THE EFFECTS OF EARLY PROGRESSIVE CLOSED KINETIC CHAIN EXERCISES IN COMPARISON WITH STANDARD EXERCISE PROGRAM AFTER BILATERAL TOTAL KNEE ARTHROPLASTY - RANDOMIZED CONTROLLED STUDY

Abstract

Purpose: This study was conducted to determine the short-term effects of a progressive closed kinetic chain exercise (CKCE) program on pain severity, edema, range of motion and functional status in patients with bilateral total knee arthroplasty (TKA) compared to standard exercise program given in open kinetic position. Methods: 36 patients (72 knees) with a mean age of 65.22 ± 6.81 years and bilateral TKA were included in the study. The patients were divided into the CKCE group (CKCE, n=16) and the control group (CG, n=16) consisting of standard exercises. The same physiotherapy program was applied to all patients in the first postoperative week. In 2nd post-operative week, the patients were divided into two groups and started exercise training appropriate for their groups. Pain, edema, range of motion measurements of the patients were evaluated at the beginning and at post-operative 4th and 7th weeks in the programs applied 3 days a week and for 6 weeks in total. The functional status assessment was performed only in the last measurement. Results: There were statistically significant improvements in pain, edema and knee range of motions at the end of the 6 weeks in both groups (p<0.05). In the 4th week measurements, the change in pain was more distinctive in CG (p<0.05), but the changes from baseline in all other measured parameters were similar in both groups (p>0.05). Conclusion: The study reveals that the progressive CKCE program in the early post-acute period seems effective for bilateral TKA patients and can be embedded in the postoperative exercise programs. However, more than the CKCE program is needed to have an additional advantage over the standard exercise program in the short term.

Keywords

• Knee arthroplasty
• closed kinetic chain exercise
• post-acute rehabilitation

BİLATERAL TOTAL DİZ PROTEZİ SONRASI ERKEN İLERLEYİCİ KAPALI KİNETİK ZİNCİR EGZERSİZLERİNİN STANDART EGZERSİZ PROGRAMINA GÖRE ETKİLERİ - RANDOMİZE KONTROLLÜ ÇALIŞMA

Öz

Amaç: Bu çalışma ilerleyici kapalı kinetik zincir egzersiz (KKZE) programının, açık kinetik pozisyonda verilen standart egzersiz programına göre bilateral total diz protezi (TDP) hastalarında ağrı şiddeti, ödem, eklem hareket açıklığı ve fonksiyonel durum üzerine kısa dönem etkilerini belirlemek amacıyla yapıldı. Yöntem: Çalışmaya yaş ortalaması 65,22 ± 6,81 yıl olan ve bilateral TDP uygulanan 36 hasta (72 diz) dahil edildi. Hastalar KKZE grubu (KKZE, n=16) ve standart egzersizlerden oluşan kontrol grubu (KG, n=16) olarak iki gruba ayrıldı. Ameliyat sonrası 1. haftada tüm hastalara aynı fizyoterapi programı uygulandı. Ameliyat sonrası 2. haftada hastalar iki gruba ayrıldı ve gruplarına uygun egzersiz eğitimine başlandı. Haftada 3 gün ve toplamda 6 hafta uygulanan programlarda hastaların ağrı, ödem, eklem hareket açıklığı ölçümleri, başlangıçta ve ameliyat sonrası 4. ve 7. haftada yapıldı. Fonksiyonel durum değerlendirmesi ise sadece son ölçümde yapıldı. Sonuçlar: Her iki grupta da ağrı, ödem, diz eklemi hareketlerinde 6 hafta sonunda istatistiksel olarak anlamlı iyileşmeler oldu (p<0,05). 4. hafta ölçümlerinde ağrı şiddetindeki değişim KG’de daha fazla idi (p<0,05) ancak tüm diğer parametrelerdeki başlangıca göre olan değişimler her iki grupta da benzerdi (p>0,05). Tartışma: Post-akut erken dönemde verilen dirençli KKZE programının bilateral TDP hastaları için etkilidir ve programlara eklenebilir. Ancak tek başına KKZE programının standart egzersiz programına kısa dönemde ek bir üstünlüğü yoktur.

Anahtar Kelimeler

• Diz protezi
• kapalı kinetik zincir egzersizi
• post-akut rehabilitasyon

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