Effectiveness of Home Exercise Program in Patients with Knee Osteoarthritis

Abstract

To investigate effects of home exercise program including isotonic, isometric and joint range of motion (ROM) exercises on pain, functional capacity and quality of life in knee OA patients. Seventy-five patients with knee OA were included into the study. Patients were exposed to home exercise program including 8-week active ROM, and isometric and isotonic exercises for quadriceps and hamstrings. In patients, severity of pain, functional capacity, severity of disease and quality of life were assessed with Visual Analogue Scale (VAS), The Western Ontario and McMaster Universities Arthritis Index (WOMAC), Lequesne\'s knee severity index (LSI) and 36-Item Short-Form Health Survey (SF-36) on admission, at the end of and 12th week after the treatment, respectively. At the end of 8th week, of 75 patients, 52 were determined to perform home exercise program regularly. At the end of treatment for 52 patients with knee OA, a significant improvement was seen in physical function, bodily pain and social functioning scores among subscales of SF-36, and VAS, WOMAC and LSI, compared to basal findings. The improvement also continued at 12th week after the treatment. Also, a marked amelioration was observed in role limitation physical, health perception, mental health, role limitation emotional and energy scores among subscales of SF-36, after completing exercise program; however, the amelioration disappared at 12th week after the teratment. Our findings indicate home exercise program increases functional level, decreases pain severity and improves quality of life. Therefore, physicians following-up patients with knee OA should take home exercise programs into consideration while planning treatment regimes.

Keywords

• knee osteoarthritis - home exercise program - pain - functional status - quality of life

Effectiveness of Home Exercise Program in Patients with Knee Osteoarthritis

Öz

Diz osteoartritli (OA) hastalarda izotonik, izometrik ve eklem hareket açıklığı (EHA) egzersizlerinden oluşan ev programının ağrı, fonksiyonel kapasite ve yaşam kalitesi üzerine etkisini araştırmak. Diz OA tanısı alan 75 hasta çalışmaya alındı. Hastalara 8 hafta aktif EHA, kuadriseps ve hamstringler için izometrik ve izotonik egzersizlerden oluşan ev programı uygulandı. Hastalarda bazalde, tedavi bitiminde ve tedavi bittikten sonra 12 haftada Vizüel Analog Skala (VAS) ile ağrı şiddeti, The Western Ontario and Mcmaster Universities Arthritis İndeks (WOMAC) ile fonksiyonel durum, Lequesne diz eklemi şiddet indeksi (LŞİ) ile hastalığın şiddeti, 36Item Short-Form Health Survey (SF-36) ile yaşam kalitesi belirlendi. 8 haftanın sonundaDiz OA’li 75 hastanın 52’nin ev egzersiz programını düzenli uyguladığı tespit edildi. 52 diz OA’li hastanın tedavi bitiminde VAS, WOMAC, LŞİ ve SF-36 alt skorlarından fiziksel fonksiyon, ağrı ve sosyal fonksiyon skorlarında bazale göre belirgin düzelme mevcuttu ve bu düzelme azalmakla birlikte tedavi bittikten sonra 12 haftada da devam ediyordu. Yine hastalarda egzersiz programı bitiminde SF-36 alt skorlarından mental sağlık, emosyonel rol, fiziksel rol, genel sağlık ve vitalite skorlarında bazale göre belirgin düzelme mevcuttu, ancak bu düzelme tedavi bittikten sonra 12 haftada devam etmiyordu. Sonuçlarımız diz OA’li hastalarda ev egzersiz programının fonksiyonel düzeyi arttırdığı, ağrı düzeyini azalttığı ve yaşam kalitesini düzelttiğini göstermektedir. Bu nedenle diz OA’li hastaları takip eden sağlık profesyonelleri tedavi planlarken ev egzersiz programlarını mutlaka gözönünde bulundurmalıdır

Anahtar Kelimeler

• Diz osteoartriti, ev egzersiz programı, ağrı, fonksiyonel durum, yaşam kalitesi

Kaynakça

1. McAlindon TE, Cooper C, Kirwan JR, Dieppe PA. Determinants of disability in osteoarthritis of the knee. Ann Rheum Dis 1993; 52: 258-62.
2. Rasch PJ, Burke RK. Kinesiology and Applied Anatomy. The Science of Human Movement, Philadelphia: Lea Fehiger 1978:285-310.
3. Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommen- dations for the management of hip and knee osteoarthri- tis, part II: OARSI evidence-based, consensus guidelines. Osteoarthritis Cartilage 2008;16:137-62.
4. Jordan KM, Arden NK, Doherty M, et al. EULAR Recommendations 2003: an evidencebased approach to the management of knee osteoarthritis: of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003;62:1145-55.
5. American College of Rheumatology Subcommittee on Osteoarthritis. Recommendations for the medical man- agement of osteoarthritis of the hip and knee. 2000 up- date. Arthritis Rheum 2000; 43:1905-15.
6. Altman R, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthritis of the knee. Arthritis Rheum 1986; 29:1039-49.
7. Hicks JE. Exercise in patients with inflammatory arthritis and connective tissue disease. In: Rheumatic Disease. Clin North Am 1990;16 (4): 845-70.
8. Tüzün S, Çifçili S, Akman M, Topsakal N, Kalaça S, Ünalan NÇ. How can we improve adherence to exercise programs in patients with osteoarthritis?: A randomized controlled trial. Turkish J Geriatrics 2012;15(3):339-48

