352–65.

    PubMed 

    Google Scholar 

  • Deyle GD, Allison SC, Matekel RL, Ryder MG, Stang JM, Gohdes DD, et al. Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Phys Ther. 2005;85(12):1301–17.

    PubMed 

    Google Scholar 

  • Niknam H, Sarmadi, Salavati, Mahyar M. The effect of Kinesio taping on weight distribution and proprioception in patients after anterior cruciate ligament reconstruction. Med Scholar. 2011;19(1):19.

    Google Scholar 

  • Yoshino Y, Yoshida T, Mori T, Hirota S, Iga J, Ueno S-i. Risk of idiopathic normal pressure hydrocephalus in older inpatients with schizophrenia. Int Psychogeriatr. 2016;28(5):863–8.

    PubMed 

    Google Scholar 

  • Kaski D, Dominguez R, Allum J, Islam A, Bronstein A. Combining physical training with transcranial direct current stimulation to improve gait in Parkinson’s disease: a pilot randomized controlled study. Clin Rehabil. 2014;28(11):1115–24.

    CAS 
    PubMed 

    Google Scholar 

  • Raffaelli C, Lanza M, Zanolla L, Zamparo P. Exercise intensity of head-out water-based activities (water fitness). Eur J Appl Physiol. 2010;109(5):829–38.

    CAS 
    PubMed 

    Google Scholar 

  • Persiyanova-Dubrova A, Marphina T, Badalov N. Water aerobics training: selection and control of the exercise intensity using the Borg scale. Vopr Kurortol Fizioter Lech Fiz Kult. 2021;98(2):39–44.

    CAS 
    PubMed 

    Google Scholar 

  • Krishnan K, Abadi FH, Zainudin FF, Barati AH, Elumalai G. Comparison of the effect of aquatic and Thera-band exercise on pain and quality of life in obese people with knee osteoarthritis. J Pain Manag. 2021;14(3):221.

  • Baharlouei H, Salehinejad MA, Talimkhani A, Nitsche MA. The effect of non-invasive brain stimulation on gait in healthy young and older adults: a systematic review of the literature. Neuroscience. 2023;516:125–40.

    CAS 
    PubMed 

    Google Scholar 

  • Kamii Y, Kojima S, Onishi H. Transcranial direct current stimulation over the posterior parietal cortex improves visuomotor performance and proprioception in the lower extremities. Front Hum Neurosci. 2022;16: 876083.

    PubMed 
    PubMed Central 

    Google Scholar 

  • McFadyen BJ, Gagné M-È, Cossette I, Ouellet M-C. Using dual task walking as an aid to assess executive dysfunction ecologically in neurological populations: A narrative review. Neuropsychological Rehabilitation. 2017;27(5):722–43.

    PubMed 

    Google Scholar 

  • Agathos CP, Ramanoël S, Bécu M, Baranton K, Bernardin D, Arleo A. An alternative view of dual-tasking in older adults: cognitive-motor interference while navigating in an ecological environment. Neurophysiol Clin. 2019;49(6):414.

    Google Scholar 

  • Ali N, Liu J, Tian H, Pan W, Tang Y, Zhong Q, et al. A novel dual-task paradigm with story recall shows significant differences in the gait kinematics in older adults with cognitive impairment: a cross-sectional study. Front Aging Neurosci. 2022;14: 992873.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Ramírez F, Gutiérrez M. Dual-task gait as a predictive tool for cognitive impairment in older adults: a systematic review. Front Aging Neurosci. 2021;13: 769462.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Marotta N, de Sire A, Marinaro C, Moggio L, Inzitari MT, Russo I, et al. Efficacy of transcranial direct current stimulation (tDCS) on balance and gait in multiple sclerosis patients: A machine learning approach. Journal of Clinical Medicine. 2022;11(12):3505.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Melo RS, Cardeira CSF, Rezende DSA, Guimarães-do-Carmo VJ, Lemos A, de Moura-Filho AG. Effectiveness of the aquatic physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in healthy community-dwelling older adults: a systematic review and meta-analysis. PLoS One. 2023;18(9): e0291193.

    CAS 
    PubMed 
    PubMed Central 

    Google Scholar 

  • de Mattos F, Pereira G, Bento PCB. Water-based exercises performed with high-speed movement improves strength and physical function in older women with knee osteoarthritis. Phys Occup Therapy Geriatr. 2020;39(1):22–40.

    Google Scholar 

  • Assar S, Gandomi F, Mozafari M, Sohaili F. The effect of total resistance exercise vs. aquatic training on self-reported knee instability, pain, and stiffness in women with knee osteoarthritis: a randomized controlled trial. BMC Sports Sci Med Rehabil. 2020;12:1–13.

    Google Scholar 

  • Kum D-M, Shin W-S. Effect of backward walking training using an underwater treadmill on muscle strength, proprioception and gait ability in persons with stroke. Physical therapy rehabilitation science. 2017;6(3):120–6.

    Google Scholar 

  • Azizi S, Dadarkhah A, Rezasoltani Z, Raeissadat SA, Mofrad RK, Najafi S. Randomized controlled trial of aquatic exercise for treatment of knee osteoarthritis in elderly people. Interventional Medicine and Applied Science. 2020;11(3):161–7.

    PubMed 

    Google Scholar 

  • Hajouj E, Hadian MR, Mir SM, Talebian S, Ghazi S. 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(5):519.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Aneksan B, Sawatdipan M, Bovonsunthonchai S, Tretriluxana J, Vachalathiti R, Auvichayapat P, et al. Five-session dual-transcranial direct current stimulation with task-specific training does not improve gait and lower limb performance over training alone in subacute stroke: a pilot randomized controlled trial. Neuromodulation: Technology at the Neural Interface. 2022;25(4):558–68.