9. Ersöz M, Kahramanlar Ş, Yanıkoğlu İ, Kızıltepe F. An ef- fective treatment for patients with knee osteoarthri- tis: intra- articuler sodium hyaluronate injections com- bined with home exercise program. Turk J Rheumatol 2001;16(3):131-7.
10. Tüzün EH, Eker L, Aytar A, Daflkapan A, Bayramoğlu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis Cartilage 2005;13:28-33.
11. Tunay VB, Baltacı G, Atay AO. Hospital-based versus home-based proprioceptive and strengthening exercise programs in knee osteoarthritis. Acta Orthop Traumatol Turc 2010;44(4):270-7.
12. Lequesne MO, Samson S. Incides of severity in osteoarthri- tis for weight bearing joints. J Rheumatol 1991;18(27):16- 28.
13. Ware JE. SF-36 health survey update. Spine 2000;15;25(24):3130-9
14. Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (nonarthroplasty). J Am Acad Orthop Surg 2009;17(9):591-600.
15. Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 2012;64(4):465-74.
16. Iwamoto J, Sato Y, Takeda T, Matsumoto H. Effectiveness of exercise for osteoarthritis of the knee: A review of the literature. World J Orthop 2011;18;2(5):37-42
17. Zhang W, Moskowitz RW, Nuki G, et al. OARSI recom- mendations for the management of hip and knee osteo- arthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 2008;16:137-62.
18. Çeliker R. Current guidelines for the management of hip and knee osteoarthritis. Hacettepe Medical Journal 2008; 39:36-44.
19. O'Reilly SC, Jones A, Muir KR, Doherty M. Quadriceps weakness in knee osteoarthritis: the effect on pain and disability. Ann Rheum Dis 1998;57:588-94.
20. Slemenda C, Heilman DK, Brandt KD, et al. Reduced quadriceps strength relative to body weight: a risk fac- tor for knee osteoarthritis in women? Arthritis Rheum 1998;41:1951-9.
21. Tan J. Balcı N, Sepici V, Gener FA. Isokinetic and isometric strength in osteoarthrosis of the knee. Am J Phys Med Rehabil 1995;74(5):364-9.
22. Umay E, Tezelli MK, Dinc A, Rukşen S. Comparison of Isotonic and Isokinetic Exercise Methods Accompanied with Balneotherapy in Patients with Knee Osteoarthritis. J PMR Sci 2012;15: 31-8.
23. Hudelmaier M, Glaser C, Englmeier K, Reiser M, Putz R, Eckstein F. Correlation of knee-joint cartilage morphol- ogy with muscle cross-sectional areas vs anthropometric variables. Anat Rec 2003; 270:175-84.
24. Iwamoto J, Takeda T, Sato Y. Effect of muscle strength- ening exercises on the muscle strength in patients with osteoarthritis of the knee. Knee 2007;14:224-30.
25. Deyle GD, Henderson NE, Matekel RL, et al. Effectiveness of manual physical therapy and exercise in osteoarthritis of knee. Ann Intern Med 2000;132:173-81.
26. Van Baar ME, Dekker J, Oostendorp RAB, et al. The ef- fectiveness of exercise therapy in patients with osteoar- thritis of the hip or knee: A randomized clinical trial. J Rheumatol 1998; 25:2432-9.
27. Thomas KS, Muir KR, Doherty M, Jones AC, O'Reilly SC, Bassey EJ. Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial. BMJ 2002; 325:752-6.
28. O’Reilly SC, Muir KR, Doherty M. Effectiveness of home exercise on pain and disability from osteoarthritis of the knee: a randomised controlled trial. Ann Rheum Dis 1999;58:15–19.
29. Fisher NM, Kame VD Jr, Rouse L, Pendergast DR. Quantitative evaluation of a home exercise program on muscle and functional capacity of patients with osteoar- thritis. Am J Phys Med Rehabil 1994;73(6):413-20.
30. Devos-Comby L, Cronan T, Roesch SC. Do exercise and self- management interventions benefit patients ith osteoar- thritis of the knee? A metaanalytic review. J Rheumatol 2006;33:744-56.
31. Doi T, Akai M, Fujino K, et al. Effect of home exercise of quadriceps on knee osteoarthritis compared with nonste- roidal antiinflammatory drugs: a randomized controlled trial. Am J Phys Med Rehabil 2008;87:258–69.
32. Shakoor N, Furmanov S, Nelson DE, Li Y, Block JA. Pain and its relationship with muscle strength and propriocep- tion in knee OA:Results of an 8-week home exercise pilot study. J Musculoskelet Neuronal Interact 2008; 8(1):35- 42.
33. Uysal FG, Basaran S. Knee osteoarthritis. Turk J Phys Med Rehab 2009; 55(1): 1-7.
34. Ettinger WH, Burns R, Messier SP, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. JAMA 1997; 277:25-31.
35. Campbell R, Evans M, Tucker M, Quilty B, Dieppe P, Donovan JL. Why don’t patients do their exercises? Understanding non-compliance with physiotherapy in pa- tients with osteoarthritis of the knee. J Epidemiol Comm Health 2001;55:132-8.