    PubMed 

    Google Scholar 

  • Hsu T-Y, Juan C-H, Tseng P. Individual differences and state-dependent responses in transcranial direct current stimulation. Front Hum Neurosci. 2016;10: 643.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Sánchez-Kuhn A, Pérez-Fernández C, Moreno M, Flores P, Sánchez-Santed F. Differential effects of transcranial direct current stimulation (tDCS) depending on previous musical training. Front Psychol. 2018;9: 1465.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Tremblay S, Larochelle-Brunet F, Lafleur LP, El Mouderrib S, Lepage JF, Théoret H. Systematic assessment of duration and intensity of anodal transcranial direct current stimulation on primary motor cortex excitability. European Journal of Neuroscience. 2016;44(5):2184–90.

    PubMed 

    Google Scholar 

  • Lee SH, Yoo YJ. A literature review on optimal stimulation parameters of transcranial direct current stimulation for motor recovery after stroke. Brain NeuroRehabilitation. 2024;17(3):e24.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Berryhill ME. Longitudinal tDCS: consistency across working memory training studies. Aims Neurosci. 2017;4(2):71–86.

    Google Scholar 

  • Chowdhury NH, Tyler DJ. Utilization of peripheral nerve feedback at a preconscious level. Front Neurosci. 2024;18: 1336431.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Suminski AJ, Mardoum P, Lillicrap TP, Hatsopoulos NG. Temporal evolution of both premotor and motor cortical tuning properties reflect changes in limb biomechanics. J Neurophysiol. 2015;113(7):2812–23.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Aizawa H, Tanji J. Corticocortical and thalamocortical responses of neurons in the monkey primary motor cortex and their relation to a trained motor task. J Neurophysiol. 1994;71(2):550–60.

    CAS 
    PubMed 

    Google Scholar 

  • Pollonini L, Miao H, Ahn H. Longitudinal effect of transcranial direct current stimulation on knee osteoarthritis patients measured by functional infrared spectroscopy: a pilot study. Neurophotonics. 2020;7(2): 025004.

    CAS 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Ahn H, Suchting R, Woods AJ, Miao H, Green C, Cho RY, et al. Bayesian analysis of the effect of transcranial direct current stimulation on experimental pain sensitivity in older adults with knee osteoarthritis: randomized sham-controlled pilot clinical study. J Pain Res. 2018. https://doi.org/10.2147/JPR.S173080.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Min D-k. Changes in sensory function after transcranial direct current stimulation on primary motor cortex area. Physical Therapy Korea. 2014;21(4):1–8.

    Google Scholar 

  • Tavares DRB, Okazaki JEF, de Andrade Santana MV, Pinto ACPN, Tutiya KK, Gazoni FM, et al. Motor cortex transcranial direct current stimulation effects on knee osteoarthritis pain in elderly subjects with dysfunctional descending pain inhibitory system: A randomized controlled trial. Brain stimulation. 2021;14(3):477–87.

    PubMed 

    Google Scholar 

  • Bashir S, Ahmad S, Alatefi M, Hamza A, Sharaf M, Fecteau S, et al. Effects of anodal transcranial direct current stimulation on motor evoked potentials variability in humans. Physiological Reports. 2019;7(13):e14087.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Hendy AM, Kidgell DJ. Anodal tDCS applied during strength training enhances motor cortical plasticity. Med Sci Sports Exerc. 2013;45(9):1721–9.

    PubMed 

    Google Scholar 

  • Bruce AS, Howard JS, Van Werkhoven H, McBride JM, Needle AR. The effects of transcranial direct current stimulation on chronic ankle instability. Med Sci Sports Exerc. 2020;52(2):335–44.

    PubMed 

    Google Scholar 

  • Yang J, Cha S, Yun D, An J, editors. Effects of tDCS on Cortical Motor Facilitation in Performing Motor Execution. 2021 9th International Winter Conference on Brain-Computer Interface (BCI); 2021: IEEE.

  • Rosenkranz K, Butler K, Williamon A, Cordivari C, Lees A, Rothwell J. Sensorimotor reorganization by proprioceptive training in musician’s dystonia and writer’s cramp. Neurology. 2008;70(4):304–15.

    CAS 
    PubMed 

    Google Scholar 

  • Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol. 2000;527(Pt 3):633.

    CAS 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Fregni F, Liebetanz D, Monte-Silva KK, Oliveira MB, Santos AA, Nitsche MA, et al. Effects of transcranial direct current stimulation coupled with repetitive electrical stimulation on cortical spreading depression. Exp Neurol. 2007;204(1):462–6.

    PubMed 

    Google Scholar 

  • Yamada Y, Sumiyoshi T. Neurobiological mechanisms of transcranial direct current stimulation for psychiatric disorders; neurophysiological, chemical, and anatomical considerations. Front Hum Neurosci. 2021;15: 631838.

    CAS 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Correa FI, Costa GC, Souza PL, Marduy A, Silva SM, Fregni F, et al. Additive effect of tDCS in combination with multicomponent training on elderly physical function capacity: a randomized, triple-blind, controlled trial. Gait Posture. 2023;106:S62.

    Google Scholar 

  • Jung J, Salazar Fajardo JC, Kim S, Kim B, Oh S, Yoon B. Effect of tDCS combined with physical training on physical performance in a healthy population. Res Q Exerc Sport. 2024;95(1):149–56.

    PubMed 

    Google Scholar 

  • Continue Reading